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Lichen Planus (Dermatology)

Chronic inflammatory T-cell-mediated mucocutaneous disease characterized by pruritic violaceous polygonal papules and plaques (the 6 Ps), white reticulated patches on mucous membranes (Wickham striae), and nail changes; potentially associated with hepatitis C.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Dermatoloji department. Book Appointment →

What is Lichen Planus (Dermatology)?

Lichen planus (LP) is a chronic inflammatory autoimmune disorder of skin, mucous membranes, hair follicles, and nails, mediated by cytotoxic CD8+ T cells targeting basal keratinocytes. Etiology is unknown but associations include hepatitis C infection, drugs (beta-blockers, ACE inhibitors, antimalarials, NSAIDs), dental amalgam (oral LP), and contact sensitizers.

Pathogenesis involves T cell-mediated apoptosis of basal keratinocytes via Fas/FasL, perforin, and granzyme pathways, producing the histologic hallmarks: hyperkeratosis, wedge-shaped hypergranulosis, sawtooth rete ridges, basal vacuolar degeneration with apoptotic Civatte bodies, and dense band-like lymphocytic infiltrate at dermoepidermal junction.

Clinical variants include classic LP (pruritic violaceous papules on flexor wrists, ankles, lower back), oral LP (reticular white Wickham striae on buccal mucosa, painful erosive form), genital LP, lichen planopilaris (scarring alopecia), nail LP (longitudinal ridging, pterygium), hypertrophic LP (lower legs, very pruritic), and bullous LP. Treatment is stepwise from topical/intralesional corticosteroids to phototherapy (NB-UVB, PUVA), oral corticosteroids, acitretin, methotrexate, mycophenolate mofetil, and emerging JAK inhibitors (tofacitinib, baricitinib).

Symptoms

Classic 6 Ps: pruritic, polygonal, planar, purple papules and plaques
Distinctive Wickham striae (fine white lines on lesions)
Flexor wrists, ankles, lumbar back distribution
Oral LP: reticular white striae on buccal mucosa, gingivitis, erosions
Nail LP: longitudinal ridging, pterygium, anonychia
Lichen planopilaris: scarring scalp alopecia

Risk Factors

Hepatitis C virus infection (especially erosive oral LP)
Drugs: beta-blockers, ACE inhibitors, antimalarials, NSAIDs
Dental amalgam (contact sensitivity, oral LP)
Family history (HLA-DR1 association)
Adult age (typically 30-60 years)
Stress, autoimmune comorbidities

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Persistent pruritic violaceous papules
  • White reticular patches in mouth or painful erosions
  • Genital lesions with pruritus or pain
  • Scarring scalp hair loss
  • Nail dystrophy with longitudinal ridging
  • Skin lesions with characteristic Wickham striae

Treatment Methods

01
Clinical examination, dermoscopy (Wickham striae), skin/mucosal biopsy for histopathology
02
Hepatitis C screening, drug history review, patch testing for oral LP if suspected
03
First line: high-potency topical corticosteroids (clobetasol propionate 0.05%) twice daily
04
Intralesional triamcinolone for hypertrophic or oral lesions
05
Topical calcineurin inhibitors (tacrolimus, pimecrolimus) for mucosal LP
06
Phototherapy: NB-UVB or PUVA for widespread disease
07
Systemic: oral prednisone, acitretin, methotrexate, mycophenolate mofetil, hydroxychloroquine
08
Emerging: JAK inhibitors (tofacitinib, baricitinib) for refractory cutaneous and lichen planopilaris

Which Department to Visit?

You can visit our Dermatoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Let us help you

You can make an appointment with our specialists or contact us for your concerns.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.