Lichen Planus

Introduction

• Description: Lichen planus is a non-neoplastic epithelial disorder that affects glabrous skin, hair-bearing skin and scalp, nails, mucous membranes, or the oral cavity and vulva.

• Prevalence: Unknown, but relatively common. Estimated to affect 0.5%–2% of the population.

• Predominant Age: 30–60 years; peak age 50–60 years.

• Genetics: No genetic pattern.

Etiology and Pathogenesis

• Causes: Unknown. Proposed—autoimmune disorder, possibly initiated by certain drugs such as β-blockers and angiotensin-converting enzyme (ACE) inhibitors. Considered to arise from a T-cell–mediated autoimmune response against basal keratinocytes.

• Risk Factors: None known.

Signs and Symptoms

• Vulvar pain, burning, pruritus, soreness.

• Dyspareunia and postcoital bleeding are common.

• Well-demarcated erosion with erythematous patches and ulceration of the vulva and inner aspects of the labia minora (may precede oral lesions by years; 33% of patients). White striae or a serpentine, white border along the margins are common.

• Loss of the labia minora with scarring, adhesions, and narrowing common (complete obliteration of the vagina possible).

• Oral lesions—reticulated gray, lacy pattern (Wickham striae) with gingivitis (vulvar involvement in 50% of patients with oral lesions).

Diagnostic Approach