Background
Lichen planus (LP) is a pruritic, papular eruption characterized by its violaceous color; polygonal shape; and, sometimes, fine scale. Lichen planus is most commonly found on the flexor surfaces of the upper extremities, on the genitalia, and on the mucous membranes. Lichen planus is most likely an immunologically mediated reaction. See Oral Lichen Planus for more information on this variant of lichen planus.
Pathophysiology
Lichen planus is a cell-mediated immune response of unknown origin. Lichen planus may be found with other diseases of altered immunity; these conditions include ulcerative colitis, alopecia areata, vitiligo, dermatomyositis, morphea, lichen sclerosis, and myasthenia gravis.
An association is noted between lichen planus and hepatitis C virus infection,[1, 2, 3, 4] chronic active hepatitis, and primary biliary cirrhosis.[5] In a meta-analysis, 16% of patients with lichen planus had hepatitis-C infection.[2] The association of lichen planus and hepatitis C exists in all regions of the world, including North America.[3] Hepatitis should be considered in patients with widespread or unusual presentations of lichen planus. Onset or exacerbation of lichen planus has been linked to stressful events.[6]
Epidemiology
Frequency
United States
Lichen planus is reported in approximately 1% of all new patients seen at health care clinics. Some areas have reported a higher incidence in December and January.
International
No significant geographical variation in frequency exists for lichen planus.
Mortality/Morbidity
In lichen planus, atrophy and scarring are seen in hypertrophic lesions and lesions on the scalp. Cutaneous lichen planus does not have a higher risk of skin cancer, but ulcerative lesions in the mouth, particularly in men, have a higher incidence of malignant transformation. However, in general, the malignant transformation rate of oral lichen planus is low (< 2% in one report).[7] Vulvar lesions in women may also be associated with squamous cell carcinoma.
Race
No racial predispositions have been noted for lichen planus.
Sex
No significant differences in incidence for lichen planus are noted between male and female patients, but in women, lichen planus may present as desquamative inflammatory vaginitis.[8]
Age
More than two thirds of lichen planus patients are aged 30-60 years; however, lichen planus can occur at any age.[9]
Chuang TY, Stitle L, Brashear R, Lewis C. Hepatitis C virus and lichen planus: A case-control study of 340 patients. J Am Acad Dermatol. Nov 1999;41(5 Pt 1):787-9. [Medline].
[Best Evidence] Shengyuan L, Songpo Y, Wen W, Wenjing T, Haitao Z, Binyou W. Hepatitis C virus and lichen planus: a reciprocal association determined by a meta-analysis. Arch Dermatol. Sep 2009;145(9):1040-7. [Medline].
Bigby M. The relationship between lichen planus and hepatitis C clarified. Arch Dermatol. Sep 2009;145(9):1048-50. [Medline].
Raslan HM, Ezzat WM, Abd El Hamid MF, Emam H, Amre KS. Skin manifestations of chronic hepatitis C virus infection in Cairo, Egypt. East Mediterr Health J. May-Jun 2009;15(3):692-700. [Medline].
Korkij W, Chuang TY, Soltani K. Liver abnormalities in patients with lichen planus. A retrospective case-control study. J Am Acad Dermatol. Oct 1984;11(4 Pt 1):609-15. [Medline].
Manolache L, Seceleanu-Petrescu D, Benea V. Lichen planus patients and stressful events. J Eur Acad Dermatol Venereol. Apr 2008;22(4):437-41. [Medline].
Ingafou M, Leao JC, Porter SR, Scully C. Oral lichen planus: a retrospective study of 690 British patients. Oral Dis. Sep 2006;12(5):463-8. [Medline].
Murphy R, Edwards L. Desquamative inflammatory vaginitis: what is it?. J Reprod Med. Feb 2008;53(2):124-8. [Medline].
Balasubramaniam P, Ogboli M, Moss C. Lichen planus in children: review of 26 cases. Clin Exp Dermatol. Jul 2008;33(4):457-9. [Medline].
Belfiore P, Di Fede O, Cabibi D, et al. Prevalence of vulval lichen planus in a cohort of women with oral lichen planus: an interdisciplinary study. Br J Dermatol. Nov 2006;155(5):994-8. [Medline].
Di Fede O, Belfiore P, Cabibi D, et al. Unexpectedly high frequency of genital involvement in women with clinical and histological features of oral lichen planus. Acta Derm Venereol. 2006;86(5):433-8. [Medline].
[Guideline] American College of Obstetricians and Gynecologists. Diagnosis and management of vulvar skin disorders. National Guideline Clearinghouse. May 2008.
Cribier B, Frances C, Chosidow O. Treatment of lichen planus. An evidence-based medicine analysis of efficacy. Arch Dermatol. Dec 1998;134(12):1521-30. [Medline].
[Best Evidence] Omidian M, Ayoobi A, Mapar M, Feily A, Cheraghian B. Efficacy of sulfasalazine in the treatment of generalized lichen planus: randomized double-blinded clinical trial on 52 patients. J Eur Acad Dermatol Venereol. Feb 10 2010;[Medline].
Lim KK, Su WP, Schroeter AL, Sabers CJ, Abraham RT, Pittelkow MR. Cyclosporine in the treatment of dermatologic disease: an update. Mayo Clin Proc. Dec 1996;71(12):1182-91. [Medline].
Conrotto D, Carbone M, Carrozzo M, et al. Ciclosporin vs. clobetasol in the topical management of atrophic and erosive oral lichen planus: a double-blind, randomized controlled trial. Br J Dermatol. Jan 2006;154(1):139-45. [Medline].
Arias-Santiago S, Buendia-Eisman A, Aneiros-Fernandez J, et al. Cardiovascular risk factors in patients with lichen planus. Am J Med. Jun 2011;124(6):543-8. [Medline].
Pavlotsky F, Nathansohn N, Kriger G, Shpiro D, Trau H. Ultraviolet-B treatment for cutaneous lichen planus: our experience with 50 patients. Photodermatol Photoimmunol Photomed. Apr 2008;24(2):83-6. [Medline].
Gonzalez-Moles MA, Scully C, Gil-Montoya JA. Oral lichen planus: controversies surrounding malignant transformation. Oral Dis. Apr 2008;14(3):229-43. [Medline].
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