Laboratory Studies

Direct immunofluorescence study in lichen planus (LP) reveals globular deposits of immunoglobulin M (IgM) and complement mixed with apoptotic keratinocytes.

Imaging Studies

No imaging studies are necessary for lichen planus.

Histologic Findings

The histopathologic features distinguish lichen planus based on the presence of irregular acanthosis and colloid bodies in the epidermis with destruction of the basal layer. The upper dermis has a bandlike ("lichenoid") infiltrate of lymphocytes and histiocytes.

The inflammatory reaction pattern is characteristic. The epidermis is hyperkeratotic with irregular acanthosis and focal thickening in the granular layer. Degenerative keratinocytes, known as colloid or Civatte bodies, are found in the lower epidermis. In addition to apoptotic keratinocytes, colloid bodies are composed of globular deposits of IgM (occasionally immunoglobulin G [IgG] or immunoglobulin A [IgA]) and complement. Linear or shaggy deposits of fibrin and fibrinogen are noted in the basement membrane zone.

The upper dermis has a bandlike infiltrate of lymphocytic (primarily helper T) and histiocytic cells with many Langerhans cells. The infiltrate is very close to the epidermis and often disrupts the dermal-epidermal junction.

Treatment & Management

Alaizari NA, Al-Maweri SA, Al-Shamiri HM, Tarakji B, Shugaa-Addin B. Hepatitis c virus infections in oral lichen planus: a systematic review and meta-analysis. Aust Dent J. 2015 Oct 17. [QxMD MEDLINE Link].
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. 1999 Nov. 41(5 Pt 1):787-9. [QxMD MEDLINE Link].
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. 2009 Sep. 145(9):1040-7. [QxMD MEDLINE Link].
Bigby M. The relationship between lichen planus and hepatitis C clarified. Arch Dermatol. 2009 Sep. 145(9):1048-50. [QxMD MEDLINE Link].
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. 2009 May-Jun. 15(3):692-700. [QxMD MEDLINE Link].
Georgescu SR, Tampa M, Mitran MI, Mitran CI, Sarbu MI, Nicolae I, et al. Potential pathogenic mechanisms involved in the association between lichen planus and hepatitis C virus infection. Exp Ther Med. 2019 Feb. 17 (2):1045-1051. [QxMD MEDLINE Link].
Atzmony L, Reiter O, Hodak E, Gdalevich M, Mimouni D. Treatments for Cutaneous Lichen Planus: A Systematic Review and Meta-Analysis. Am J Clin Dermatol. 2016 Feb. 17(1):11-22. [QxMD MEDLINE Link].
Fazel N. Cutaneous lichen planus: A systematic review of treatments. J Dermatolog Treat. 2015 Jun. 26(3):280-3. [QxMD MEDLINE Link].
Rasi A, Behzadi AH, Davoudi S, Rafizadeh P, Honarbakhsh Y, Mehran M, et al. Efficacy of oral metronidazole in treatment of cutaneous and mucosal lichen planus. J Drugs Dermatol. 2010 Oct. 9(10):1186-90. [QxMD MEDLINE Link].
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. 2010 Feb 10. [QxMD MEDLINE Link].
Arias-Santiago S, Buendia-Eisman A, Aneiros-Fernandez J, et al. Cardiovascular risk factors in patients with lichen planus. Am J Med. 2011 Jun. 124(6):543-8. [QxMD MEDLINE Link].
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. 2008 Apr. 24(2):83-6. [QxMD MEDLINE Link].
Korkij W, Chuang TY, Soltani K. Liver abnormalities in patients with lichen planus. A retrospective case-control study. J Am Acad Dermatol. 1984 Oct. 11(4 Pt 1):609-15. [QxMD MEDLINE Link].
Manolache L, Seceleanu-Petrescu D, Benea V. Lichen planus patients and stressful events. J Eur Acad Dermatol Venereol. 2008 Apr. 22(4):437-41. [QxMD MEDLINE Link].
Murphy R, Edwards L. Desquamative inflammatory vaginitis: what is it?. J Reprod Med. 2008 Feb. 53(2):124-8. [QxMD MEDLINE Link].
Balasubramaniam P, Ogboli M, Moss C. Lichen planus in children: review of 26 cases. Clin Exp Dermatol. 2008 Jul. 33(4):457-9. [QxMD MEDLINE Link].
Ingafou M, Leao JC, Porter SR, Scully C. Oral lichen planus: a retrospective study of 690 British patients. Oral Dis. 2006 Sep. 12(5):463-8. [QxMD MEDLINE Link].
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. 2006 Nov. 155(5):994-8. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Lucchese A, Dolci A, Minervini G, Salerno C, DI Stasio D, Minervini G, et al. Vulvovaginal gingival lichen planus: report of two cases and review of literature. Oral Implantol (Rome). 2016 Apr-Jun. 9 (2):54-60. [QxMD MEDLINE Link].
Robles-Méndez JC, Rizo-Frías P, Herz-Ruelas ME, Pandya AG, Ocampo Candiani J. Lichen planus pigmentosus and its variants: review and update. Int J Dermatol. 2018 May. 57 (5):505-514. [QxMD MEDLINE Link].
Pai VV, Kikkeri NN, Sori T, Dinesh U. Graham-little piccardi lassueur syndrome: an unusual variant of follicular lichen planus. Int J Trichology. 2011 Jan. 3 (1):28-30. [QxMD MEDLINE Link].
Gonzalez-Moles MA, Scully C, Gil-Montoya JA. Oral lichen planus: controversies surrounding malignant transformation. Oral Dis. 2008 Apr. 14(3):229-43. [QxMD MEDLINE Link].
Knackstedt TJ, Collins LK, Li Z, Yan S, Samie FH. Squamous Cell Carcinoma Arising in Hypertrophic Lichen Planus: A Review and Analysis of 38 Cases. Dermatol Surg. 2015 Dec. 41(12):1411-8. [QxMD MEDLINE Link].
Cribier B, Frances C, Chosidow O. Treatment of lichen planus. An evidence-based medicine analysis of efficacy. Arch Dermatol. 1998 Dec. 134(12):1521-30. [QxMD MEDLINE Link].
Lim KK, Su WP, Schroeter AL, Sabers CJ, Abraham RT, Pittelkow MR. Cyclosporine in the treatment of dermatologic disease: an update. Mayo Clin Proc. 1996 Dec. 71(12):1182-91. [QxMD MEDLINE Link].
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. 2006 Jan. 154(1):139-45. [QxMD MEDLINE Link].
Paul J, Foss CE, Hirano SA, Cunningham TD, Pariser DM. An open-label pilot study of apremilast for the treatment of moderate to severe lichen planus: A case series. J Am Acad Dermatol. 2013 Feb. 68(2):255-61. [QxMD MEDLINE Link].
Lai YC, Yew YW, Schwartz RA. Lichen planus and dyslipidemia: a systematic review and meta-analysis of observational studies. Int J Dermatol. 2016 Feb 12. [QxMD MEDLINE Link].

Media Gallery

Lichen planus on the flexor part of the wrist.
Close-up view of lichen planus.
Lichen planus shows Wickham striae (white, fine, reticular scales).
Lichen planus on the oral mucosa with ulceration in the center of the lesion appears with whitish papules and plaques in the periphery.
Lichen planus lesion. Courtesy of Syed Wali Peeran, with no alterations, Wikimedia Commons (https://commons.wikimedia.org/wiki/File:Lichen_planus-Skin_lesion.jpg).
Intraoral lichen planus lesion. Courtesy of Syed Wali Peeran, with no alterations, Wikimedia Commons (https://commons.wikimedia.org/wiki/File:Lichen_planus-intra_oral_lesion.jpg).

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Author

Tsu-Yi Chuang, MD, MPH, FAAD Clinical Professor, Department of Dermatology, Keck School of Medicine of the University of Southern California; Dermatologist, HealthCare Partners

Tsu-Yi Chuang, MD, MPH, FAAD is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, International Society of Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Laura Stitle, MD Staff Physician, Department of Dermatology, Indiana University Medical Center

Laura Stitle, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Warren R Heymann, MD Head, Division of Dermatology, Professor, Department of Internal Medicine, Rutgers New Jersey Medical School

Warren R Heymann, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

Additional Contributors

Joshua A Zeichner, MD Assistant Professor, Director of Cosmetic and Clinical Research, Mount Sinai School of Medicine; Chief of Dermatology, Institute for Family Health at North General

Joshua A Zeichner, MD is a member of the following medical societies: American Academy of Dermatology, National Psoriasis Foundation

Disclosure: Received consulting fee from Valeant for consulting; Received grant/research funds from Medicis for other; Received consulting fee from Galderma for consulting; Received consulting fee from Promius for consulting; Received consulting fee from Pharmaderm for consulting; Received consulting fee from Onset for consulting.

Lichen Planus Workup

Laboratory Studies

Imaging Studies

Histologic Findings

References

Tables

Contributor Information and Disclosures

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