How do the physical findings of lichen planus vary by subtype?

Updated: Feb 24, 2020
  • Author: Tsu-Yi Chuang, MD, MPH, FAAD; Chief Editor: William D James, MD  more...
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Variations in lichen planus include the following:

  • Hypertrophic lichen planus: These extremely pruritic lesions are most often found on the extensor surfaces of the lower extremities, especially around the ankles. Hypertrophic lesions are often chronic; residual pigmentation and scarring can occur when the lesions eventually clear.

  • Atrophic lichen planus: Atrophic lichen planus is characterized by a few lesions, which are often the resolution of annular or hypertrophic lesions.

  • Erosive/ulcerative lichen planus: These lesions are found on the mucosal surfaces and evolve from sites of previous lichen planus involvement. A rare variant of lichen planus is vulvovaginal-gingival syndrome. [20] It is characterized by erosions and desquamation of the mucosa in the vulval, vaginal, and gingival regions. It can be associated with mucocutaneous scarring and vaginal stricture formation.

  • Follicular lichen planus (also known as lichen planopilaris): This is characterized by keratotic papules that may coalesce into plaques. This condition is more common in women than in men, and ungual and erosive mucosal involvement is more likely to be present. A scarring alopecia may result. A variant of lichen planopilaris is frontal fibrosing alopecia. It is characterized by marginal progressive hair loss on the scalp, eyebrows, and axillae. [21] Another variant of follicular lichen planus is Graham-Little-Piccardi-Lasseur syndrome. [22] Features of this syndrome include progressive scalp cicatricial alopecia, noncicatricial alopecia of the axillae and pubic areas, and keratosis pilaris–like follicular papules over the trunk and extremities.

  • Annular lichen planus: Lichen planus papules that are purely annular are rare. Annular lesions with an atrophic center can be found on the buccal mucosa and the male genitalia.

  • Linear lichen planus: Isolated linear lesions may form a zosteriform lesion, or they may develop as a Köebner effect.

  • Vesicular and bullous lichen planus: Most commonly, these lesions develop on the lower limbs or in the mouth from preexisting lichen planus lesions. A rare condition, lichen planus pemphigoides, is a combination of both lichen planus and bullous pemphigoid.

  • Actinic lichen planus: Subtropic or actinic lichen planus occurs in regions, such as Africa, the Middle East, and India. This mildly pruritic eruption usually spares the nails, the scalp, the mucous membranes, and covered areas. Lesions are characterized by nummular patches with a hypopigmented zone surrounding a hyperpigmented center.

  • Lichen planus pigmentosus: This is a rare variant of lichen planus but can be more common in persons with darker-pigmented skin, such as Latinos or Asians. It usually appears on face and neck. Some believe it is similar to or the same as erythema dyschromicum perstans (ie, ashy dermatosis).

  • Lichen planus pemphigoides: This is a rare form of lichen planus. Blisters subsequently develop on lichen planus lesions. Clinically, histopathologically and immunopathologically, it has features of lichen planus and bullous pemphigoid, it but carries a better prognosis than pemphigoid.

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