What are the signs and symptoms of lichen planus in chronic hepatitis C (CHC)?

Updated: Apr 02, 2020
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Answer

Primary dermatologic disorders associated with chronic hepatitis C infection

Lichen planus

LP is a pruritic papulosquamous disorder involving the skin, scalp, nails, oral mucosa, and genitalia. [45, 46, 47, 48, 49, 50, 51, 15]

The lesions and pathology are often typical unlike many papulosquamous skin disorders, such as seborrhea, atopic dermatitis, and contact dermatitis; these skin disorders have scaling, erythema, and pruritus and are included in the differential diagnosis of LP but lack its pathologic and clinical specificity. Intracellular HCV infection of epithelial cells is proven for LP. [15]

Often, the papular lesions of LP suddenly appear on the volar acral surfaces of the wrists and arms and are pruritic. Oral symptoms are less common, but painful erosions can occur in oral lichen planus (OLP). Hair loss in lichen planopilaris, exquisite pruritus of markedly hypertrophic plaques on the lower legs in hypertrophic LP, and painful genital erosions can be presenting findings.

The prevalence of oral, cutaneous, pharyngeal, and/or vulval LP in 87 HCV-infected patients was 19.5%. [52] Another study found no significant association between cutaneous lichen planus and HCV infection. [53]

A retrospective analysis of 808 Italian patients with oral lichen planus showed that 137 of them were infected with HCV. [54]

Note the images below:

Lichen planus. Courtesy of Walter Reed Army Medica Lichen planus. Courtesy of Walter Reed Army Medical Center Dermatology.
Lichen planus. Courtesy of Walter Reed Army Medica Lichen planus. Courtesy of Walter Reed Army Medical Center Dermatology.
Lichen planus. Courtesy of Walter Reed Army Medica Lichen planus. Courtesy of Walter Reed Army Medical Center Dermatology.
Lichen planus (hypertrophic type). Courtesy of Wal Lichen planus (hypertrophic type). Courtesy of Walter Reed Army Medical Center Dermatology.
Lichen planus (oral lesions). Courtesy of Walter R Lichen planus (oral lesions). Courtesy of Walter Reed Army Medical Center Dermatology.
Lichen planus (volar wrist). Courtesy of Walter Re Lichen planus (volar wrist). Courtesy of Walter Reed Army Medical Center Dermatology.

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