Which physical findings are characteristic of lichen planus or acral necrolytic erythema in patients with hepatitis C (Hep C)?

Updated: Mar 26, 2021
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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LP presents as flat-topped pruritic papules or coalescent plaques on the extensor surfaces of the limbs and trunk. Some individual lesions may have a purple-red hue, a fine retiform surface scale (termed Wickham striae), and an angular appearance. Involvement of the scalp hair is a cause of alopecia of the scarring variety (termed lichen planopilaris). The leaf-shaped alopecic areas appear like fingertips touching the scalp with normal intervening areas. Oral involvement with buccal lesions is common. Gum, lip, and tongue involvement can be a chronic premalignant disorder. Lesions lack the specificity of skin lesions and present as purple-red mucosal patches. Occasionally, prurigolike nodules with heaped keratotic material on a thickened base occur on the limbs and trunk. Lesions on the genitalia can be nonspecific and are one cause of vulvar pruritus.

The lesions of acral necrolytic erythema are flaccid bullae and described as large, painful, partially eroded, violaceous patches on the proximal half of the dorsal aspect of the feet extending over the medial and lateral malleolus. [56]

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