Lichen planus (LP) can occur on the skin alone; h. However, it is also seen inside the oral cavity, on the scalp, nails and the genital mucosa. Symptoms of lichen planus may wax and wane. They may increase during periods of trauma, or during stress and anxiety.
Cutaneous LP
Lichen planus is a papulosquamous skin disease which produces intense itching (pruritus). It consists of lesions which are characterized by six P’s:
• Pruritic
• Purplish
• Planar
• Polygonal
• Papules
• Plaques
The rash starts suddenly, and occurs on the inside of the wrists, the legs and the trunk. The lesions often show a lacy white network covering them, called Wickham’s striae. They may be shiny or be covered with scales. They often appear in lines, especially
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It is most often asymptomatic. However, the lesions may become ulcerated or spread, becoming very painful. The oral lesions typically affect the sides of the tongue, the buccal mucosa or the gingival mucosa. In about a fourth of patients, the vulva or vagina is also involved. However, oral LP may also be accompanied by lesions in the scalp, the nails and the eyes. Pain, heat sensitivity, dryness of the mouth, a metallic taste and a burning sensation of the affected area may reduce the quality of life in ulcerative forms of oral LP.
Forms of oral LP
Oral LP may take any of four forms:
• Erosive: this is the most painful type and consists of spreading erythematous lesions with irregular ulcers, often complicated by secondary fungal or bacterial infection.
• Reticular: this is the most common form. It consists of the appearance of Wickham’s striae on any part of the mucosa covering the inside of the mouth, the lips, palate, tongue or gums. It is usually bilateral and not associated with other symptoms.
• Papular: here the lesions are in the form of bluish-white or reddish spots
• Atrophic: here atrophic lesions showing gray or white Wickham’s striae occur against an erythematous oral mucosa.
• Bullous: this consists of large sacs filled with fluid, which break often to leave a painful erosion.
Genital