Continuing medical education
Lichen planus and lichenoid dermatoses: Clinical overview and molecular basis

https://doi.org/10.1016/j.jaad.2018.02.010Get rights and content

Deriving from the Greek word λειχήν for “tree moss” and the Latin word planus for “planar,” lichen planus is a relatively uncommon and heterogeneous cutaneous disorder that typically develops in middle-aged adults. Despite the significant clinical burden associated with the disorder, little well-conducted molecular research has been undertaken, possibly because of heterogeneity impeding consistent and confident phenotyping. The multiple variants of lichenoid disease bear overlapping clinical and pathologic features despite manifesting as distinct clinical disorders. The first article in this 2-part continuing medical education series provides a comprehensive overview of the clinical and pathologic characteristics of cutaneous lichenoid dermatoses and links these manifestations to recent advances in our understanding of the underlying pathobiology of such diseases.

Section snippets

Cutaneous lichen planus

Key points

  1. Cutaneous lichen planus represents a relatively uncommon dermatosis, affecting <1% of the population

  2. Consisting of polygonal, pruritic, planar papules or plaques, lichen planus is a heterogeneous papulosquamous eruption of variable morphologic manifestation but a consistent histologic phenotype

  3. The etiology of lichen planus remains elusive, although immune dysregulation, infectious, environmental, and genetic factors may play a role in disease pathobiology

Morphologic variants of cutaneous lichen planus

Key points

  1. Being morphologically heterogeneous, lichen planus may be hyperkeratotic, annular, bullous, pigmented, or atrophic

  2. Lichenoid variants are plentiful and comprise lichenoid drug eruption, lichen planus–like keratosis, lichen nitidus, lichen sclerosus, and lichen striatus

  3. Overlap syndromes refer to lichen planus coexisting with a distinct second clinical entity

Cutaneous LP does not always manifest in a classic presentation, because there is an array of LP variants that possess distinct clinical

References (170)

  • R.K. Scher

    Lichen planus of the nail

    Dermatol Clin

    (1985)
  • A. Tosti et al.

    Nail lichen planus: clinical and pathologic study of twenty-four patients

    J Am Acad Dermatol

    (1993)
  • A. Asarch et al.

    Lichen planus-like eruptions: an emerging side effect of tumor necrosis factor-alpha antagonists

    J Am Acad Dermatol

    (2009)
  • A.J. West et al.

    A comparative histopathologic study of photodistributed and nonphotodistributed lichenoid drug eruptions

    J Am Acad Dermatol

    (1990)
  • R.D. Sontheimer

    Lichenoid tissue reaction/interface dermatitis: clinical and histological perspectives

    J Invest Dermatol

    (2009)
  • A. Barbaud

    Drug patch testing in systemic cutaneous drug allergy

    Toxicology

    (2005)
  • W. Chen et al.

    Generalized lichen nitidus

    J Am Acad Dermatol

    (1997)
  • B. Garcia-Bravo et al.

    Lichen sclerosus et atrophicus. A study of 76 cases and their relation to diabetes

    J Am Acad Dermatol

    (1988)
  • J.J. Meffert et al.

    Lichen sclerosus

    J Am Acad Dermatol

    (1995)
  • A. Kreuter et al.

    Coexistence of lichen sclerosus and morphea: a retrospective analysis of 472 patients with localized scleroderma from a German tertiary referral center

    J Am Acad Dermatol

    (2012)
  • N. Oyama et al.

    Autoantibodies to extracellular matrix protein 1 in lichen sclerosus

    Lancet

    (2003)
  • A. Tosti et al.

    Nail lichen striatus: clinical features and long-term follow-up of five patients

    J Am Acad Dermatol

    (1997)
  • L. Le Cleach et al.

    Clinical practice. Lichen planus

    N Engl J Med

    (2012)
  • M. Depaoli

    Clinico-statistical data on lichen ruber planus

    Minerva Dermatol

    (1964)
  • H. Schmidt

    Frequency, duration and localization of lichen planus. A study based on 181 patients

    Acta Derm Venereol

    (1961)
  • M. Bhattacharya et al.

    Lichen planus: a clinical and epidemiological study

    J Dermatol

    (2000)
  • G. Wagner et al.

    Clinical variants of lichen planus

    J Dtsch Dermatol Ges

    (2013)
  • D. Pandhi et al.

    Lichen planus in childhood: a series of 316 patients

    Pediatr Dermatol

    (2014)
  • C. Steffen et al.

    Louis-Frederic Wickham and the Wickham’s striae of lichen planus

    Skinmed

    (2004)
  • J.S. Lehman et al.

    Lichen planus

    Int J Dermatol

    (2009)
  • C.W. Lee et al.

    Lichen planus specific antigen and antibodies—in a patient with generalized lichen planus

    J Korean Med Sci

    (1987)
  • S. Akarsu et al.

    Lichen planus pigmentosus distributed along the lines of Blaschko

    Int J Dermatol

    (2013)
  • M. Mohrenschlager et al.

    Primary manifestation of a zosteriform lichen planus: isotopic response following herpes zoster sine herpete?

    Br J Dermatol

    (2008)
  • C. Irvine et al.

    Long-term follow-up of lichen planus

    Acta Derm Venereol

    (1991)
  • N. Mobini et al.

    Noninfectious erythematous, papular, and squamous diseases

  • R.P. Usatine et al.

    Diagnosis and treatment of lichen planus

    Am Fam Physician

    (2011)
  • A. Lallas et al.

    Accuracy of dermoscopic criteria for the diagnosis of psoriasis, dermatitis, lichen planus and pityriasis rosea

    Br J Dermatol

    (2012)
  • B. Li et al.

    Annular atrophic lichen planus

    Eur J Dermatol

    (2010)
  • E. Willsteed et al.

    Lichen planus pemphigoides: a clinicopathological study of nine cases

    Histopathology

    (1991)
  • J.P. Welsh et al.

    A novel visual clue for the diagnosis of hypertrophic lichen planus

    Arch Dermatol

    (2006)
  • B. Manz et al.

    Squamous cell carcinoma as a complication of long-standing hypertrophic lichen planus

    Int J Dermatol

    (2005)
  • N. Al-Mutairi et al.

    Clinicopathological characteristics of lichen planus pigmentosus and its response to tacrolimus ointment: an open label, non-randomized, prospective study

    J Eur Acad Dermatol Venereol

    (2010)
  • A. Kashima et al.

    Two Japanese cases of lichen planus pigmentosus-inversus

    Int J Dermatol

    (2007)
  • D. Eisen et al.

    Number V oral lichen planus: clinical features and management

    Oral Dis

    (2005)
  • K. Zendell

    Genital lichen planus: update on diagnosis and treatment

    Semin Cutan Med Surg

    (2015)
  • T. Badri et al.

    Isolated genital annular lichen planus

    Acta Dermatovenerol Alp Pannonica Adriat

    (2011)
  • C. Tziotzios et al.

    Frontal fibrosing alopecia: reflections and hypotheses on etiology and pathogenesis

    Exp Dermatol

    (2016)
  • P. Rich et al.

    Nail manifestations of cutaneous disease

  • S. Goettmann et al.

    Nail lichen planus: epidemiological, clinical, pathological, therapeutic and prognosis study of 67 cases

    J Eur Acad Dermatol Venereol

    (2012)
  • G.N. Fox et al.

    Extensive lichenoid drug eruption due to glyburide: a case report and review of the literature

    Cutis

    (2005)
  • Cited by (111)

    View all citing articles on Scopus

    Dr Tziotzios and Mr Lee contributed equally to this article.

    Funding sources: None.

    Conflicts of interest: None disclosed.

    Date of release: November 2018

    Expiration date: November 2021

    View full text