Lichen planus: Difference between revisions

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VisualWikitext

Latest revision as of 21:22, 7 September 2017

For patient information, click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]

Synonyms and keywords: Ruber planus; Wickham striae

Overview

Lichen planus is an inflammatory disease that affects the skin and the oral mucosa.

Historical Perspective

Classification

Lichen Planopilaris is the specific name given to lichen planus on the scalp that may cause permanent, scarring alopecia. If left untreated the scarring will cause permanent hair loss. The Cicatricial Alopecia Research Foundation is a non-profit organization that provides support and resources for people with lichen planopilaris.

Pathophysiology

Causes

Common Causes

The cause of lichen planus is not known; however, there are cases of lichen planus-type rashes (known as lichenoid reactions) occurring as allergic reactions to medications for high blood pressure, heart disease and arthritis. These lichenoid reactions are referred to as lichenoid mucositis (of the mucosa) or dermatitis (of the skin). Lichen planus has been reported as a complication of chronic hepatitis C virus infection and can be a sign of chronic graft-versus-host disease of the skin. It has been suggested that true lichen planus may respond to stress, where lesions may present on the mucosa or skin during times of stress in those with the disease.

Causes in Alphabetical Order

Differentiating lichen planus from other Diseases

The clinical presentation of lichen planus may also resemble other conditions, including:

A biopsy is useful in identifying histological features that help differentiate lichen planus from these conditions.

Epidemiology and Demographics

Age

Lichen planus in children is rare, and it occurs most often in middle-aged adults.

Gender

Lichen planus affects women more than men (at a ratio of 3:2).

Risk Factors

Some of the risk factors for lichen planus are as follows:

Exposure to medications, dyes, and other chemical substances (including gold, antibiotics, arsenic, iodides, chloroquine, quinacrine, quinide, phenothiazines, and diuretics)
Disorders such as hepatitis C

Natural History, Complications, and Prognosis

Lichen planus is usually not harmful and may get better with treatment. It usually clears up within 18 months. However it may last for weeks to months, and may come and go for years. If lichen planus is caused by a medication, the rash should go away once the medicine is stopped.

A possible complication that is associated with lichen planus is that mouth ulcers that are there for a long time may develop into oral cancer.

Diagnosis

Symptoms

The microscopic appearance of lichen planus is pathognomonic for the condition

Hyperparakeratosis with thickening of the granular cell layer
Development of a "saw-tooth" appearance of the rete pegs
Degeneration of the basal cell layer
Infiltration of inflammatory cells into the subepithelial layer of connective tissue

Other symptoms such as:

Physical Examination

The typical rash of lichen planus is well-described by the "5 P's": well-defined pruritic, planar, purple, polygonal papules. The commonly affected sites are near the wrist and the ankle. The rash tends to heal with prominent blue-black or brownish discoloration that persists for a long time. Besides the typical lesions, many morphological varieties of the rash may occur. The presence of cutaneous lesions is not constant and may wax and wane over time. Oral lesions tend to last far longer than cutaneous lichen planus lesions.

The following images show good examples of how lichen planus manifests on the body.

Lichen planus close up
Lichen planus on the arm
Lichen planus on the oral mucosa
Lichen planus on the hands

Skin

Lichen Planus Actinicus

Face

Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]

Trunk

Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]

Extremity

Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]

Lichen planus annular

Trunk

Lichen planus annular. Adapted from Dermatology Atlas.^[1]
Lichen planus annular. Adapted from Dermatology Atlas.^[1]

Lichen Planus Follicularis

Neck

Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]

Extremity

Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]

Scalp

Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]

Lichen Planus Linearis

Trunk

Lichen planus linearis. Adapted from Dermatology Atlas.^[1]
Lichen planus linearis. Adapted from Dermatology Atlas.^[1]

Extremity

Lichen planus linearis. Adapted from Dermatology Atlas.^[1]
Lichen planus linearis. Adapted from Dermatology Atlas.^[1]
Lichen planus linearis. Adapted from Dermatology Atlas.^[1]
Lichen planus linearis. Adapted from Dermatology Atlas.^[1]
Lichen planus linearis. Adapted from Dermatology Atlas.^[1]
Lichen planus linearis. Adapted from Dermatology Atlas.^[1]
Lichen planus linearis. Adapted from Dermatology Atlas.^[1]
Lichen planus linearis. Adapted from Dermatology Atlas.^[1]
Lichen planus linearis. Adapted from Dermatology Atlas.^[1]

Lichen Planus Verrucosus

Lichen planus verrucosus . Adapted from Dermatology Atlas.^[1]
Lichen planus verrucosus . Adapted from Dermatology Atlas.^[1]

Lichen Planus Vesicular

Trunk

Lichen planus vesicular . Adapted from Dermatology Atlas.^[1]
Lichen planus vesicular . Adapted from Dermatology Atlas.^[1]
Lichen planus vesicular . Adapted from Dermatology Atlas.^[1]
Lichen planus vesicular . Adapted from Dermatology Atlas.^[1]
Lichen planus vesicular . Adapted from Dermatology Atlas.^[1]

Extremity

Lichen planus vesicular. Adapted from Dermatology Atlas.^[1]
Lichen planus vesicular . Adapted from Dermatology Atlas.^[1]
Lichen planus vesicular . Adapted from Dermatology Atlas.^[1]
Lichen planus vesicular. Adapted from Dermatology Atlas.^[1]
Lichen planus vesicular . Adapted from Dermatology Atlas.^[1]
Lichen planus vesicular . Adapted from Dermatology Atlas.^[1]
Lichen planus vesicular . Adapted from Dermatology Atlas.^[1]
Lichen planus vesicular . Adapted from Dermatology Atlas.^[1]
Lichen planus vesicular . Adapted from Dermatology Atlas.^[1]

Mucosal Lichen Planus

Oral cavity

Mucosal lichen planus. Adapted from Dermatology Atlas.^[1]
Mucosal lichen planus . Adapted from Dermatology Atlas.^[1]
Mucosal lichen planus . Adapted from Dermatology Atlas.^[1]

Differential diagnosis

Lichen planus must be differentiated from other diseases that cause ust be differentiated from other diseases that cause rash and eczema such as secondary syphilis and pityriasis rosea.

Disease	Rash Characteristics	Signs and Symptoms	Associated Conditions	Images
Cutaneous T cell lymphoma/Mycosis fungoides^[2]	Premycotic phase: A scaly, red rash in areas of the body that usually are not exposed to the sun. This rash does not cause symptoms and may last for months or years. Patch phase: Thin, erythematous, eczema-like rash. Plaque phase: Small raised bumps (papules) or hardened lesions on the skin, which may be erythematous. Tumor phase: Tumors form on the skin. Infection secondary to ulcers.	Epidermal atrophy or poikiloderma Generalized itching (pruritus) Pain in the affected area of the skin Insomnia Red (erythematous) patches scattered over the skin of the trunk and the extremities Tumor-like lobulated outgrowths form on the skin in the latter phase of the disease Weight loss Lymphadenopathy Malaise and fatigue Anemia May progress to Sezary syndrome (skin involvement plus hematogenous dissemination)	Sezary syndrome	By Bobjgalindo - Own work, GFDL, https://commons.wikimedia.org/w/index.php?curid=7139812
Pityriasis rosea^[3]	Pink or salmon in color, which may be scaly; referred to as "herald patch" Oval shape Long axis oriented along the cleavage lines Distributed on the trunk and proximal extremities Squamous marginal collarette and a “fir-tree” or “Christmas tree” distribution on posterior trunk Secondary to viral infections Resolves spontaneously after 6-8 weeks	Preceded by a prodrome of: Sore throat Gastrointestinal disturbance Fever Arthralgia	Infection by any of the following:^[4] HHV-6 HHV-7 HHV-8	By James Heilman,MD - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=16305230
Pityriasis lichenoides chronica	Recurrent lesions are usually less evenly scattered than in cases of psoriasis Brownish red or orange-brown in color Lesions are capped by a single detachable, opaque, mica-like scale Often leave hypopigmented macules	High fever Malaise Myalgias Paraesthesia Pruritus	Infection by any of the following:^[5] Epstein-Barr virus (EBV) Toxoplasma gondii Human immunodeficiency virus (HIV)
Nummular dermatitis^[6]	Multiple coin-shaped eczematous lesions Commonly affecting the extremities (lower>upper) and trunk May ooze fluid and become dry and crusty	Often appears after a skin injury, such as a burn, abrasion (from friction), or insect bite Lesions commonly relapse after occasional remission or may persist for long periods Pruritus	Associated with: Dry skin Emotional stress Allergens (rubber chemicals, formaldehyde, neomycin, chrome, mercury, and nickel) Staphylococcus infection Seasonal variation Alcohol Drugs Atopy
Secondary syphilis^[7]	Round, coppery, red colored lesions on palms and soles Papules with collarette of scales	Fever Generalized lymphadenopathy Sore throat Patchy hair loss Headache Weight loss Myalgia Fatigue	Associated with: Condylomata lata Corona verinata Positive VDRL test	By James Heilman,MD - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=16305230
Bowen’s disease^[8]	Erythematous, small, scaly plaque, which enlarges erratically over time Scale is usually yellow or white and it is easily detachable without any bleeding Well-defined margins	Pruritus Pain Bleeding lesions	Associated with:^[9] Erythroplasia of Queyrat (Bowen's disease of the penis) Squamous cell carcinoma Solar radiation and ultraviolet (UV) exposure Radiotherapy Immunosuppression Arsenic exposure Human papilloma virus (HPV) type 16 Merkel cell polyomavirus Sjögren’s syndrome	By Klaus D. Peter, Gummersbach, Germany - Own work (own photograph), CC BY 3.0 de, https://commons.wikimedia.org/w/index.php?curid=6839115
Exanthematous pustulosis^[10]	Numerous small, primarily non-follicular, sterile pustules, arising within large areas of edematous erythema	Fever Leukocytosis Intracorneal, subcorneal, and/or intraepidermal pustules with papillary dermal edema containing neutrophils and eosinophils	Associated with:^[11] Antibiotics (penicillins, sulfonamides, tetracyclines) Carbamazepine Calcium channel blockers (Diltiazem) Hydroxychloroquine	By See below - (2010). "Acute generalized exanthematous pustulosis: an unusual side effect of meropenem". Indian J Dermatol 55 (2): 176–7. DOI:10.4103/0019-5154.62759. PMID 20606889. PMC: 2887524., CC BY 1.0, https://commons.wikimedia.org/w/index.php?curid=52979729
Hypertrophic lichen planus^[12]	Classically involves shin and ankles and is characterized by hyperkeratotic plaques and nodules covered by a scale Lesions may transform into hyperkeratotic thickened, elevated, purplish or reddish plaques and nodules	Chronic pruritus Scaling May be asymptomatic	Associated with Hepatitis C virus infection^[13]	Di James Heilman, MD - Opera propria, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=11509003
Sneddon–Wilkinson disease^[14]	Flaccid pustules that are often generalized and have a tendency to involve the flexural areas Annular configuration	Pruritus May be asymptomatic	Associated with: Monoclonal gammopathy, usually an IgA paraproteinemia^[15] Crohn's disease^[16] Osteomyelitis Adalimumab^[17]
Small plaque parapsoriasis^[18]	Erythematous plaques with fine scaly surface May present with elongated, finger-like patches Symmetrical distribution on the flanks Known as digitate dermatosis	Lesions may be asymptomatic May be mildly pruritic May fade or disappear after sun exposure during the summer season, but typically recur during the winter	May progress to mycosis fungoides^[19]
Intertrigo^[20]	Red and fleshy looking lesion in skin folds Itching Oozing May be sore	Pruritus Musty odor	Associated with: Infections (Fungal, bacterial, viral) Allergies Diabetes Obesity	Source: https://www.cdc.gov/
Langerhans cell histiocytosis^[21]	Scaling and crusting of scalp	Pathological fractures^[22] Visceromegaly (hepatomegaly, spleenomegaly) Chronic cough Dyspnea^[23] Lymphadenopathy	Associated with: Diabetes insipidus^[24] Pancytopenia
Tinea manuum/pedum/capitis^[25]	Scaling, flaking, and sometimes blistering of the affected areas Hair loss with a black dot on scalp in case of tinea capitis	Pruritus KOH preparation of the lesions confirms fungal infection	Associated with: Diabetes Immunosupression Intimate contact with infected person May lead to asthma exacerbation
Seborrheic dermatitis	Papulosquamous, scaly, flaky, itchy, and red rash found particularly at sebaceous gland-rich areas of the body	Pruritus	Associated with:^[26] AIDS Stress^[27] Fungal infection Fatigue Sleep deprivation Change of season Parkinson's disease Biotin deficiency	By Roymishali - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=27267929

Head

Oral lichen planus may present in one of three forms.

The reticular form is the most common presentation and manifests as white lacy streaks on the mucosa (known as Wickham's striae) or as smaller papules (small raised area). The lesions tend to be bilateral and are asymptomatic. The lacy streaks may also be seen on other parts of the mouth, including the gingiva (gums), the tongue, palate and lips.
The bullous form presents as fluid-filled vesicles which project from the surface.
The erosive form presents with erythematous (red) areas that are ulcerated and uncomfortable. The erosion of the thin epithelium may occur in multiple areas of the mouth, or in one area, such as the gums, where they resemble desquamative gingivitis. Wickham's striae may also be seen near these ulcerated areas. This form may undergo malignant transformation.

Throat

Rarely, lichen planus shows esophageal involvement, where it can present with erosive esophagitis and stricturing. It has also been hypothesized that it is a precursor to squamous cell carcinoma of the esophagus.

Genitals

Lichen planus may also affect the genital mucosa - vulvovaginal-gingival lichen planus. It can resemble other skin conditions such as atopic dermatitis and psoriasis.

Clinical experience suggests that Lichen planus of the skin alone is easier to treat as compared to one which is associated with oral and genital lesions.

Lichen planus. Adapted from Dermatology Atlas.^[1]
Lichen planus. Adapted from Dermatology Atlas.^[1]
Lichen planus. Adapted from Dermatology Atlas.^[1]
Lichen planus. Adapted from Dermatology Atlas.^[1]
Lichen planus. Adapted from Dermatology Atlas.^[1]

Treatment

Currently there is no cure for lichen planus but there are certain types of medicines used to reduce the effects of the inflammation. Lichen planus may go into a dormant state after treatment. There are also reports that lichen planus can flare up years after it is considered cured.

Medical Therapy

Pharmacotherapy

Acute Pharmacotherapies

Chronic Pharmacotherapies

Oral retinoids
Immunosuppressant medications

Surgery

Prevention

References

↑ ^1.000 ^1.001 ^1.002 ^1.003 ^1.004 ^1.005 ^1.006 ^1.007 ^1.008 ^1.009 ^1.010 ^1.011 ^1.012 ^1.013 ^1.014 ^1.015 ^1.016 ^1.017 ^1.018 ^1.019 ^1.020 ^1.021 ^1.022 ^1.023 ^1.024 ^1.025 ^1.026 ^1.027 ^1.028 ^1.029 ^1.030 ^1.031 ^1.032 ^1.033 ^1.034 ^1.035 ^1.036 ^1.037 ^1.038 ^1.039 ^1.040 ^1.041 ^1.042 ^1.043 ^1.044 ^1.045 ^1.046 ^1.047 ^1.048 ^1.049 ^1.050 ^1.051 ^1.052 ^1.053 ^1.054 ^1.055 ^1.056 ^1.057 ^1.058 ^1.059 ^1.060 ^1.061 ^1.062 ^1.063 ^1.064 ^1.065 ^1.066 ^1.067 ^1.068 ^1.069 ^1.070 ^1.071 ^1.072 ^1.073 ^1.074 ^1.075 ^1.076 ^1.077 ^1.078 ^1.079 ^1.080 ^1.081 ^1.082 ^1.083 ^1.084 ^1.085 ^1.086 ^1.087 ^1.088 ^1.089 ^1.090 ^1.091 ^1.092 ^1.093 ^1.094 ^1.095 ^1.096 ^1.097 ^1.098 ^1.099 ^1.100 ^1.101 ^1.102 ^1.103 ^1.104 ^1.105 ^1.106 ^1.107 ^1.108 ^1.109 ^1.110 ^1.111 ^1.112 ^1.113 ^1.114 ^1.115 ^1.116 ^1.117 ^1.118 ^1.119 ^1.120 ^1.121 ^1.122 ^1.123 ^1.124 ^1.125 ^1.126 ^1.127 ^1.128 ^1.129 ^1.130 ^1.131 ^1.132 ^1.133 ^1.134 ^1.135 ^1.136 ^1.137 "Dermatology Atlas".
↑ "Mycosis Fungoides and the Sézary Syndrome Treatment (PDQ®)—Patient Version - National Cancer Institute".
↑ Mahajan K, Relhan V, Relhan AK, Garg VK (2016). "Pityriasis Rosea: An Update on Etiopathogenesis and Management of Difficult Aspects". Indian J Dermatol. 61 (4): 375–84. doi:10.4103/0019-5154.185699. PMC 4966395. PMID 27512182.
↑ Prantsidis A, Rigopoulos D, Papatheodorou G, Menounos P, Gregoriou S, Alexiou-Mousatou I, Katsambas A (2009). "Detection of human herpesvirus 8 in the skin of patients with pityriasis rosea". Acta Derm. Venereol. 89 (6): 604–6. doi:10.2340/00015555-0703. PMID 19997691.
↑ Smith KJ, Nelson A, Skelton H, Yeager J, Wagner KF (1997). "Pityriasis lichenoides et varioliformis acuta in HIV-1+ patients: a marker of early stage disease. The Military Medical Consortium for the Advancement of Retroviral Research (MMCARR)". Int. J. Dermatol. 36 (2): 104–9. PMID 9109005.
↑ Jiamton S, Tangjaturonrusamee C, Kulthanan K (2013). "Clinical features and aggravating factors in nummular eczema in Thais". Asian Pac. J. Allergy Immunol. 31 (1): 36–42. PMID 23517392.
↑ "STD Facts - Syphilis".
↑ Neagu TP, Tiglis M, Botezatu D, Enache V, Cobilinschi CO, Vâlcea-Precup MS, GrinTescu IM (2017). "Clinical, histological and therapeutic features of Bowen's disease". Rom J Morphol Embryol. 58 (1): 33–40. PMID 28523295.
↑ Murao K, Yoshioka R, Kubo Y (2014). "Human papillomavirus infection in Bowen disease: negative p53 expression, not p16(INK4a) overexpression, is correlated with human papillomavirus-associated Bowen disease". J. Dermatol. 41 (10): 878–84. doi:10.1111/1346-8138.12613. PMID 25201325.
↑ Szatkowski J, Schwartz RA (2015). "Acute generalized exanthematous pustulosis (AGEP): A review and update". J. Am. Acad. Dermatol. 73 (5): 843–8. doi:10.1016/j.jaad.2015.07.017. PMID 26354880.
↑ Schmid S, Kuechler PC, Britschgi M, Steiner UC, Yawalkar N, Limat A, Baltensperger K, Braathen L, Pichler WJ (2002). "Acute generalized exanthematous pustulosis: role of cytotoxic T cells in pustule formation". Am. J. Pathol. 161 (6): 2079–86. doi:10.1016/S0002-9440(10)64486-0. PMC 1850901. PMID 12466124.
↑ Ankad BS, Beergouder SL (2016). "Hypertrophic lichen planus versus prurigo nodularis: a dermoscopic perspective". Dermatol Pract Concept. 6 (2): 9–15. doi:10.5826/dpc.0602a03. PMC 4866621. PMID 27222766.
↑ Shengyuan L, Songpo Y, Wen W, Wenjing T, Haitao Z, Binyou W (2009). "Hepatitis C virus and lichen planus: a reciprocal association determined by a meta-analysis". Arch Dermatol. 145 (9): 1040–7. doi:10.1001/archdermatol.2009.200. PMID 19770446.
↑ Lutz ME, Daoud MS, McEvoy MT, Gibson LE (1998). "Subcorneal pustular dermatosis: a clinical study of ten patients". Cutis. 61 (4): 203–8. PMID 9564592.
↑ Kasha EE, Epinette WW (1988). "Subcorneal pustular dermatosis (Sneddon-Wilkinson disease) in association with a monoclonal IgA gammopathy: a report and review of the literature". J. Am. Acad. Dermatol. 19 (5 Pt 1): 854–8. PMID 3056995.
↑ Delaporte E, Colombel JF, Nguyen-Mailfer C, Piette F, Cortot A, Bergoend H (1992). "Subcorneal pustular dermatosis in a patient with Crohn's disease". Acta Derm. Venereol. 72 (4): 301–2. PMID 1357895.
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↑ Satter EK, High WA (2008). "Langerhans cell histiocytosis: a review of the current recommendations of the Histiocyte Society". Pediatr Dermatol. 25 (3): 291–5. doi:10.1111/j.1525-1470.2008.00669.x. PMID 18577030.
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↑ Misery L, Touboul S, Vinçot C, Dutray S, Rolland-Jacob G, Consoli SG, Farcet Y, Feton-Danou N, Cardinaud F, Callot V, De La Chapelle C, Pomey-Rey D, Consoli SM (2007). "[Stress and seborrheic dermatitis]". Ann Dermatol Venereol (in French). 134 (11): 833–7. PMID 18033062.

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v t e Diseases of the skin and subcutaneous tissue (integumentary system) (L, 680-709)
Infections	Template:Navbox subgroup
Bullous disorders	acantholysis (Pemphigus, Transient acantholytic dermatosis) · Pemphigoid (Bullous, Cicatricial, Gestational) · Dermatitis herpetiformis
Inflammatory	Template:Navbox subgroup
Radiation-related disorders	Sunburn · actinic rays (Actinic keratosis, Actinic cheilitis) · Polymorphous light eruption (Acne aestivalis) · Radiodermatitis · Erythema ab igne
Pigmentation disorder	hypopigmentation (Albinism, Vitiligo) · hyperpigmentation (Melasma, Freckle, Café au lait spot, Lentigo/Liver spot, Acanthosis nigricans, Acral acanthotic anomaly)
Other skin	keratosis/hyperkeratosis (Seborrheic keratosis, Callus) · other epidermal thickening (Ichthyosis acquisita, Palmoplantar keratoderma) skin ulcer (Pyoderma gangrenosum, Bedsore) Cutaneous Markers of Internal Malignancy (Florid cutaneous papillomatosis, acanthosis nigricans, sign of Leser-Trelat) atrophic (Lichen sclerosus, Acrodermatitis chronica atrophicans) necrobiosis (Granuloma annulare, Necrobiosis lipoidica) · other granuloma (Granuloma faciale, Pyogenic granuloma) cutaneous vasculitis (Livedoid vasculitis, Erythema elevatum diutinum)
Connective tissues	collagen disease: Keloid localized connective tissue disorders: Lupus erythematosus (Discoid lupus erythematosus, Subacute cutaneous lupus erythematosus) · Scleroderma/Morphea · Linear scleroderma · Calcinosis cutis · Sclerodactyly · Ainhum
see also congenital, neoplasia

@@ Line 3: / Line 3: @@
    Name           = Lichen planus |
    Image          = Lichen planus 1.jpg|
-  Caption        = |
-  DiseasesDB     = 7452 |
-  ICD10          = {{ICD10|L|43||l|40}} |
-  ICD9           = {{ICD9|697.0}} |
-  ICDO           = |
-  OMIM           = 151620                        |
-  MedlinePlus    = |
-  MeshID         = D008010 |
 }}
 {{SI}}
@@ Line 16: / Line 8: @@
 '''For patient information, click [[Lichen planus (patient information)|here]]'''
-{{CMG}}
+{{CMG}};{{AE}} {{KS}}
+{{SK}} Ruber planus; Wickham striae
 ==Overview==
 '''Lichen planus''' is an [[inflammatory]] [[disease]] that affects the [[skin]] and the [[oral mucosa]].
-== Cause ==
+==Historical Perspective==
+==Classification==
+'''Lichen Planopilaris''' is the specific name given to lichen planus on the [[scalp]] that may cause permanent, scarring [[alopecia]]. If left untreated the scarring will cause permanent hair loss. The Cicatricial Alopecia Research Foundation is a non-profit organization that provides support and resources for people with lichen planopilaris.
+==Pathophysiology==
+==Causes==
+===Common Causes===
+The cause of lichen planus is not known; however, there are cases of lichen planus-type rashes (known as lichenoid reactions) occurring as [[allergic reaction]]s to [[medications]] for [[high blood pressure]], [[heart disease]] and [[arthritis]].  These lichenoid reactions are referred to as lichenoid mucositis (of the mucosa) or dermatitis (of the skin).  Lichen planus has been reported as a complication of chronic [[hepatitis C]] virus infection and can be a sign of chronic [[graft-versus-host disease]] of the skin.  It has been suggested that true lichen planus may respond to [[Stress (medicine)|stress]], where lesions may present on the mucosa or skin during times of stress in those with the disease.
+===Causes in Alphabetical Order===
+*[[Allergic reaction]]s to [[medications]] for [[high blood pressure]]
+*[[Arthritis]]
+*[[Bendrofluazide]]
+*[[Chloroquine]]
+*[[Gold salts]]
+*[[Graft-versus-host disease]]
+*[[Heart disease]]
+*[[Hepatitis C]]
+*[[Hydrochlorothiazide]]
+*[[Lichen planopilaris]]
+*[[Lichen ruber moniliformis]]
+*[[Mepacrine]]
+*[[Methyldopa]]
+*[[Methyldopate]]
+*[[Penicillamine]]
+*[[Stress]]
+== Differentiating lichen planus from other Diseases ==
+The clinical presentation of lichen planus may also resemble other conditions, including:
+*  Lichenoid drug reaction
+*  [[Discoid lupus erythematosus]]
+*  Chronic [[ulcerative stomatitis]]
+*  [[Pemphigus vulgaris]]
+*  Benign [[mucous membrane pemphigoid]]
+*  Oral [[leukoplakia]]
+*  Frictional [[keratosis]]
+A biopsy is useful in identifying histological features that help differentiate lichen planus from these conditions.
+==Epidemiology and Demographics==
+===Age===
+Lichen planus in children is rare, and it occurs most often in middle-aged adults.
-The cause of lichen planus is not known; however, there are cases of lichen planus-type rashes (known as lichenoid reactions) occurring as [[allergic reaction]]s to [[medications]] for [[high blood pressure]], [[heart disease]] and [[arthritis]].  These lichenoid reactions are referred to as lichenoid mucositis (of the mucosa) or dermatitis (of the skin).  Lichen planus has been reported as a complication of chronic [[hepatitis C]] virus infection and can be a sign of chronic [[graft-versus-host disease]] of the skin.  It has been suggested that true lichen planus may respond to [[Stress (medicine)|stress]], where lesions may present on the mucosa or skin during times of stress in those with the disease.  Lichen planus affects women more than men (at a ratio of 3:2), and occurs most often in middle-aged adults.  Lichen planus in children is rare.
+===Gender===
-== Clinical features ==
+Lichen planus affects women more than men (at a ratio of 3:2).
-The typical rash of lichen planus is well-described by the "5 P's": well-defined pruritic, planar, purple, polygonal papules.  The commonly affected sites are near the wrist and the ankle. The rash tends to heal with prominent blue-black or brownish discoloration that persists for a long time. Besides the typical lesions, many morphological varieties of the rash may occur.  The presence of cutaneous lesions is not constant and may wax and wane over time.  Oral lesions tend to last far longer than cutaneous lichen planus lesions.
+==Risk Factors==
+Some of the risk factors for lichen planus are as follows:
-Oral lichen planus may present in one of three forms.
+*Exposure to medications, dyes, and other chemical substances (including [[gold]], [[antibiotics]], [[arsenic]], [[iodide]]s, [[chloroquine]], [[quinacrine]], [[quinide]], [[phenothiazine]]s, and [[diuretics]])
-*The reticular form is the most common presentation and manifests as white lacy streaks on the mucosa (known as Wickham's striae) or as smaller papules (small raised area).  The lesions tend to be bilateral and are asymptomatic.  The lacy streaks may also be seen on other parts of the mouth, including the gingiva (gums), the tongue, palate and lips.
+*Disorders such as [[hepatitis C]]
-*The bullous form presents as fluid-filled vesicles which project from the surface.
-*The erosive form presents with erythematous (red) areas that are ulcerated and uncomfortable.  The erosion of the thin epithelium may occur in multiple areas of the mouth, or in one area, such as the gums, where they resemble [[desquamative gingivitis]].  Wickham's striae may also be seen near these ulcerated areas.  This form may undergo malignant transformation.
+==Natural History, Complications, and Prognosis==
+Lichen planus is usually not harmful and may get better with treatment. It usually clears up within 18 months. However it may last for weeks to months, and may come and go for years. If lichen planus is caused by a medication, the rash should go away once the medicine is stopped.
+A possible complication that is associated with lichen planus is that [[mouth ulcer]]s that are there for a long time may develop into [[oral cancer]].
+==Diagnosis==
+===Symptoms===
 The microscopic appearance of lichen planus is pathognomonic for the condition
-*Hyperparakeratosis with thickening of the granular cell layer
+*[[Hyperparakeratosis]] with thickening of the granular cell layer
 *Development of a "saw-tooth" appearance of the [[rete pegs]]
 *Degeneration of the [[basal cell layer]]
 *Infiltration of inflammatory cells into the subepithelial layer of connective tissue
-Lichen planus may also affect the genital mucosa - vulvovaginal-gingival lichen planus. It can resemble other skin conditions such as [[atopic dermatitis]] and [[psoriasis]].
+Other symptoms such as:
+*[[Cicatricial alopecia]]
+*[[Genital ulcer]]
+*[[Gum pathology]]
+*[[Hyperkeratosis]]
+*[[Koebner phenomenon]]
+*[[Lichenoid dermatitis]]
+*[[Mucosal leucoplakia]]
+*[[Nail pitting]]
+*[[Oral ulcer|Oral ulceration]]
+*[[Pruritis]]
+*[[Tongue]] abnormality
+===Physical Examination===
+The typical rash of lichen planus is well-described by the "5 P's": well-defined [[pruritic]], [[planar]], purple, [[polygonal papules]].  The commonly affected sites are near the wrist and the ankle. The rash tends to heal with prominent blue-black or brownish discoloration that persists for a long time. Besides the typical lesions, many morphological varieties of the rash may occur.  The presence of cutaneous lesions is not constant and may wax and wane over time.  Oral lesions tend to last far longer than cutaneous lichen planus lesions.
+The following images show good examples of how lichen planus manifests on the body.
+<div align="left">
+<gallery heights="175" widths="175">
+image:Lichen planus1.jpg|Lichen planus close up
+image:Lichen planus2.jpg|Lichen planus on the arm
+image:Lichen planus3.jpg|Lichen planus on the oral mucosa
+image:Lichen planus4.jpg|Lichen planus on the hands
+</gallery>
+</div>
+====Skin====
+=====Trunk=====
+<gallery>
+Image:Lichen planus02.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus03.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus04.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus08.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus10.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus12.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus13.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus14.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus17.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus25.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus30.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus33.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+</gallery>
+=====Extremity=====
+<gallery>
+Image:Lichen planus01.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus05.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus06.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus07.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus09.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus11.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus15.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus16.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus18.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus19.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus20.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus21.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus22.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus23.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus24.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus26.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus27.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus29.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus31.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus32.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus41.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus42.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus43.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus44.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus45.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus46.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus47.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus48.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus49.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus50.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus51.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus56.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus57.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus58.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus59.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus60.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus61.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus62.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus63.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus64.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus65.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus66.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+</gallery>
+=====Oral cavity=====
+<gallery>
+Image:Lichen planus34.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus52.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus53.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus54.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus55.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus68.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus69.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus70.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus71.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+</gallery>
+=====Face=====
+<gallery>
+Image:Lichen planus67.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+</gallery>
+=====Lichen Planus Actinicus=====
+======Face======
+<gallery>
+Image:Lichen planus actinicus01.jpg|Lichen planus actinicus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus actinicus04.jpg|Lichen planus actinicus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+</gallery>
+======Trunk======
+<gallery>
+Image:Lichen planus actinicus02.jpg|Lichen planus actinicus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus actinicus03.jpg|Lichen planus actinicus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+</gallery>
+======Extremity======
+<gallery>
+Image:Lichen planus actinicus05.jpg|Lichen planus actinicus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus actinicus06.jpg|Lichen planus actinicus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus actinicus07.jpg|Lichen planus actinicus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus actinicus08.jpg|Lichen planus actinicus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus actinicus08.jpg|Lichen planus actinicus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus actinicus09.jpg|Lichen planus actinicus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus actinicus10.jpg|Lichen planus actinicus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus actinicus11.jpg|Lichen planus actinicus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus actinicus12.jpg|Lichen planus actinicus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus actinicus13.jpg|Lichen planus actinicus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus actinicus14.jpg|Lichen planus actinicus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus actinicus15.jpg|Lichen planus actinicus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus actinicus16.jpg|Lichen planus actinicus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus actinicus17.jpg|Lichen planus actinicus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus actinicus19.jpg|Lichen planus actinicus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+</gallery>
+=====Lichen planus annular=====
+======Trunk======
+<gallery>
+Image:Lichen planus annular03.jpg|Lichen planus annular. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus annular04.jpg|Lichen planus annular. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+</gallery>
+=====Lichen Planus Follicularis=====
+======Neck======
+<gallery>
+Image:Lichen planus follicularis01.jpg|Lichen planus follicularis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus follicularis02.jpg|Lichen planus follicularis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus follicularis03.jpg|Lichen planus follicularis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+</gallery>
+======Extremity======
+<gallery>
+Image:Lichen planus follicularis04.jpg|Lichen planus follicularis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus follicularis05.jpg|Lichen planus follicularis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus follicularis06.jpg|Lichen planus follicularis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus follicularis07.jpg|Lichen planus follicularis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus follicularis08.jpg|Lichen planus follicularis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus follicularis18.jpg|Lichen planus follicularis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+</gallery>
+======Scalp======
+<gallery>
+Image:Lichen planus follicularis08.jpg|Lichen planus follicularis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus follicularis09.jpg|Lichen planus follicularis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus follicularis11.jpg|Lichen planus follicularis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus follicularis12.jpg|Lichen planus follicularis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus follicularis13.jpg|Lichen planus follicularis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus follicularis14.jpg|Lichen planus follicularis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus follicularis15.jpg|Lichen planus follicularis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus follicularis16.jpg|Lichen planus follicularis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus follicularis17.jpg|Lichen planus follicularis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+</gallery>
+=====Lichen Planus Linearis=====
+======Trunk======
+<gallery>
+Image:Lichen planus linearis04.jpg|Lichen planus linearis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus linearis12.jpg|Lichen planus linearis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+</gallery>
+======Extremity======
+<gallery>
+Image:Lichen planus linearis01.jpg|Lichen planus linearis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus linearis02.jpg|Lichen planus linearis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus linearis06.jpg|Lichen planus linearis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus linearis07.jpg|Lichen planus linearis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus linearis08.jpg|Lichen planus linearis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus linearis09.jpg|Lichen planus linearis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus linearis03.jpg|Lichen planus linearis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus linearis05.jpg|Lichen planus linearis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus linearis10.jpg|Lichen planus linearis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+</gallery>
+======Lichen Planus Verrucosus======
+<gallery>
+Image:Lichen planus verrucosus01.jpg|Lichen planus verrucosus . <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus verrucosus02.jpg|Lichen planus verrucosus . <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+</gallery>
+=====Lichen Planus Vesicular=====
+======Trunk======
+<gallery>
+Image:Lichen planus vesicular01.jpg|Lichen planus vesicular . <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus vesicular02.jpg|Lichen planus vesicular . <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus vesicular03.jpg|Lichen planus vesicular . <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus vesicular08.jpg|Lichen planus vesicular . <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus vesicular09.jpg|Lichen planus vesicular . <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+</gallery>
+======Extremity======
+<gallery>
+Image:Lichen planus vesicular04.jpg|Lichen planus vesicular. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus vesicular05.jpg|Lichen planus vesicular . <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus vesicular06.jpg|Lichen planus vesicular . <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus vesicular07.jpg|Lichen planus vesicular. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus vesicular10.jpg|Lichen planus vesicular . <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus vesicular11.jpg|Lichen planus vesicular . <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus vesicular12.jpg|Lichen planus vesicular . <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus vesicular13.jpg|Lichen planus vesicular . <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus vesicular14.jpg|Lichen planus vesicular . <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+</gallery>
+=====Mucosal Lichen Planus=====
+======Oral cavity======
+<gallery>
+Image:Mucosal lichen planus01.jpg|Mucosal lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Mucosal lichen planus02.jpg|Mucosal lichen planus . <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Mucosal lichen planus03.jpg|Mucosal lichen planus . <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+</gallery>
+==Differential diagnosis==
+Lichen planus must be differentiated from other diseases that cause ust be differentiated from other diseases that cause rash and eczema such as secondary syphilis and pityriasis rosea.
+{| class="wikitable"
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Rash Characteristics
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Signs and Symptoms
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Associated Conditions
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Images
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Cutaneous T cell lymphoma]]/[[Mycosis fungoides]]<ref name="urlMycosis Fungoides and the Sézary Syndrome Treatment (PDQ®)—Patient Version - National Cancer Institute">{{cite web |url=https://www.cancer.gov/types/lymphoma/patient/mycosis-fungoides-treatment-pdq |title=Mycosis Fungoides and the Sézary Syndrome Treatment (PDQ®)—Patient Version - National Cancer Institute |format= |work= |accessdate=}}</ref>
+|
+* '''Premycotic phase:''' A scaly, red [[rash]] in areas of the [[body]] that usually are not exposed to the sun. This rash does not cause symptoms and may last for months or years.
+* '''Patch phase:''' Thin, [[erythematous]], [[eczema]]-like rash.
+* '''[[Plaque]] phase:''' Small raised [[Bumps on skin|bumps]] ([[Papule|papules]]) or hardened [[lesions]] on the skin, which may be [[erythematous]].
+* '''[[Tumor]] phase:''' Tumors form on the [[skin]]. [[Infection]] secondary to [[Ulcer|ulcers]].
+|
+* [[Epidermis (skin)|Epidermal]] [[atrophy]] or poikiloderma
+* Generalized [[itching]] ([[pruritus]])
+* [[Pain]] in the affected area of the skin
+* [[Insomnia]]
+* Red ([[erythematous]]) patches scattered over the [[skin]] of the [[trunk]] and the [[extremities]]
+* Tumor-like lobulated outgrowths form on the skin in the latter phase of the disease
+* [[Weight loss]]
+* [[Lymphadenopathy]]
+* [[Malaise]] and [[fatigue]]
+* [[Anemia]]
+* May progress to [[Sezary syndrome]] (skin involvement plus hematogenous dissemination)
+|
+* [[Sezary syndrome]]
+|
+[[Image:Mycosis_fungoides.JPG|200px|thumb|By Bobjgalindo - Own work, GFDL, https://commons.wikimedia.org/w/index.php?curid=7139812]]
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pityriasis rosea]]<ref name="pmid27512182">{{cite journal |vauthors=Mahajan K, Relhan V, Relhan AK, Garg VK |title=Pityriasis Rosea: An Update on Etiopathogenesis and Management of Difficult Aspects |journal=Indian J Dermatol |volume=61 |issue=4 |pages=375–84 |year=2016 |pmid=27512182 |pmc=4966395 |doi=10.4103/0019-5154.185699 |url=}}</ref>
+|
+* Pink or salmon in color, which may be scaly; referred to as "herald patch"
+* Oval shape
+* Long axis oriented along the cleavage lines
+* Distributed on the [[trunk]] and [[proximal extremities]]
+* Squamous marginal collarette and a “fir-tree” or “Christmas tree” distribution on  posterior trunk
+* Secondary to [[viral infection]]<nowiki/>s
+* Resolves spontaneously after 6-8 weeks
+|
+* Preceded by a prodrome of:
+** [[Sore throat]]
+** [[Gastrointestinal tract|Gastrointestinal]] disturbance
+** [[Fever]]
+** [[Arthralgia]]
+|
+* Infection by any of the following:<ref name="pmid19997691">{{cite journal |vauthors=Prantsidis A, Rigopoulos D, Papatheodorou G, Menounos P, Gregoriou S, Alexiou-Mousatou I, Katsambas A |title=Detection of human herpesvirus 8 in the skin of patients with pityriasis rosea |journal=Acta Derm. Venereol. |volume=89 |issue=6 |pages=604–6 |year=2009 |pmid=19997691 |doi=10.2340/00015555-0703 |url=}}</ref>
+** [[Human herpesvirus 6|HHV-6]]
+** [[HHV-7]]
+** [[HHV-8]]
+|
+[[Image:Pityriasisrosea.png|200px|thumb|By James Heilman,MD - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=16305230]]
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pityriasis lichenoides chronica]]
+|
+* Recurrent [[lesions]] are usually less evenly scattered than in cases of psoriasis
+* Brownish red or orange-brown in color
+* [[Lesions]] are capped by a single detachable, opaque, mica-like scale
+* Often leave [[Hypopigmented area|hypopigmented]] [[Macule|macules]]
+|
+* High [[fever]]
+* [[Malaise]]
+* [[Myalgias]]
+* [[Paraesthesia]]
+* [[Pruritis|Pruritus]]
+|
+* Infection by any of the following:<ref name="pmid9109005">{{cite journal |vauthors=Smith KJ, Nelson A, Skelton H, Yeager J, Wagner KF |title=Pityriasis lichenoides et varioliformis acuta in HIV-1+ patients: a marker of early stage disease. The Military Medical Consortium for the Advancement of Retroviral Research (MMCARR) |journal=Int. J. Dermatol. |volume=36 |issue=2 |pages=104–9 |year=1997 |pmid=9109005 |doi= |url=}}</ref>
+** [[Epstein Barr virus|Epstein-Barr virus]] (EBV)
+** ''[[Toxoplasma gondii]]''
+** [[Human Immunodeficiency Virus (HIV)|Human immunodeficiency virus]] (HIV)
+|
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Nummular dermatitis]]<ref name="pmid23517392">{{cite journal |vauthors=Jiamton S, Tangjaturonrusamee C, Kulthanan K |title=Clinical features and aggravating factors in nummular eczema in Thais |journal=Asian Pac. J. Allergy Immunol. |volume=31 |issue=1 |pages=36–42 |year=2013 |pmid=23517392 |doi= |url=}}</ref>
+|
+* Multiple coin-shaped [[Eczematous Scaling|eczematous]] [[lesions]]
+* Commonly affecting the [[extremities]] (lower>upper) and [[trunk]]
+* May ooze [[fluid]] and become dry and crusty
+|
+* Often appears after a skin injury, such as a [[burn]], [[abrasion]] (from friction), or [[insect bite]]
+* [[Lesions]] commonly relapse after occasional remission or may persist for long periods
+* [[Pruritis|Pruritus]]
+|
+* Associated with:
+** Dry skin
+** Emotional stress
+** [[Allergens]] (rubber chemicals, [[formaldehyde]], [[neomycin]], chrome, [[Mercury (element)|mercury]], and [[nickel]])
+** [[Staphylococcus]] infection
+** Seasonal variation
+** [[Alcohol]]
+** [[Drugs]]
+** [[Atopy]]
+|
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Secondary syphilis]]<ref name="urlSTD Facts - Syphilis">{{cite web |url=https://www.cdc.gov/std/syphilis/stdfact-syphilis.htm |title=STD Facts - Syphilis |format= |work= |accessdate=}}</ref>
+|
+* Round, coppery, red colored [[lesions]] on palms and soles
+* [[Papule|Papules]] with collarette of scales
+|
+* [[Fever]]
+* [[Lymphadenopathy|Generalized lymphadenopathy]]
+* [[Sore throat]]
+* [[Hair loss|Patchy hair loss]]
+* [[Headaches|Headache]]
+* [[Weight loss]]
+* [[Myalgia]]
+* [[Fatigue]]
+|
+* Associated with:
+** [[Condyloma latum|Condylomata lata]]
+** Corona verinata
+** Positive [[Venereal disease research laboratory (VDRL) test|VDRL]] test
+|
+[[Image:Secondary_Syphilis.jpg|200px|thumb|By James Heilman,MD - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=16305230]]
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Bowen’s disease]]<ref name="pmid28523295">{{cite journal |vauthors=Neagu TP, Tiglis M, Botezatu D, Enache V, Cobilinschi CO, Vâlcea-Precup MS, GrinTescu IM |title=Clinical, histological and therapeutic features of Bowen's disease |journal=Rom J Morphol Embryol |volume=58 |issue=1 |pages=33–40 |year=2017 |pmid=28523295 |doi= |url=}}</ref>
+|
+* [[Erythematous]], small, scaly plaque, which enlarges erratically over time
+* Scale is usually yellow or white and it is easily detachable without any [[bleeding]]
+* Well-defined margins
+|
+* [[Pruritis|Pruritus]]
+* [[Pain]]
+* Bleeding [[lesions]]
+|
+* Associated with:<ref name="pmid25201325">{{cite journal |vauthors=Murao K, Yoshioka R, Kubo Y |title=Human papillomavirus infection in Bowen disease: negative p53 expression, not p16(INK4a) overexpression, is correlated with human papillomavirus-associated Bowen disease |journal=J. Dermatol. |volume=41 |issue=10 |pages=878–84 |year=2014 |pmid=25201325 |doi=10.1111/1346-8138.12613 |url=}}</ref>
+** [[Erythroplasia of Queyrat]] ([[Bowen's disease]] of the [[penis]])
+** [[Squamous cell carcinoma]]
+** Solar radiation and [[ultraviolet]] (UV) exposure
+** [[Radiation therapy|Radiotherapy]]
+** [[Immunosuppression]]
+** [[Arsenic]] exposure
+** [[Human papillomavirus|Human papilloma virus]] (HPV) type 16
+** [[Polyomavirus|Merkel cell polyomavirus]]
+** [[Sjögren's syndrome|Sjögren’s syndrome]]
+|
+[[Image:Bowen.jpg|200px|thumb|By Klaus D. Peter, Gummersbach, Germany - Own work (own photograph), CC BY 3.0 de, https://commons.wikimedia.org/w/index.php?curid=6839115]]
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Exanthematous pustulosis]]<ref name="pmid26354880">{{cite journal |vauthors=Szatkowski J, Schwartz RA |title=Acute generalized exanthematous pustulosis (AGEP): A review and update |journal=J. Am. Acad. Dermatol. |volume=73 |issue=5 |pages=843–8 |year=2015 |pmid=26354880 |doi=10.1016/j.jaad.2015.07.017 |url=}}</ref>
+|
+* Numerous small, primarily non-follicular, sterile [[pustules]], arising within large areas of [[Edema|edematous]] [[erythema]]
+|
+* [[Fever]]
+* [[Leukocytosis]]
+* Intracorneal, subcorneal, and/or intraepidermal [[pustules]] with [[papillary]] [[dermal]] [[edema]] containing [[neutrophils]] and [[eosinophils]]
+|
+* Associated with:<ref name="pmid12466124">{{cite journal |vauthors=Schmid S, Kuechler PC, Britschgi M, Steiner UC, Yawalkar N, Limat A, Baltensperger K, Braathen L, Pichler WJ |title=Acute generalized exanthematous pustulosis: role of cytotoxic T cells in pustule formation |journal=Am. J. Pathol. |volume=161 |issue=6 |pages=2079–86 |year=2002 |pmid=12466124 |pmc=1850901 |doi=10.1016/S0002-9440(10)64486-0 |url=}}</ref>
+** [[Antibiotics]] ([[Penicillin|penicillins]], [[sulfonamides]], [[tetracyclines]])
+** [[Carbamazepine]]
+** [[Calcium channel blocker|Calcium channel blockers]] ([[Diltiazem]])
+** [[Hydroxychloroquine]]
+|
+[[Image:Acute_generalized_exanthematous_pustulosis.jpg|200px|thumb|By See below - (2010). "Acute generalized exanthematous pustulosis: an unusual side effect of meropenem". Indian J Dermatol 55 (2): 176–7. DOI:10.4103/0019-5154.62759. PMID 20606889. PMC: 2887524., CC BY 1.0, https://commons.wikimedia.org/w/index.php?curid=52979729]]
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Lichen planus|Hypertrophic lichen planus]]<ref name="pmid27222766">{{cite journal |vauthors=Ankad BS, Beergouder SL |title=Hypertrophic lichen planus versus prurigo nodularis: a dermoscopic perspective |journal=Dermatol Pract Concept |volume=6 |issue=2 |pages=9–15 |year=2016 |pmid=27222766 |pmc=4866621 |doi=10.5826/dpc.0602a03 |url=}}</ref>
+|
+* Classically involves shin and ankles and is characterized by [[Hyperkeratosis|hyperkeratotic]] [[Plaque|plaques]] and [[Nodule (medicine)|nodules]] covered by a scale
+* [[Lesions]] may transform into [[Hyperkeratosis|hyperkeratotic]] thickened, elevated, purplish or reddish [[Plaque|plaques]] and [[nodules]]
+|
+* Chronic [[pruritis|pruritus]]
+* Scaling
+* May be [[asymptomatic]]
+|
+* Associated with [[Hepatitis C virus]] infection<ref name="pmid19770446">{{cite journal |vauthors=Shengyuan L, Songpo Y, Wen W, Wenjing T, Haitao Z, Binyou W |title=Hepatitis C virus and lichen planus: a reciprocal association determined by a meta-analysis |journal=Arch Dermatol |volume=145 |issue=9 |pages=1040–7 |year=2009 |pmid=19770446 |doi=10.1001/archdermatol.2009.200 |url=}}</ref>
+|
+[[Image:Lichen_planus2.JPG|200px|thumb|Di James Heilman, MD - Opera propria, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=11509003]]
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |Sneddon–Wilkinson disease<ref name="pmid9564592">{{cite journal |vauthors=Lutz ME, Daoud MS, McEvoy MT, Gibson LE |title=Subcorneal pustular dermatosis: a clinical study of ten patients |journal=Cutis |volume=61 |issue=4 |pages=203–8 |year=1998 |pmid=9564592 |doi= |url=}}</ref>
+|
+* [[Flaccid]] [[pustules]] that are often generalized and have a tendency to involve the flexural areas
+* Annular configuration
+|
+* [[Pruritis|Pruritus]]
+* May be asymptomatic
+|
+* Associated with:
+** [[Monoclonal gammopathy]], usually an [[IgA]] paraproteinemia<ref name="pmid3056995">{{cite journal |vauthors=Kasha EE, Epinette WW |title=Subcorneal pustular dermatosis (Sneddon-Wilkinson disease) in association with a monoclonal IgA gammopathy: a report and review of the literature |journal=J. Am. Acad. Dermatol. |volume=19 |issue=5 Pt 1 |pages=854–8 |year=1988 |pmid=3056995 |doi= |url=}}</ref>
+** [[Crohn's disease]]<ref name="pmid1357895">{{cite journal |vauthors=Delaporte E, Colombel JF, Nguyen-Mailfer C, Piette F, Cortot A, Bergoend H |title=Subcorneal pustular dermatosis in a patient with Crohn's disease |journal=Acta Derm. Venereol. |volume=72 |issue=4 |pages=301–2 |year=1992 |pmid=1357895 |doi= |url=}}</ref>
+** [[Osteomyelitis]]
+** [[Adalimumab]]<ref name="pmid23489057">{{cite journal |vauthors=Sauder MB, Glassman SJ |title=Palmoplantar subcorneal pustular dermatosis following adalimumab therapy for rheumatoid arthritis |journal=Int. J. Dermatol. |volume=52 |issue=5 |pages=624–8 |year=2013 |pmid=23489057 |doi=10.1111/j.1365-4632.2012.05707.x |url=}}</ref>
+|
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Parapsoriasis|Small plaque parapsoriasis]]<ref name="pmid7026622">{{cite journal |vauthors=Lambert WC, Everett MA |title=The nosology of parapsoriasis |journal=J. Am. Acad. Dermatol. |volume=5 |issue=4 |pages=373–95 |year=1981 |pmid=7026622 |doi= |url=}}</ref>
+|
+* [[Erythematous]] [[plaques]] with fine scaly surface
+* May present with elongated, finger-like patches
+* Symmetrical distribution on the flanks
+* Known as digitate dermatosis
+|
+* [[Lesions]] may be [[asymptomatic]]
+* May be mildly [[Itch|pruritic]]
+* May fade or disappear after sun exposure during the summer season, but typically recur during the winter
+|
+* May progress to [[mycosis fungoides]]<ref name="pmid16191852">{{cite journal |vauthors=Väkevä L, Sarna S, Vaalasti A, Pukkala E, Kariniemi AL, Ranki A |title=A retrospective study of the probability of the evolution of parapsoriasis en plaques into mycosis fungoides |journal=Acta Derm. Venereol. |volume=85 |issue=4 |pages=318–23 |year=2005 |pmid=16191852 |doi=10.1080/00015550510030087 |url=}}</ref>
+|
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Intertrigo]]<ref name="pmid16156342">{{cite journal |vauthors=Janniger CK, Schwartz RA, Szepietowski JC, Reich A |title=Intertrigo and common secondary skin infections |journal=Am Fam Physician |volume=72 |issue=5 |pages=833–8 |year=2005 |pmid=16156342 |doi= |url=}}</ref>
+|
+* Red and fleshy looking [[lesion]] in [[skin]] folds
+* [[Itching]]
+* Oozing
+* May be sore
+|
+* [[Pruritis|Pruritus]]
+* Musty odor
+|
+* Associated with:
+** [[Infections]] (Fungal, bacterial, viral)
+** [[Allergies]]
+** [[Diabetes Mellitus|Diabetes]]
+** [[Obesity]]
+|
+[[Image:Axillary_intertrigo.png|200px|thumb|Source: https://www.cdc.gov/]]
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Langerhans cell histiocytosis]]<ref name="pmid18577030">{{cite journal |vauthors=Satter EK, High WA |title=Langerhans cell histiocytosis: a review of the current recommendations of the Histiocyte Society |journal=Pediatr Dermatol |volume=25 |issue=3 |pages=291–5 |year=2008 |pmid=18577030 |doi=10.1111/j.1525-1470.2008.00669.x |url=}}</ref>
+|
+* Scaling and crusting of [[scalp]]
+|
+* Pathological fractures<ref name="pmid1636041">{{cite journal |vauthors=Stull MA, Kransdorf MJ, Devaney KO |title=Langerhans cell histiocytosis of bone |journal=Radiographics |volume=12 |issue=4 |pages=801–23 |year=1992 |pmid=1636041 |doi=10.1148/radiographics.12.4.1636041 |url=}}</ref>
+* Visceromegaly ([[hepatomegaly]], [[spleenomegaly]])
+* [[Chronic cough, severe cold|Chronic cough]]
+* [[Dyspnea]]<ref name="pmid17527085">{{cite journal |vauthors=Sholl LM, Hornick JL, Pinkus JL, Pinkus GS, Padera RF |title=Immunohistochemical analysis of langerin in langerhans cell histiocytosis and pulmonary inflammatory and infectious diseases |journal=Am. J. Surg. Pathol. |volume=31 |issue=6 |pages=947–52 |year=2007 |pmid=17527085 |doi=10.1097/01.pas.0000249443.82971.bb |url=}}</ref>
+* [[Lymphadenopathy]]
+|
+* Associated with:
+** [[Diabetes insipidus]]<ref name="pmid16047354">{{cite journal |vauthors=Grois N, Pötschger U, Prosch H, Minkov M, Arico M, Braier J, Henter JI, Janka-Schaub G, Ladisch S, Ritter J, Steiner M, Unger E, Gadner H |title=Risk factors for diabetes insipidus in langerhans cell histiocytosis |journal=Pediatr Blood Cancer |volume=46 |issue=2 |pages=228–33 |year=2006 |pmid=16047354 |doi=10.1002/pbc.20425 |url=}}</ref>
+** [[Pancytopenia]]
+|
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Tinea manuum]]/pedum/capitis<ref name="pmid15050029">{{cite journal |vauthors=Al Hasan M, Fitzgerald SM, Saoudian M, Krishnaswamy G |title=Dermatology for the practicing allergist: Tinea pedis and its complications |journal=Clin Mol Allergy |volume=2 |issue=1 |pages=5 |year=2004 |pmid=15050029 |pmc=419368 |doi=10.1186/1476-7961-2-5 |url=}}</ref>
+|
+* Scaling, flaking, and sometimes blistering of the affected areas
+* Hair loss with a black dot on scalp in case of [[tinea capitis]]
+|
+* [[Pruritis|Pruritus]]
+* [[KOH]] preparation of the [[lesions]] confirms [[fungal infection]]
+|
+* Associated with:
+** [[Diabetes mellitus|Diabetes]]
+** [[Immunosupression]]
+** Intimate contact with infected person
+** May lead to [[asthma]] exacerbation
+|
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Seborrheic dermatitis]]
+|
+* [[Papulosquamous]], scaly, flaky, [[itchy]], and red [[rash]] found particularly at [[sebaceous gland]]-rich areas of the body
+|
+* [[Pruritus]]
+|
+* Associated with:<ref name="pmid16848386">{{cite journal |vauthors=Schwartz RA, Janusz CA, Janniger CK |title=Seborrheic dermatitis: an overview |journal=Am Fam Physician |volume=74 |issue=1 |pages=125–30 |year=2006 |pmid=16848386 |doi= |url=}}</ref>
+** [[AIDS]]
+** [[Stress]]<ref name="pmid18033062">{{cite journal |vauthors=Misery L, Touboul S, Vinçot C, Dutray S, Rolland-Jacob G, Consoli SG, Farcet Y, Feton-Danou N, Cardinaud F, Callot V, De La Chapelle C, Pomey-Rey D, Consoli SM |title=[Stress and seborrheic dermatitis] |language=French |journal=Ann Dermatol Venereol |volume=134 |issue=11 |pages=833–7 |year=2007 |pmid=18033062 |doi= |url=}}</ref>
+** [[Fungal infection]]
+** [[Fatigue]]
+** [[Sleep deprivation]]
+** Change of season
+** [[Parkinson's disease|Parkinson's]] disease
+** [[Biotin]] deficiency
+|
+[[Image:Seborrhoeic_dermatitisnew.jpg|thumb|200px|By Roymishali - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=27267929]]
+|}
+====Head====
+Oral lichen planus may present in one of three forms.
+*The [[reticular]] form is the most common presentation and manifests as white lacy streaks on the mucosa (known as Wickham's striae) or as smaller papules (small raised area).  The lesions tend to be bilateral and are [[asymptomatic]].  The lacy streaks may also be seen on other parts of the mouth, including the gingiva (gums), the tongue, palate and lips.
+*The [[bullous]] form presents as fluid-filled vesicles which project from the surface.
+*The erosive form presents with [[erythematous]] (red) areas that are ulcerated and uncomfortable.  The erosion of the thin [[epithelium]] may occur in multiple areas of the mouth, or in one area, such as the gums, where they resemble [[desquamative gingivitis]].  Wickham's striae may also be seen near these ulcerated areas.  This form may undergo malignant transformation.
+====Throat====
 Rarely, lichen planus shows esophageal involvement, where it can present with erosive esophagitis and stricturing.  It has also been hypothesized that it is a precursor to squamous cell carcinoma of the esophagus.
+====Genitals====
+Lichen planus may also affect the genital mucosa - vulvovaginal-gingival lichen planus. It can resemble other skin conditions such as [[atopic dermatitis]] and [[psoriasis]].
 Clinical experience suggests that Lichen planus of the skin alone is easier to treat as compared to one which is associated with oral and genital lesions.
+<gallery>
+Image:Lichen planus35.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus36.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus37.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Lichen planus39.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-== Differential Diagnosis ==
-The clinical presentation of lichen planus may also resemble other conditions, including:
-*  Lichenoid drug reaction
+Image:Lichen planus40.jpg|Lichen planus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-*  Discoid Lupus Erythematosus
-*  Chronic Ulcerative Stomatitis
-*  Pemphigus Vulgaris
-*  Benign Mucous Membrane Pemphigoid
-*  Oral [[leukoplakia]]
-*  Frictional [[keratosis]]
-A biopsy is useful in identifying histological features that help differentiate lichen planus from these conditions.
+</gallery>
 == Treatment ==
 Currently there is no cure for lichen planus but there are certain types of medicines used to reduce the effects of the inflammation. Lichen planus may go into a dormant state after treatment. There are also reports that lichen planus can flare up years after it is considered cured.
+===Medical Therapy===
+====Pharmacotherapy====
-Medicines used to treat lichen planus include:
+=====Acute Pharmacotherapies=====
 * [[Wiktionary:oral|Oral]] and [[topical]] [[steroids]].
+* [[Hydroxychloroquine]]
+* [[Tacrolimus]]
+* [[Dapsone]]
+=====Chronic Pharmacotherapies=====
 * Oral [[retinoids]]
-* immunosuppressant medications
+* [[Immunosuppressant]] medications
-* [[hydroxychloroquine]]
-* [[tacrolimus]]
+===Surgery===
-* [[dapsone]]
+===Prevention===
-== Lichen planopilaris ==
+==References==
+{{Reflist|2}}
-Lichen Planopilaris is the specific name given to lichen planus on the [[scalp]] that may cause permanent, scarring [[alopecia]]. If left untreated the scarring will cause permanent hair loss. The Cicatricial Alopecia Research Foundation is a non-profit organization that provides support and resources for people with lichen planopilaris.
 {{Diseases of the skin and subcutaneous tissue}}
-{{SIB}}
 <br>
-[[de:Lichen ruber planus]]
-[[fr:Lichen plan]]
-[[he:ילפת שטוחה]]
-[[nl:Lichen planus]]
-[[ja:扁平苔癬]]
-[[pl:Liszaj płaski]]
-[[tr:Liken planus]]
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+[[Category:Rheumatology]]
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+[[Category:Needs content]]

Lichen planus: Difference between revisions

Latest revision as of 21:22, 7 September 2017

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Common Causes

Causes in Alphabetical Order

Differentiating lichen planus from other Diseases

Epidemiology and Demographics

Age

Gender

Risk Factors

Natural History, Complications, and Prognosis

Diagnosis

Symptoms

Physical Examination

Skin

Trunk

Extremity

Oral cavity

Face

Lichen Planus Actinicus

Face

Trunk

Extremity

Lichen planus annular

Trunk

Lichen Planus Follicularis

Neck

Extremity

Scalp

Lichen Planus Linearis

Trunk

Extremity

Lichen Planus Verrucosus

Lichen Planus Vesicular

Trunk

Extremity

Mucosal Lichen Planus

Oral cavity

Differential diagnosis

Head

Throat

Genitals

Treatment

Medical Therapy

Pharmacotherapy

Acute Pharmacotherapies

Chronic Pharmacotherapies

Surgery

Prevention

References

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