A benign but pruritic skin eruption, lichen planus is a relatively rare disorder that usually produces scaling, purple papules marked by white lines or spots. The features of these lesions are called the “4 Ps”— purple, polygonal, pruritic, and papule.
In most patients, lichen planus resolves spontaneously in 6 to 18 months. In a few, chronic lichen planus may persist for several years.
The cause of lichen planus is unknown. Eruptions similar to lichen planus have been induced by arsenic, bismuth, gold, quinidine, propranolol, and naproxen. Exposure to developers used in color photography may likewise cause an eruption that’s indistinguishable from lichen planus.
Lichen planus is found in all geographic areas, with equal distribution among races. Eruptions of lesions with features characteristic of lichen planus occur most often in middle-age people and are uncommon in young and elderly people.
Lichen planus may develop suddenly or insidiously. Initial lesions commonly appear on the arms or legs (generally on the wrist and medial sides of the thighs) and evolve into the generalized eruption of flat, glistening, purple papules marked with white lines or spots (Wickham’s striae). These lesions may be linear from scratching or may coalesce into plaques. Lesions often affect the mucous membranes (especially the buccal mucosa), male genitalia and, less often, the nails. These lesions are painful, especially when ulcers develop. Mild to severe pruritus is common.
Treatment is essentially symptomatic. The goal of therapy is to relieve itching with topical fluorinated steroids and occlusive dressings, intralesional injections of steroids, oatmeal baths, and antihistamines. Erosive oral lesions should be treated with triamcinolone acetonide in Orabase twice daily. Generalized severely pruritic skin lesions may be treated with systemic corticosteroids. An initial dosage of oral prednisone may be prescribed; thereafter, the dosage is decreased by approximately one-third each week. If the patient experiences a recurrence of itching after the drug is discontinued, he’ll be given a low dose every other morning. If a drug is suspected as the cause, it should be discontinued.
❑ Administer medications as ordered, and inform the patient of possible adverse effects, especially drowsiness produced by antihistamines.
❑ Provide emotional support and reassure the patient that lichen planus, although annoying, is usually a benign, self-limiting condition, although lesions may persist for months or years.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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Title: Professional Guide to Diseases (Eighth Edition)
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2005
ISBN: 1-58255-370-X
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