General Medical Information

Lichen Planus

Wilberto Nieves-Neira
Bhagirath Majmudar
Ira R. Horowitz

Lichen planus is rare in children. It can affect the mucous membranes of the mouth and vagina with white patches or erosions and the flexor surfaces of the extremities with shiny pruritic papules. The classic definition of lichen planus includes “five Ps”: purplish, pruritic, polygonal papules, and plaques. Scaling is faint with surface streaking (Wickham’s striae). These are grayish-white, hyperkeratotic striae with a lacy or reticular pattern. Extensive desquamation of the vagina may occur in severe cases. Diagnosis is based on biopsy. The course of the disease is unpredictable, with exacerbations and recurrences. Occasionally the condition is self-limited. Topical steroids are the treatment of choice for lichen planus. Vulvitis and erosive vaginitis may be controlled with potent steroid creams (clobetasol propionate) for 1 to 2 weeks followed by gradual tapering of the dosage and then switching to hydrocortisone. Antihistamines are indicated to control pruritus.