Abstract
Case study A 53-year-old female presents with a 1-month history of an itchy rash affecting her wrists, ankles and lower back. She also has a sensitive white rash covering her oral cavity.
This is lichen planus. It is an idiopathic, chronic, inflammatory disease of the skin and mucous membranes. It affects up to 1% of the adult population.
Lichen planus classically presents between the ages of 50–70 with intensely itchy, flat topped papules. Common sites are the wrists, forearms, ankles, pre-sacral area and genitals. The surface of the lesions is often shiny with a network of white lines called Wickham’s striae.
Oral lichen planus affects half of all cases and it can be the sole presentation. The diagnosis is clinical, but biopsies can be taken in difficult cases.
Lichen planus can normally be managed in primary care. Treatment for cutaneous lichen planus should begin with potent or very potent topical steroids. Difficult-to-treat cutaneous lichen planus can be referred to dermatology. They may consider treatments such as oral corticosteroids, systemic retinoids, ultraviolet light and oral immunosuppressants.
Oral lichen planus can be initially treated with a potent steroid mouthwash. Difficult cases can be referred to oral medicine where further treatment options include topical tacrolimus and systemic treatments.