GUIDELINES IN DERMATOLOGY

gdkapak

LICHEN PLANUS

Selen Aydın1
Asena Çiğdem Doğramacı2

1Hatay Mustafa Kemal University, Faculty of Medicine, Department of Dermatology, Hatay, Türkiye
2Hatay Mustafa Kemal University, Faculty of Medicine, Department of Dermatology, Hatay, Türkiye

Aydın S, Doğramacı AÇ. Lichen Planus. In: Kutlubay Z, editor. Guidelines in Dermatology. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.131-138.

ABSTRACT

Lichen planus (LP) is a T-cell mediated chronic inflammatory disorder that primarily involves the skin and mucous membranes, characterized by the presence of pruritic, violaceous papules as its principal lesion. LP favors the flexoral surfaces of the extremities and mucous membranes of the oral cavity. It is mostly observed in middle aged adults and impacts around 1% of the global population annually. Although the precise pathogenesis of this disease is incompletely understood, LP is widely regarded as an autoimmune disease. Its etiology has yet to be fully elucidated, and the factors responsible for triggering the T-cell-dependent autoimmune damage to epidermal keratinocytes could differ. Potential triggers include viruses, certain medications, vaccinations, specific HLA haplotypes, and exogenous contact allergens such as dental amalgams. These stimuli may activate CD8+ T-cells and the interferon signaling pathway. Histopathological examination of affected tissue reveals a dense, band-like lymphocitic infiltrate at the dermoepidermal junction, along with the presence of Civatte bodies. LP may present in various clinical variants, classified based on the morphology and anatomical location of the lesions. A range of papulosquamous diseases must be distinguished from lichen planus during the diagnostic workup. Mucosal involvement requires differentiation from conditions such as pemphigus vulgaris, candidiasis, lupus erythematosus, secondary syphilis and mucous membrane pemphigoid.

The main aim of lichen planus (LP) treatment is to mitigate inflammation, alleviate patient discomfort, and minimize the potential risk of cancer development. In cases of mild disease, the application of topical corticosteroids and emollients constitutes the first-line therapeutic approach. For recalcitrant or widespread disease, systemic therapies may be required, including systemic corticosteroids, systemic retinoids, narrowband ultraviolet B (NB-UVB) phototherapy, and photochemotherapy with psoralen-UVA (PUVA). Additionally, immune-modulating agents such as oral cyclosporine, azathioprine, methotrexate, and mycophenolate mofetil may be employed. Biologic agents including tumor necrosis factor alpha (TNF-a) inhibitors and rituximab; as well as intravenous immunoglobulin (IVIg) therapy, can be used. The therapeutic management of LP is quite challenging, and further research is necessary to establish an optimized treatment algorithm.

Keywords: Lichen planus; Lichen planus, oral; Skin diseases; papulosquamouss

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