This is a fairly common, itchy inflammatory
dermatosis. It can occur anywhere, but is most
common on the flexor surfaces of the wrists and
lower legs. It presents as pruritic, papular, flat
polygonal lesions, which may coalesce to form
small plaques. A white lace-like pattern
may form on the top of plaques (Wickham's striae).
Lichen planus may also present as annular, atrophic
or hypertrophic lesions. Mucosal involvement is
common, particularly around the mouth, but also
around the genitalia, causing white plaques or
ulcers, which may be painful. Severe forms of the
disease can affect the nails, causing dystrophy. Most
patients recover spontaneously within 18 months.
Hypertrophic and atrophic disease are generally
more persistent, and ulcerative mucosal disease is
premalignant. Although the disease is self-limiting,
symptomatic treatment involves the use of potent topical steroids, or, in resistant cases, systemic steroids
and immunosuppressive agents.
Lichen sclerosus et atrophicus
This uncommon disorder is characterized by
well-defined white, macular, atrophic lesions that
particularly affect the genital region. Lichen sclerosus
is an autoimmune-associated disorder that more
commonly affects females than males. Individuals
can be affected at any age. Where there is clinical
doubt, a biopsy of the lesion may be taken to
confirm the diagnosis. Management of genital lichen
sclerosus is symptomatic, involving potent topical
steroids, with an antiseptic or antibiotic if necessary.
Extragenital lichen sclerosus does not always require
treatment. The condition can disappear of its own
accord some years after presentation. Long-term
disease can result in scarring and deformity of the
genital area, causing complications such as phimosis,
anal fissuring, and fusion of the labia minora.