Lichen planus is a recurrent inflammatory condition that can affect any area of skin, mucosa, nails, and scalp. Although the etiology is unknown, it is often associated with autoimmune diseases suggesting an autoimmune cause.
Symptoms of lichen planus may include intense vulvar pruritus, pain, and/or dysuria. Vaginal involvement is seen in 70% of cases and may result in vaginal discharge, dyspareunia, and occasionally postcoital bleeding. Coexisting oral or other cutaneous lesions are common. Vulvar lichen planus is characterized by violaceous, glassy, erosive, or papular lesions. Desquamation may be present. Recurrent lesions may lead to extensive scarring with resultant loss of the vulvar architecture including stenosis of the vaginal introitus and urethral obstruction.
Erosive Lichen Planus. Glassy erosive lesions of lichen planus with “lichenification,” or thickening of the epidermis, in peripheral areas. (Photo contributor: Hope Haefner, MD.)
Lichenoid drug eruptions can be clinically indistinguishable from lichen planus. Medications including β-blockers, methyldopa, penicillamine, quinidine, nonsteroidal anti-inflammatory drugs (NSAIDs), angiotensin-converting enzyme (ACE) inhibitors, sulfonvylurea agents, carbamazepine, gold, lithium, quinidine, or hydrochlorothiazide (HCTZ) have been associated with lichenoid drug eruptions.
Management and Disposition
ED management of lichen planus includes antihistamines for pruritis and gynecologic referral. If a lichenoid drug eruption is suspected, recommend discontinuation of medications that may be causative. Advise patients on good vulvar hygiene including cessation of scratching to prevent secondary infections. Sitz baths may help alleviate symptoms. Definitive diagnosis is made by biopsy.
Erosive Lichen Planus. Glassy erosive lesions of lichen planus. (Photo contributor: Hope Haefner, MD.)
Erosive Lichen Planus—Oral. Lichen planus can affect any area of skin, mucosa, nails, and scalp. (Photo contributor: Hope Haefner, MD.)
HCTZ and NSAIDs are common triggers for recurrent lichen planus.
Lichen planus does not involve the perianal region, whereas lichen sclerosis may.