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Lichen planus

Published: September 18, 2026Updated: September 18, 2026

Important: Informational content intended for healthcare professionals. It does not replace clinical evaluation or establish a doctor-patient relationship.

Overview

  • Names: Planck Lichen (PL), Lichen planus / lichen ruber planus, Wilson’s Planck Lichen
    • Variants: oral lichen planus (OLP), planopilar lichen planus (PPL), nail lichen planus, hypertrophic lichen planus, bullous lichen planus, actinic lichen planus, pigmented lichen planus, etc. Gorouhi 2014 , Solimani 2021
  • History
    • Described and named “lichen planus” by Erasmus Wilson in 1869. Boorghani 2010
    • Wickham’s striae were described in the late 19th century and remain a cardinal clinical sign. Gorouhi 2014
  • Epidemiology
    • Global mucocutaneous LP: approximate prevalence 0.5–1% of the general population. Gorouhi 2014
    • Oral lichen planus (OLP) : combined global prevalence 0.89% in the general population (0.57% Asia; 1.68% Europe; 1.39% South America), higher in women and those over 40 years of age. Li 2020
    • Local studies confirm a higher frequency of oral involvement compared to cutaneous involvement in dental consultation series. Omal 2012
    • Peak age: 30–70 years; rare in childhood. Le Cleach 2012 , Boorghani 2010
    • Sex: slight female predominance (≈ 1.3–1.5:1 in LPO). Li 2020
    • Associations: Hepatitis C (HCV): increased risk (OR ~4–5 for LP/LPO in meta-analysis), with geographical variation (stronger in the Mediterranean, Japan, and parts of South America). Lodi 2010 , Alaizari 2016
  • ICD Codes
    • ICD-10 L43 – Lichen planus (general category), L43.0 – Hypertrophic lichen planus, L43.1 – Bullous lichen planus, L43.2 – Lichenoid drug reaction, L43.3 – Subacute (active) lichen planus, L43.8 – Other lichen planus, L43.9 – Lichen planus, unspecified, L46.11 – Classical planopilar (follicular LP) lichen
    • ICD-11 (EA91: Lichen planus) EA91.0 – Acute eruptive lichen planus, EA91.1 – Hypertrophic lichen planus, EA91.2 – Follicular lichen planus / LPP, EA91.3 – Lichen planus of the skin and genital mucosa, EA91.4 – Lichen planus and lichenoid reactions of the oral mucosa, EA91.5 – Nail lichen planus, EA91.6 – Subacute lichen planus, EA91.Y/EA91.Z – Other / unspecified

  • Diagnostic checklist (quick)
    • Essential clinic
      • Are there typical pruritic violaceous papules/plaques (6P)?
      • Are there Wickham’s striae on skin/mucosa?
      • Topography: wrists, legs, buccal mucosa, genitals, scalp, nails.
      • Chronic course or self-limiting outbreaks?
      • New medications in the last 3–6 months? (possible drug-induced lichenoid)
      • Risk factors for HCV/liver disease?
    • Laboratory / minimal cabinet
      • HCV serology (at least once).
      • Complete blood count, liver function tests, and renal function tests before systemic therapy.
    • Biopsy
      • Type: 4–5 mm punch skin / mucosa incision.
      • Location: recent active lesion / erosion border in LPO.
      • Second biopsy in the middle for IFD if there is doubt about lupus, pemphigoid, pemphigus.

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