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Features of Lichen Planus - GPonline
Features of Lichen Planus - GPonline
Two proposed triggers for the condition should be mentioned, although neither
is a major cause in the UK. Hepatitis C virus infection seems to be associated
with a proportion of cases, and dental amalgam containing mercury appears to
be a cause of some cases of oral lichen planus.
The physical signs that allow a confident diagnosis are flat-topped papules or
plaques with a purplish hue and a whitish, lacy appearance, due to
hyperkeratosis, on the surface.
In the hypertrophic variant, the lesions are thickened and there is marked
hyperkeratosis, resulting in warty plaques that occur most commonly on the
shins. These lesions are often more chronic and difficult to treat than those
found in ordinary lichen planus. It is not uncommon for lichen planus to be
confined to the mucous membranes of the mouth and genitalia.
Some rarer variants of lichen planus include: erosive lichen planus, usually of
the mucous membranes; atrophic lichen planus; bullous lichen planus; and
actinic lichen planus, which causes hyperpigmented patches on the face.
Highly potent steroids can be used for a few weeks at a time for stubborn
lesions, and topical tacrolimus 0.1 per cent ointment has been found to be a
useful non-steroid treatment for some patients.
Symptomatic cases of oral lichen planus can usually be controlled with topical
steroid in the form of Adcortyl in Orabase, soluble prednisolone or
betamethasone used as a mouthwash or an aerosol device, directed at the oral
mucosa.
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