Lichen planus (LP) is a pruritic papulosquamous eruption in which autoreactive T lymphocytes attack basal keratinocytes in the skin, mucous membranes, hair follicles, and/or nail units. The etiology is unclear, but viruses, medications, or contact allergens have all been implicated.
Childhood LP has been described after hepatitis B vaccination. Drugs causing LP-like eruptions (lichenoid drug reactions) include antihypertensives (ACE inhibitors: captopril and enalapril; beta blockers: propranolol and labetalol), thiazide diuretics, antimalarials (quinidine and hydroxychloroquine), penicillamine, NSAIDs, griseofulvin, tetracycline, antiepileptics, and many other drugs.
LP usually affects the glabrous (non-hair-bearing) skin and sometimes the mucosa, scalp, and nails. (See oral lichen planus for oral mucosal presentation and see lichen planopilaris for scalp presentation.) The frequency of childhood LP varies from 2.1%-11.2% of all cases of LP.
The majority of children who develop LP develop the classic form. Other variants include actinic, hypertrophic, linear, eruptive, follicular, atrophic, and bullous lesions.
LP may resolve spontaneously over several months. However, the disease generally has a chronic course with frequent remissions and exacerbations.
Lichen planus in Child
See also in: Anogenital,Nail and Distal DigitAlerts and Notices
Important News & Links
Synopsis
Codes
ICD10CM:
L43.9 – Lichen planus, unspecified
SNOMEDCT:
4776004 – Lichen planus
L43.9 – Lichen planus, unspecified
SNOMEDCT:
4776004 – Lichen planus
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Psoriasis – Well-demarcated erythematous papules and plaques (on trauma-prone areas such as knees, elbows, and scalp) covered with silvery scale.
- Lichen nitidus – Small, pinpoint, monomorphic, skin-colored, round or dome-shaped papules in clusters. Common sites include the forearms, trunk, abdomen, and genitalia.
- Lichen striatus – Linear arrangement of hypopigmented or hyperpigmented inflammatory, lichenoid to eczematous papules on the extremities. No Wickham striae or violaceous hue. Much less pruritus than lichen planus.
- Pityriasis lichenoides chronica – Small, ovoid, pink-brown papules covered with thin scale and crust that resolve with hypopigmentation.
- Granuloma annulare – Skin-colored beaded dermal papules in an annular pattern (hands and feet). No surface changes.
- Sarcoidosis – Erythematous to violaceous edematous dermal papules and plaques (face, extremities). No surface changes. Associated lymphadenopathy, uveitis, and chest symptoms.
- Lichenoid drug eruption – May appear more eczematous or psoriasiform than classic LP. Unlike exanthematous drug eruptions, lichenoid drug eruptions can occur several months to years after the drug is started.
- Papular epidermal nevus with "skyline" basal cell layer (PENS) is a rare, newly described entity where affected children develop few hyperkeratotic polygonal or rectangular papules in one or more body locations. PENS syndrome describes a subset of patients with PENS with associated neurological findings such as epilepsy or neurodevelopmental delay.
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
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References
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Last Reviewed:05/06/2019
Last Updated:07/09/2023
Last Updated:07/09/2023
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Lichen planus in Child
See also in: Anogenital,Nail and Distal Digit