Your concern
Lichen planus
Violaceous, itchy, flat-topped papules, often on the wrists: a recognisable picture, if you know it.
Lichen planus is an inflammatory skin condition with a fairly characteristic appearance: small polygonal papules, flat on the surface, violaceous in colour, often intensely itchy. The classic sites are the inner wrists, the ankles and the lower back, but it can appear elsewhere.
A detail recognisable to the naked eye, when present, is fine whitish streaks on the surface of the lesions, like a network. It is a useful sign because it does not belong to the conditions lichen is most often confused with.
Two things the patient rarely connects alone guide the visit. The first is that lichen can also involve the mucous membranes — the mouth in particular, with the same whitish network — and sometimes the oral mucosa is the only site involved. The second is that it can affect the nails and the scalp, and in those sites timing matters: unlike the skin, where lesions tend to resolve leaving at most a dark mark, on the scalp prolonged inflammation can result in hair loss that does not recover. This is why it is not a picture to observe at length before having it examined.
On the scalp, time is not neutral
On the skin, lichen planus tends to burn out over time, leaving at most a hyperpigmentation that later fades: waiting there costs itching but not permanent damage. On the scalp the matter changes, because prolonged inflammation can damage the follicle definitively, and hair lost in those patches does not regrow. If areas of the scalp appear red, itchy or are losing hair, assessment should not be put off to the next season.
How it shows
- Small flat, polygonal, violaceous papules
- Itching, often intense
- Fine whitish streaks on the surface of the lesions
- Typical sites: inner wrists, ankles, lower back
- Possible whitish network on the lining of the mouth
- Nail changes or patches on the scalp
How we proceed
- 1Dermatological visit: appearance, site and distribution of the lesions
- 2Inspection of mucosae, nails and scalp, even if the patient does not report them
- 3Where the picture is atypical, skin biopsy for confirmation
- 4Therapy based on the site and the intensity of inflammation
- 5Follow-up: scarring sites are watched more closely than others
Available treatments
- Dermatology visit
- Examination of mucosae and appendages
- Targeted anti-inflammatory therapy
- Scheduled follow-up
Book a visit
Our specialists will evaluate your case and define the most suitable treatment plan.
Book in FlorenceBook in SienaSiena · Firenze
Frequently asked questions
Is it contagious?+
No. Lichen planus is not transmitted from person to person: it is not an infection but an inflammatory reaction of the skin. The question comes up almost every time, because the appearance of the lesions can suggest something catching, and it is worth answering immediately to remove an unnecessary worry.
Do dark marks remain afterwards?+
Often yes, and it is worth knowing so as not to read them as a relapse. When lesions settle they frequently leave post-inflammatory hyperpigmentation, that is, a darker mark at the site: it is not active lichen, it is its aftermath. It tends to fade over time, more slowly in darker skin types, and sun protection helps prevent it becoming more obvious.
I have a white network in my mouth, is it related?+
It may well be, and it is one of the reasons the visit also looks where the patient has reported nothing. Oral lichen has exactly that whitish reticular appearance, often on the lining of the cheeks, and is sometimes the only manifestation. It should be assessed and followed over time: it is one of the sites where periodic review has a precise purpose.
Related reading
Have a question? Let's talk.
Book a first visit: the physician will evaluate your situation and guide you to the most suitable treatment.
Book a dermatology visit