The following symptoms and complaints may indicate lichen ruber planus:
- Flat, mostly polygonal, reddish-purple papules (nodules) that are noticeably itchy
- Papules can be arranged in larger groups and sometimes confluent (flow together) to form plaques (areal or plate-like substance proliferation of the skin)
- Papules show a surface reflection when light is incident from the side
- The whitish reticulation (reticular hyperkeratosis) on the papules of lichen ruber planus is called “Wickham’s drawing” (Wickham’s streak).
- Occurrence of Köbner’s phenomenon: In Köbner’s phenomenon, a non-specific skin irritation (e.g., scratching) triggers the skin symptoms that already exist due to a skin disease in another part of the body.
- Derby, yellowish, hyperkeratotic plaques, on the edges with red margins on the palms and soles, including the lateral edges.
- Pruritus (itching) – almost always, sometimes very intense.
According to the distribution pattern, lichen ruber planus can be divided as follows:
- Lichen planus exanthematicus (generalized lichen planus).
- Localized lichen planus, e.g.:
- Lichen planopilaris (lichen of the hairy scalp).
- Lichen ruber acuminatus (affection of the hairy skin areas with mild itching and exanthema/rash).
- Lichen ruber follicularis capillitii (infestation of the scalp with a scarring alopecia / hair loss).
- Lichen ruber verrucosus (on the lower legs nodular, large foci with a tendency to scarring).
- Erythrodermic lichen planus
- Lichen planus linearis (Lichen planus striatus)
- Inverse LP – inverse form with affection of the flexures or intertriginous (areas of the body surface where opposite skin surfaces touch).
- Lichen planus mucosae (lichen planus of the mucosa); occurrence in more than 50% of patients; clinical picture: symmetrical, reticular or nummular (“coin-shaped”) white plaques, also disseminated (“scattered”), 0.1 cm white papules of the buccal mucosa and / or tongue and / or gingiva (oral mucosa).
- Lichen planus genitalis (genital lichen planus; see also below Lichen planus vulvae/Lichen ruber planus of the vagina): here whitish, but also red or erosive plaques; often with erosions (skin defect) at the introitus vaginae (vaginal entrance).
- Lichen planus of the nails (lichen unguis).
Localization
- Flexor sides of wrists and forearms, lower back, knee bends and lower legs, lateral ankle area of ankles.
- Mucous membranes (30-40% of cases): lichen ruber mucosae (considered a precancerous lesion/tissue that transforms into tumor tissue facultatively or obligatorily if it persists for a long time).
- Isolated on the mucous membranes (25% of cases).
- Skin and mucous membranes (20%).
- Isolated to the skin (10%)
- Nails (10% of cases)
- Capillitium (hairy scalp): here Lichen planus follicularis capillitii.
Mnemonic: itchy wrists, think of lichen ruber planus.
