Lichen planus atrophicans L43.81

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 16.02.2023

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atrophic lichen planus; lichen atrophique; Lichen plan sclèreux

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Normally, lichn ruber heals without consequences. A rare variant of lichn ruber (<1% of all lichn ruber cases) is characterized by severe vacuolated epithelial atrophy, possibly with focal hyperpigmentation. These cases tend to show an extensive pattern of lesions caused by confluence of the lesions (see Fig.). Preferably, the lower legs and feet are affected. In rare cases, atrophic healing stages can be observed even in longstanding classic lichen ruber.

In particular, however, anular lichen ru ber tends to central atrophy of the lesions.

Atrophy as a consequence of healing can also be observed in bullous lichen ruber.

Atrophies are also observed in lichen ruber infestation of the nails up to complete loss of the nails.

Furthermore, lichen ruber follicularis leads to follicular atrophy and focal hair loss at the capillitium.

Clinical features
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Mostly few, centrally sunken, 0.2-0.5 cm, but also confluent into larger anular plaques, brownish, occasionally bluish lesions with atrophic parchment-like surface. Loss of hair and follicular ostia.

Graham-Littlesyndrome: An enormously chronic variant of lichen ruber follicularis with follicular, acute keratotic lesions on the trunk, the typical clinical and histologic signs of lichen ruber, and (lymphocytic) scarring alopecia (lichen ruber follicularis capillitii) and scarring nail dystrophy is called Graham-Little syndrome.

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Image of lichen ruber. The infiltrate is usually rather sparse. The epithelium is atrophic with striae.

Differential diagnosis
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According to the Lichen planus.

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  1. Arduino PG et al (2014) Pimecrolimus vs. tacrolimus for the topicaltreatment
    of unresponsive oral erosive lichen planus: a 8 week randomizeddouble-blind
    controlled study.J Eur Acad Dermatol Venereol 28:475-482

  2. Li B et al (2010) Annular atrophic lichen planus. Eur J Dermatol 20:842-843

  3. Pandhi D et al. (2014) Lichen planus in childhood: a series of 316 patients.
    Pediatric dermatol 31: 59-67.

  4. Sugashima Y et al. (2012) Annular atrophic lichen planus of the lip. Dermatol Online J 18:14


Please ask your physician for a reliable diagnosis. This website is only meant as a reference.


Last updated on: 16.02.2023