Cutaneous lichen planus is often only part of the disease. Mucosal and nail involvement changes treatment and follow-up, and a lichenoid drug eruption will not settle until the drug stops.
Examine the mouth for white reticular striae or erosions, ask about genital soreness or dyspareunia, and look at the nails and scalp. Review the medication list for common culprits: antihypertensives such as beta-blockers and ACE inhibitors, thiazides, antimalarials, NSAIDs and checkpoint inhibitors. Hepatitis C testing is reasonable where local prevalence or risk factors warrant it.
- Examine the oral mucosa for striae and erosions
- Ask directly about genital symptoms
- Check nails for ridging, thinning or pterygium, and the scalp for scarring
- Review recent drug starts for a lichenoid eruption
- Arrange long-term oral review for erosive disease because of the small cancer risk
Why it matters
Missed mucosal or scarring disease changes both treatment and follow-up.
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