Lichen planus often involves several sites at once, and patients rarely volunteer oral or genital symptoms when they come with a rash on the wrists or shins. Ask about soreness with spicy food, gum bleeding, vulval or penile soreness, and painful intercourse. Examine the buccal mucosa, tongue, gums and lips, and offer genital examination with a chaperone. Erosive disease at either site is the form most linked to scarring and to later cancer, so record its extent with a photograph or diagram as a baseline.
- Ask directly about oral and genital symptoms in every patient with lichen planus
- Examine the buccal mucosa, tongue, gums and lips
- Offer genital examination with a chaperone
- Record erosive areas with a photograph or diagram as a baseline
Why it matters
Mucosal lichen planus is easily missed when the presenting complaint is skin.
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