Cutaneous lichen planus often has mucosal involvement that the patient has not mentioned. Examine the oral mucosa for white lacy striae or erosions, and ask about genital soreness or dyspareunia, since erosive genital disease can scar. Consider hepatitis C testing where risk factors or local prevalence warrant it, as the association is well recognised. Erosive oral or genital lichen planus needs longer follow-up because of a small risk of squamous cell carcinoma.
- Examine the oral mucosa in every patient with cutaneous lichen planus.
- Ask directly about genital soreness, discharge or pain with intercourse.
- Consider hepatitis C testing where risk factors or local prevalence warrant it.
- Arrange long-term follow-up for erosive mucosal disease.
Why it matters
Mucosal disease is where lichen planus scars and, rarely, turns malignant, and it is easily missed when the skin is the presenting complaint.
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