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Health condition · Clinically reviewed

Lichen planus, from itchy skin papules to oral, genital and scalp disease.

An inflammatory condition that can show up in more than one place at once. Recognising the pattern early makes treatment - and surveillance where it matters - much more effective.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against British Association of Dermatologists (BAD) guidance and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK dermatology practice, including topical, systemic and oral medicine pathways for lichen planus.

Key facts

Lichen planus at a glance.

The essentials, in plain English - what it is, where it shows up, and how it’s confirmed and treated in the UK today.

  • What it is

    A T-cell mediated inflammatory dermatosis - immune cells attack the basal layer of skin, mucosa, nails or hair follicles.

  • Sites affected

    Skin, mouth, genitals, nails and scalp - each with its own pattern and its own treatment emphasis.

  • Classic skin sign

    Purple, polygonal, itchy papules with fine white lines called Wickham striae, typically on the wrists, ankles and lower back.

  • Cause

    Unknown in most cases - thought to be autoimmune, with links to hepatitis C and certain drugs in a minority.

  • Confirming it

    Usually clinical - a skin or mucosal biopsy is used when the picture is atypical or malignancy needs excluding.

  • Outlook

    Cutaneous lichen planus often settles within one to two years; oral, genital and scalp forms tend to be more persistent.

Why this guide matters

One condition, several very different faces.

Lichen planus doesn’t behave the same way in every patient. Where it turns up changes what to watch for and how urgently it needs treating.

  • Site changes the stakes

    Itchy skin papules are uncomfortable but usually self-limiting; erosive oral, genital and scalp disease can scar or need cancer surveillance.

  • A biopsy settles uncertainty

    The saw-tooth pattern and band-like infiltrate on biopsy confirm the diagnosis and rule out mimics, including lichenoid drug reactions.

  • Treatment is stepped, not one-size

    Topical steroids come first almost everywhere - phototherapy, systemic agents and specialist surveillance are added where the disease demands it.

How the diagnosis is made

From first papules to a confirmed plan.

The steps a UK GP or dermatologist will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    Clinical examination

    A dermatologist looks for the characteristic purple, polygonal papules with Wickham striae and asks about itch, onset and any new medicines.

  2. 02

    Assessing

    Site-by-site mapping

    Skin, mouth, genitals, nails and scalp are each checked, since lichen planus rarely stays confined to just one area.

  3. 03

    Confirming

    Skin biopsy

    A punch biopsy shows the classic saw-tooth rete ridges and a band-like lymphocytic infiltrate at the dermo-epidermal junction, reviewed by a specialist dermatopathologist.

  4. 04

    Confirming

    Oral or genital biopsy if atypical

    Erosive oral or genital lesions, or anything that looks unusual, are biopsied to exclude malignancy and confirm the diagnosis with specialist oral medicine or gynaecology input.

  5. 05

    Confirming

    Medication review

    Gold, antimalarials, NSAIDs and ACE inhibitors can trigger a lichenoid drug eruption that mimics lichen planus, so current and recent medicines are reviewed carefully.

  6. 06

    Planning

    Selective hepatitis C screening

    Blood testing for hepatitis C is considered in certain patients, particularly with oral or widespread cutaneous disease, given the recognised association.

  7. 07

    Planning

    Surveillance planning

    Erosive oral lichen planus carries a small malignancy risk, so a specialist annual review and photographic monitoring plan is agreed from the outset.

Typical timeline: clinical diagnosis in one visit, biopsy results within one to two weeks.

Symptoms

What lichen planus actually looks like.

The classic purple papules on skin, and the very different patterns it takes in the mouth, genitals, nails and scalp.

  • Cutaneous lichen planus

    Purple, violaceous, polygonal papules with fine white Wickham striae - intensely itchy, typically on wrists, ankles and the lower back.

  • Oral lichen planus

    A white, lace-like reticular pattern inside the cheeks - the erosive form causes painful ulceration and needs malignancy surveillance.

  • Genital lichen planus

    Vulval or penile involvement, sometimes overlapping with lichen sclerosus, causing soreness, scarring or painful intercourse.

  • Nail lichen planus

    Longitudinal ridging, thinning and, in severe cases, pterygium - permanent scarring where the cuticle fuses to the nail bed.

  • Lichen planopilaris (scalp)

    A scarring alopecia of the scalp with redness and scaling around hair follicles - needs early specialist dermatology input to limit permanent hair loss.

  • Lichenoid drug eruption

    A near-identical rash triggered by gold, antimalarials, NSAIDs or ACE inhibitors - settles once the drug is identified and stopped.

  • Itch and Koebner phenomenon

    Itch can be severe, and new lesions often appear along scratch marks or sites of skin trauma - a useful clinical clue.

  • Red flag - erosive oral disease

    Persistent oral ulceration or any suspicious white or red patch deserves biopsy and ongoing surveillance for oral cancer risk.

Treatment

How lichen planus is treated in the UK.

Topical corticosteroids first, with phototherapy, systemic agents and site-specific surveillance built in where the disease needs it - a multidisciplinary specialist approach.

  • Potent topical corticosteroid

    First-line for most cutaneous, oral and genital lichen planus - specialist dermatology guides potency, site and duration.

  • Topical calcineurin inhibitor

    Tacrolimus ointment for oral or genital lichen planus - useful where long-term steroid use on delicate mucosa needs to be limited.

  • Intralesional corticosteroid

    Injected directly into localised, treatment-resistant plaques or hypertrophic lesions under specialist dermatology care.

  • Narrowband UVB phototherapy

    For widespread cutaneous disease that has not responded to topical treatment - delivered under specialist dermatology supervision.

  • Short-course oral corticosteroid

    Reserved for severe, widespread or rapidly progressive disease, prescribed and monitored by a specialist.

  • Acitretin, methotrexate or ciclosporin

    Systemic options for refractory disease, used through specialist-commissioned dermatology pathways with appropriate monitoring.

  • Oral lichen planus care package

    Topical steroid mouthwash or gel, meticulous dental hygiene and annual specialist oral medicine review for malignancy surveillance.

  • Hydroxychloroquine

    A selective option in certain presentations, particularly some cutaneous and lichen planopilaris cases, under specialist direction.

A note on the team involved

Lichen planus is often managed by more than one specialist.

Depending on the site affected, a specialist dermatology team may work alongside specialist oral medicine, gynaecology or dental colleagues - particularly for erosive oral or genital disease, where BAD-aligned multidisciplinary care is the standard.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or dermatologist knows your skin, mouth and history, and can tell you which parts apply to you. If in doubt, get seen.

  • British Association of Dermatologists (BAD). Patient information leaflet on lichen planus.

  • British Association of Dermatologists (BAD). Guidance on lichen planopilaris and scarring alopecia.

  • British Society for Oral Medicine. Guidance on oral lichen planus and malignancy surveillance.

  • NHS. Lichen planus overview and treatment pathways.

Red flags

When lichen planus needs urgent attention.

Most lichen planus is manageable with routine specialist care. These are the situations that deserve a faster or more careful response.

  • Erosive oral lichen planus

    Painful, non-healing ulceration inside the mouth carries a small but real malignancy risk and needs specialist oral medicine surveillance.

  • New or changing oral white or red patch

    Any patch that looks different from the usual reticular pattern, or that fails to settle, should be biopsied promptly.

  • Rapidly progressive scalp scarring

    Lichen planopilaris can cause irreversible hair loss - early specialist dermatology referral limits permanent damage.

  • Nail pterygium forming

    Progressive nail changes with early pterygium signal a window to intervene before permanent nail destruction.

  • Widespread, rapidly spreading rash

    Extensive or fast-progressing cutaneous disease, or signs of a severe drug reaction, warrants urgent dermatology assessment.

  • Genital scarring or painful sex

    Progressive vulval or penile scarring needs prompt specialist review to limit long-term architectural change.

  • Suspected drug-induced lichenoid eruption

    A new rash appearing after starting gold, an antimalarial, an NSAID or an ACE inhibitor should prompt a medication review with your prescriber.

  • Unexplained deranged liver function

    Given the recognised hepatitis C association, unexplained abnormal liver blood tests alongside lichen planus merit further investigation.

  • Severe, unremitting itch

    Itch that disrupts sleep or daily life despite treatment deserves a specialist review of the overall management plan.

Living with it

A manageable condition, with the right rhythm.

Four things that make the biggest difference day to day - protecting the skin from trauma, oral hygiene, patience with a variable course, and keeping surveillance appointments.

A quiet reminder

Different sites, different timelines - both are normal.

Skin lesions may fade within a year or two while oral or scalp disease lingers - that difference doesn’t mean treatment has failed.

  1. 01 Skin

    Avoid trauma to affected skin

    New lesions can appear at sites of scratching or injury (the Koebner phenomenon) - gentle skincare and short nails help reduce flares.

  2. 02 Mouth

    Keep up meticulous oral hygiene

    Gentle brushing, alcohol-free mouthwash and regular dental review reduce irritation and support healing of oral lesions.

  3. 03 Patience

    Expect a slow, variable course

    Cutaneous lichen planus often settles within one to two years, but oral, genital and scalp forms can persist and need ongoing management.

  4. 04 Review

    Keep surveillance appointments

    Annual specialist review for erosive oral disease and scarring forms catches problems early - don’t let follow-up lapse.

Frequently asked

Everything we get asked about lichen planus.

Quick answers on causes, oral and genital involvement, hair loss risk and treatment.

  • What is lichen planus?

    A T-cell mediated inflammatory condition in which immune cells attack the skin, mouth, genitals, nails or scalp. It causes itchy purple papules on the skin, a white lace-like pattern in the mouth, and can affect several sites at once.

  • What causes lichen planus?

    The exact cause is unknown, but it is thought to be autoimmune. A minority of cases are linked to hepatitis C infection or triggered by drugs such as gold, antimalarials, NSAIDs and ACE inhibitors - this is called a lichenoid drug eruption.

  • Is oral lichen planus a cause for concern?

    The reticular, lace-like form is usually harmless, but the erosive form is painful and carries a small increased risk of oral cancer over time. This is why specialists recommend annual review and biopsy of any atypical or non-healing area, and it is worth comparing against conditions like leukoplakia if a white patch looks unusual.

  • Can lichen planus affect the genitals?

    Yes - genital lichen planus can affect the vulva or penis, sometimes overlapping in appearance with lichen sclerosus. It can cause soreness, scarring and discomfort during intercourse, and specialist assessment helps tell the two conditions apart.

  • Does lichen planus cause permanent hair loss?

    It can, when it affects the scalp - a form called lichen planopilaris, which is a scarring alopecia. Early specialist dermatology treatment is important because hair loss from scarring is usually permanent once it has happened.

  • How is lichen planus treated?

    Potent topical corticosteroids are first-line for most cutaneous, oral and genital disease. Other options include topical calcineurin inhibitors, intralesional steroid injections, narrowband UVB phototherapy, and systemic treatments such as acitretin, methotrexate or ciclosporin for resistant cases - all guided by specialist dermatology.

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