I. Pathophysiology and clinical features

  1. A dermatologic condition with onset most common in middle age

  2. Unknown etiology, possibly immune-mediated; associated with certain drugs including beta-blockers, ACEIs, NSAIDs, sulfonylureas, and other drugs.

  3. Possible association with hepatitis C virus based on prevalence studies

  4. Vulvar involvement may be associated with increased risk of malignancy

  5. Typically remits after 1-2y (except oral, which is often chronic)

  6. Typically affects skin (especially flexor surfaces of wrists), nails (onychodystrophy or nail loss), mucous membranes (in 30-70% of pts; can include painful ulcerations), and genitalia (penile glans or vulva)

  7. Usual appearance is shiny, flat, polygonal, purplish papules or placques, often with white lacelike patterns ("Wickham's striae")

  8. Often pruritic; painful when erode or ulcerate

  9. In pts with the condition, often get lesions in areas of trauma inc. scratching ("Koebner reaction")

  10. Post-inflammatory hyperpigmentation can occur after healing

II. Diagnosis

  1. Usually by biopsy

  2. Differential dx includes graft-vs-host reactions and secondary syphilis.

III. Treatment:

  1. There are not many well-controlled trials; topical corticosteroids have been shown to be effective forboth oral and skin lesions.