Mucosal Lichen Planus
Mucosal lichen planus may involve the oral or genital mucosa, or both. The most common form is the non-erosive with a white lacy pattern. The erosive form is painful with beefy desquamation. Oral lesions primarily involve the buccal mucosa and lateral edge of the tongue. This may extend to involve the mucosal lip, but rarely extends beyond the vermillion border. Antibodies to hepatitis C are detected in about 30% of patients with mucosal involvement.
The penis and vulva may be involved. Itching and burning is intense. Also marked erythema and mucosal fragility are common. Secondary candidiasis occurs frequently, likely as a side effect of topical treatment with topical steroids.
Mucosal non-erosive lesions may resemble leukoplakia or candidiasis and penile lesions can be difficult to distinguish from psoriasis papules Erosive lesions should be discerned from pemphigus vulgaris, paraneoplastic pemphigus and a fixed drug eruption.