Skin Patient history and clinical presentation need to be taken to diagnose<unk> . Patient with suspected cutaneous<unk>  needs to be evaluated clinically through patient interview and physical examination. Patients should be questioned about their medication history, any history of pruritus or genital pain and history of dysphagia or odynophagia. Examination of entire cutaneous surface including the scalp, oral cavity and external genitalia need to be included. Wickham's striae often can be seen during microscopic examination of cutaneous lesions of<unk> . To confirm the diagnosis of cutaneous<unk> , a skin biopsy can be done. A punch biopsy of sufficient depth to the mid dermis is usually significant. Immunofluorescence studies are not always needed. Direct immunofluorescence (DIF) can be useful in patients with bullous lesions to differentiate the condition from an autoimmune vesiculobullous disease. Mouth A diagnosis of oral<unk>  <unk>  is confirmed through review of the patient history, physical examination, and histologic findings. The clinical evaluation should include a patient history that assesses the following: * History of<unk>  involving other body sites or other skin disorders that may present with similar findings (e.g., autoimmune blistering diseases) * Presence of associated symptoms (e.g., pain, burning) * Medication the patients are taking within the few weeks to months after drug initiation e.g. antihypertensives, antidepressants, diuretics, antidiabetics, NSAIDs, etc. to evaluate for the possibility of an oral lichenoid drug eruption * History of dental restorations, use of dental appliances, or oral exposure to substances that may cause oral lichenoid contact eruptions (e.g. dental composites, cobalt chromium based dentures etc.) A full examination that includes the evaluation of the mucosal and cutaneous surfaces, including the vulva, vagina, penis, scalp, and nails should be performed. Thorough examination may lead to the detection of extraoral manifestations of<unk>  that provide additional support for the diagnosis or the identification of clinical findings that suggest another diagnosis. Tissue biopsies of oral<unk>  help to confirm the diagnosis and are particularly of value for erythematous and erosive<unk> , which share features with multiple other mucosal disorders, including oral malignancy. Biopsies to confirm oral<unk>  are less essential in patients who present with classic reticular<unk> , particularly in patients in whom a diagnosis of<unk>  has already been confirmed through biopsy of an extraoral manifestation of this disorder. Differential diagnosis Skin # Lichenoid drug eruption #* The cutaneous manifestations resemble idiopathic<unk> . # Chronic graft-versus-host disease #* The history of preceding hematopoietic cell transplant is helpful for diagnosis # Psoriasis # Atopic dermatitis # Cutaneous lupus erythematosus # Discoid lupus erythematosus Mouth Oral lichenoid drug reaction Lichenoid drug eruptions may be caused by a variety of systemic medications and share clinical features with oral<unk> . Histologic findings of a deep mixed infiltrate with lymphocytes, plasma cells, and neutrophils (with or without eosinophils) and perivascular inflammation favor this diagnosis. Oral lichenoid contact reaction (allergic contact mucositis) Oral lichenoid contact reactions may be caused by a variety of substances. The clinical and histologic features of oral lichenoid contact reactions are similar to oral<unk> . Patch testing and recognition of the proximity of an offending substance to the eruption can aid with diagnosis. Autoimmune blistering diseases Mucous membrane pemphigoid and other autoimmune blistering diseases may present with oral erosions and desquamative gingivitis similar to that seen in erosive<unk> . Biopsies for routine histologic examination and direct immunofluorescence are useful for distinguishing these disorders from oral<unk> . Graft-versus-host disease (GVHD) Lacy, reticulated plaques or erosions that resemble oral<unk>  may occur in GVHD. The histologic findings of these disorders are also similar. The patient history is useful for differentiating chronic GVHD from oral<unk> . Oral involvement in acute GVHD is less well characterized than chronic GVHD, but has been associated with erythematous, erosive, ulcerative, or lichenoid oral lesions. Leukoplakia Leukoplakia Leukoplakia is a manifestation of squamous epithelial hyperplasia that may be a precursor to oral squamous cell carcinoma. White patches or plaques usually appear on the oral mucosa. To rule out malignancy, a biopsy of leukoplakia is indicated. Oral squamous cell carcinoma Oral squamous cell carcinoma (SCC) can present as erythematous or white patches, ulcers, or exophytic masses. The highest risk for oral SCC may occur in patients with erythematous or erosive oral<unk> . A biopsy is indicated. Leukoedema Leukoedema is a common, benign finding in the oral cavity that presents as white-gray, somewhat translucent plaques on the mucosa. The buccal mucosa is the most common site for involvement. Symptoms are absent, and no treatment is necessary. Oropharyngeal candidiasis Oropharyngeal candidiasis (also known as thrush) is a common infection that has a predilection for infants, older adults with dentures, immunosuppressed individuals, and individuals utilizing intraoral corticosteroid therapy. Patients present with white plaques or erythematous patches on the buccal mucosa, palate, tongue, or oropharynx that may be mistaken for reticular<unk> . Histopathology Histopathology of<unk>  The histologic findings of oral<unk>  can offer strong support for the diagnosis, but are not pathognomonic. Clinical correlation is required. Common histologic findings of oral<unk>  include: *Parakeratosis and slight acanthosis of the epithelium * Saw-toothed rete ridges * Liquefaction (hydropic) degeneration of the basal layer with apoptotic keratinocytes (referred to as Civatte, colloid, hyaline, or cytoid bodies) * An amorphous band of eosinophilic material at the basement membrane composed of fibrin or fibrinogen. * A lichenoid (band-like) lymphocytic infiltrate immediately subjacent to the epithelium.
Lichen planus
Geographic tongue
Lichen nitidus
Leukoplakia
Lichen simplex chronicus
Lichen myxedematosus
Lichen sclerosus
Tinea barbae