What are the other Names for this Condition? (Also known as/Synonyms)

• Hypertrophic LP
• Lichen Planus Verrucosus

What is Hypertrophic Lichen Planus? (Definition/Background Information)

• Lichen planus (LP) is a common, benign condition of generally unknown cause affecting the skin and mucus membranes. Classically, lichen planus skin lesions have been described as papular (elevated skin lesions), purple (purplish-red), polygonal (with some straight, not round, edges), and pruritic (itchy) - the “4 P’s”. These can occur anywhere in the body and inside the oral cavity
• Hypertrophic Lichen Planus is characterized by thick skin lesions that occur on the arms and lower legs, particularly around the hands and feet. The main symptom of these lesions is itching. In general, individuals in the 30-60-year age group are affected the most
• The treatment for Hypertrophic Lichen Planus in symptomatic individuals may include the use of topical steroidal creams and moisturizers, immunosuppressive therapy, and photo-chemotherapy. The prognosis of the condition is generally good with suitable management of the same

Who gets Hypertrophic Lichen Planus? (Age and Sex Distribution)

• Hypertrophic Lichen Planus is an uncommon skin condition that is typically seen in young, middle-aged, and older adults in the age group of 30-60 years
• It can affect both males and females, although females are affected more than males
• In general, lichen planus occurs worldwide, and individuals of all racial and ethnic backgrounds may be affected. However, the incidence of hypertrophic pattern of lichen planus is higher in African Americans

What are the Risk Factors for Hypertrophic Lichen Planus? (Predisposing Factors)

• The risk factors for Hypertrophic Lichen Planus are presently unknown or unidentified

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Hypertrophic Lichen Planus? (Etiology)

In a majority of cases, the exact cause of the development of Hypertrophic Lichen Planus having skin involvement is unknown (idiopathic).

• In some cases, abnormal cell-mediated immunity may be the potential cause
• There is no definitive proof that certain types of diet play a role in the formation of this skin condition
• Lichen planus is non-contagious and is not transmitted from one individual to another; one cannot contract the condition through close physical interaction with the affected individuals

What are the Signs and Symptoms of Hypertrophic Lichen Planus?

Generally, the timing of the development of the signs and symptoms is important in ensuring an accurate diagnosis. Lichen planus has a slow onset; it may take days and weeks for the signs and symptoms to develop. Nevertheless, although the skin lesions can be itchy, Hypertrophic Lichen Planus may be asymptomatic in many individuals. After the onset of the condition, the lesions may last many months and, sometimes, even for years.

The signs and symptoms of Hypertrophic Lichen Planus may include:

• The thick skin lesions (plaques) are found on the arms and legs, especially around the hands and feet
• There may be involvement of the nails, which may be malformed
• The size of the lesion may vary from 1 mm to 10 mm
• Chronic itching and scaling of the skin that causes the skin to become thick, discolored, and crusted with keratin build-up

The severity of the condition may vary; it is difficult to predict who gets mild or severe symptoms.

How is Hypertrophic Lichen Planus Diagnosed?

The following are the diagnostic methods and tests that may be used for Hypertrophic Lichen Planus:

• A thorough physical examination and a complete medical history are very crucial. A diagnosis of Hypertrophic Lichen Planus may be arrived at clinically by analyzing the presentations
• Dermoscopy: Dermoscopy is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Skin biopsy: A skin biopsy is performed and sent to a laboratory for a pathological examination, for examination under a microscope. After putting together clinical findings, special studies on tissues (if needed), and microscope findings, the pathologist arrives at a definitive diagnosis. A skin biopsy is performed to rule out other similar conditions
• A differential diagnosis may be considered to eliminate the following conditions:
  • Lichen simplex chronicus (LSC)
  • Kaposi’s sarcoma
  • Severe cases of psoriasis
  • Prurigo nodularis (PN)

Note: In most cases, based on the signs and symptoms, a diagnosis can be made by the dermatologist through a physical examination without a skin biopsy.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Hypertrophic Lichen Planus?

The complications of Hypertrophic Lichen Planus may include:

• Bacterial and fungal infections: The condition may cause continuous itching and scaling of the skin, which creates skin moistness, providing a suitable environment for bacteria and fungi to grow and thrive
• Rarely, squamous cell carcinoma can develop from the lesions
• The lesions can last for years resulting in self-image issues, emotional stress, and psychological trauma in some individuals
• If the emotional stress is severe, it may even lead to depression and social isolation

How is Hypertrophic Lichen Planus Treated?

In some individuals, lichen planus is a self-limiting disorder that can resolve without treatment. If the symptoms are mild, simple treatment with topical steroids and other topicals may be all that is required. The treatment strategies that may be adopted in the management of Hypertrophic Lichen Planus for those with significant signs and symptoms include:

• Use of topical corticosteroid creams and lotions
• Oral steroids are helpful in individuals with severe itching and cosmetic issues
• Immunosuppressive therapy, such as using cyclosporine, when the condition does not respond to steroidal treatments
• Photochemotherapy (PUVA, using oral Psoralens and UVA light) can be used in generalized Hypertrophic Lichen Planus and those that do not respond to medications
• For severe cases, systemic retinoids may be tried
• Surgical excision with skin grafts may be required in some cases
• Providing reassurance and helping with feelings of stress and anxiety
• Follow-up care with regular screening and checkups is important since the condition can last for many months and years

Note: If any of the prescribed treatment medications or methods cause new stinging or burning symptoms, then it is important to discontinue the medication or method and immediately inform the healthcare provider.

• For those with mild skin conditions, self-care measures are recommended, such as washing with mild (antibacterial) soap and applying a warm compress

A few self-care tips and home remedies for Hypertrophic Lichen Planus include:

• Completely avoid scratching the affected areas
• A comfortable, cool bath may help soothe the skin; but avoid excessive washing and scrubbing of the skin
• Wear smooth cotton clothes
• Use only mild perfumes, soaps, and detergents

How can Hypertrophic Lichen Planus be Prevented?

• Currently, there are no specific methods or guidelines available to prevent Hypertrophic Lichen Planus
• A careful and periodic monitoring or follow-up of the condition is recommended

What is the Prognosis of Hypertrophic Lichen Planus? (Outcomes/Resolutions)

• Hypertrophic Lichen Planus may be asymptomatic in some individuals. Such individuals do not require any treatment; providing reassurance (for emotional issues) and maintaining periodic observance by the healthcare provider may be sufficient treatment
• There is no established cure for Hypertrophic Lichen Planus. However, some individuals are known to have mild symptoms, and the condition may spontaneously get better without any treatment. The lesions may completely disappear over time. The prognosis of the condition is excellent in such cases
• In some individuals, the symptoms may appear, subside, and then recur with time. Ulcerative lesions are generally difficult to treat. In such cases, symptomatic treatment may be provided to improve one’s quality of life
• Individuals with milder signs and symptoms have a better prognosis than those with severe signs and symptoms
• Regular follow-up visits with the healthcare providers are important

Additional and Relevant Useful Information for Hypertrophic Lichen Planus:

• It has not been observed that dietary factors, such as oily foods and chocolate-based products, contribute to Hypertrophic Lichen Planus development
• Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken to avoid strong soaps and chemicals that could potentially worsen the condition
• The presence of dirt on the body does not cause the condition. However, it helps to be clean and hygienic, which will help prevent the condition from getting worse