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

• Atrophic LP

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

• Atrophic Lichen Planus (LP) is an uncommon variant of lichen planus (LP), a medical condition that affects the skin and/or mucosal membranes. Atrophic LP is characterized by slowly growing papules or plaques with atrophied centers, mostly on the legs
• Atrophic Lichen Planus is mostly asymptomatic, and no significant complications are noted. Some cases are known to resolve spontaneously, while others may require treatment using topical steroidal agents and oral medications. The prognosis is generally good in most individuals

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

• Atrophic Lichen Planus is an uncommon skin condition, and the presentation of symptoms may occur at any age
• Both males and females may be affected
• Worldwide, individuals of all racial and ethnic groups may be affected. However, the incidence of the condition is rare

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

• Having had a previous bout of classic lichen planus is a risk factor for Atrophic Lichen Planus
• Currently, no other risk factors have been clearly identified for the condition
• It is also not associated with any medication use

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 Atrophic Lichen Planus? (Etiology)

• Currently, the exact underlying cause of Atrophic Lichen Planus is not well-understood
• Some experts believe that it may be an advanced form of other lichen planus subtypes such as hypertrophic lichen planus

What are the Signs and Symptoms of Atrophic Lichen Planus?

The signs and symptoms of Atrophic Lichen Planus may include the following:

• Presence of papules (elevated skin areas that are well-circumscribed) and plaques (slightly elevated thickened skin areas of varying shapes) 
• These skin lesions are known to appear pale; the papules/plaques may be whitish-blue in color
• The center of the lesions shows atrophied skin tissue
• The involvement of the legs is commonly noted
• Other sites include the chest, back, armpits, and even the glans penis (in males). However, the lesions may develop on any region of the body
• The lesions may occur in areas that were previously affected by classic lichen planus

How is Atrophic Lichen Planus Diagnosed?

Atrophic Lichen Planus is diagnosed on the basis of the following information:

• A thorough physical examination and a complete medical history are very crucial; a dermatologist will carefully examine the lesions to help in the diagnosis
• Dermoscopy: Dermoscopy is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Potassium hydroxide (KOH) test: The KOH prep involves microscopic observation of skin scrapings for structures belonging to fungi
• Skin biopsy: A biopsy of the lesion is usually performed to confirm the diagnosis. A pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed), and microscope findings, the pathologist arrives at a definitive diagnosis. Both routine stains as well as immunofluorescent stains are likely to be done

A differential diagnosis may be necessary to eliminate other conditions that present similar signs and symptoms. These include:

• Discoid lupus erythematosus
• Granuloma annulare (GA)
• Mycosis fungoides/cutaneous T-cell lymphoma
• Sarcoidosis
• Secondary syphilis
• Subacute cutaneous lupus erythematosus (SCLE)
• Tinea infection

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 Atrophic Lichen Planus?

The complications of Atrophic Lichen Planus may include:

• Extensive involvement of skin
• Scarring on the skin causing emotional stress
• Low self-esteem if the lesions or scarring occur on the face or elsewhere on visible parts of the skin
• Treatment resistance
• Complications may occur with or without treatment, and in some cases, due to treatment also

How is Atrophic Lichen Planus Treated?

Some cases of Atrophic Lichen Planus are known to get better over time and resolve completely. If necessary, the following treatment measures may be considered:

• Topical steroids for mild cases
• Oral steroids and other systemic therapies (intramuscular corticosteroids) may be considered for severe cases
• Oral retinoids
• Phototherapy (narrowband UVB)

Regular medical screening at periodic intervals may be recommended.

How can Atrophic Lichen Planus be Prevented?

The cause and risk factors are not clearly identified for Atrophic Lichen Planus. Thus, no methods or guidelines are available presently for its prevention.

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

• In the majority, the prognosis for mild cases of Atrophic Lichen Planus is good since the condition may resolve on its own or with topical steroid treatment
• Severe cases may be managed with topical and oral medications. However, it may take several months for healing to occur

Additional and Relevant Useful Information for Atrophic Lichen Planus:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/skin-disorders/