Early, scattered lesions of lichen planus. More developed and extensive lesions may mimic discoid lupus, psoriasis or secondary syphilis. The flexor surfaces of the extremities, particularly the wrists, are common locations for lichen planus. Another clue to the diagnosis is that lesions may occur in areas exposed to trauma, such as lacerations. This tendency is known as an isomorphic response, or Koebner's phenomenon.
Lesions often resolve with intense hyperpigmentation.
While some patients may be asymptomatic, most experience intense pruritus, a hallmark of lichen planus. In vesiculobullous lichen planus, patients exhibit blisters within the plaques, while the actinic type of lichen planus occurs on sun-exposed areas of skin. Hypertrophic lichen planus on the anterior surface of the leg. While lichen planus often occurs only on cutaneous surfaces, it may also involve the oral mucosa, the genital mucosa, the nails and the scalp. Moreover, these areas may be exclusively involved.