Lichen planus of anogenital region: clinical spectrum and approaches to therapy

Lichen planus is among the most common chronic anogenital noninfectious dermatoses both in male and female. The disease is characterized by clinical polymorphism, frequent involvement of skin and oral mucosa and protracted course. Typical, hypertrophic and erosive forms are distinguished. Erosive variant is commonly encountered in women and has a prominent tendency for scarring. The most common anogenital form in men is the typical lichen planus, which usually resolves completely. Vulvovagino-gingival and penogingival lichen planus are rare severe disease forms. Evolutional and biological heterogeny of clinical manifestations complicates the disease diagnosis. Lichen planus pathogenesis remains unclear. Pronounced scarring tendency in anogenital cases is believed to be the consequence of epithelial-mesenchimal transition. High-quality clinical trials of various therapeutic modalities in anogenital lichen planus are lacking. Management of such patients is mostly based on case series reports, practical experience and general principles of dermatologic treatment. This review focuses on contemporary views on clinical presentation, pathogenesis, diagnosis and approach to therapy of anogenital lichen planus.