Clinical Description of Lichen Planus on the Right Medial Lower Extremity
Lichen planus on the lower extremity presents as violaceous (purple), polygonal, flat-topped papules and plaques with fine white lines called Wickham striae, typically accompanied by intense pruritus. 1
Primary Morphologic Features
The lesions on the medial lower leg will display these characteristic findings:
- Violaceous (purple-colored) papules and plaques with a distinctive flat-topped appearance and polygonal shape 1, 2
- Wickham striae: Fine, lacy, reticular white lines visible on the surface of lesions, which are pathognomonic for lichen planus and help distinguish it from other papulosquamous conditions 1
- Intense pruritus is the predominant symptom, often severe enough to significantly impact quality of life 1, 2
Location-Specific Considerations for Lower Extremities
The lower extremities, particularly the legs and ankles, are common sites for cutaneous lichen planus:
- Lesions favor flexor surfaces but can occur on any part of the lower leg, including the medial aspect 2, 3
- The distribution may be localized or part of more widespread disease affecting wrists, forearms, and other typical sites 1
Variant Presentations on Lower Extremities
Hypertrophic lichen planus is particularly common on the lower legs and shins:
- Presents as hyperkeratotic, thick, verrucous plaques rather than typical flat-topped papules 4
- These lesions are intensely pruritic and can persist for years 4
- May mimic other conditions such as verrucous lupus erythematosus or chronic eczema 4
Chronic Disease Evolution
In long-standing cases on the lower extremity:
- Lesions may become increasingly hyperkeratotic and plaque-like over time 1
- Post-inflammatory hyperpigmentation commonly develops after resolution, which can be particularly prominent and persistent 5
- Hypopigmented macules may rarely occur, particularly in darker-skinned individuals 6
Key Diagnostic Pitfalls
When examining the medial lower extremity, avoid these common errors:
- Do not confuse with lichen sclerosus: Lichen sclerosus presents with porcelain-white (not violaceous) papules and plaques with ecchymosis, predominantly affects anogenital areas, and lacks Wickham striae 1
- Look for mucosal involvement: Check the oral mucosa for white, reticulated patches on the buccal mucosa, which supports the diagnosis and may indicate more extensive disease 4
- Assess for koebnerization: Lesions may appear in linear patterns following trauma or scratching 5
Associated Findings to Document
Complete your examination by checking: