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Distinguishing Features of LPLK vs Lichen Planus

Int J Dermatol; ePub 2018 Dec 18; Vincek

Clinicopathologic correlation is necessary to diagnose lichen planus‐like keratosis (LPLK), as the most consistent feature is a clinical history of a lesion/neoplastic process rather than an inflammatory process. This according to a recent study that sought to investigate the clinical and histopathological characteristics of LPLK. There are histopathologic features that can help distinguish lichen planus‐like keratosis from lichen planus; however, these features are nonspecific and lacking in almost half of the cases. A clinicopathologic review was performed of all LPLK cases (1366) signed in 1 calendar year in a busy academic practice. Researchers found:

  • LPLK occurs mostly as a single lesion (97%) with the chest (41.4%) being the most common site.
  • It is almost equally present in women and men (51.5%–48.5%).
  • The most common clinical concern (65%) is basal cell carcinoma.
  • Parakeratosis, red blood extravasation, and presence of dermal eosinophils and plasma cells, usually not seen in lichen planus, are helpful signs to suggest LPLK but are seen only in a minority of cases.


Vincek V. Lichen planus‐like keratosis: Clinicopathological evaluation of 1366 cases. [Published online ahead of print December 18, 2018]. Int J Dermatol. doi:10.1111/ijd.14358.