What should you know about familial bullous lichen planus?

Lichen planus can produce itchy, flat or raised bumps with a purple, reddish, or brown tone. In a bullous pattern, fluid-filled blisters may develop over or near these lesions and can break to leave tender erosions or crust. The mouth, genitals, nails, or scalp may also be involved in lichen planus, so mention symptoms outside the original rash. A family history may support the diagnosis, but blistering skin conditions can look alike. Examination and sometimes a skin sample help identify the cause.

Keep nails short, use fragrance-free moisturiser, and avoid scratching, friction, and hot water. Do not puncture blisters at home; protect an open area with a clean, non-stick dressing and follow clinical wound-care advice. Topical corticosteroids may calm local inflammation, while oral corticosteroid treatment may be discussed when disease is extensive or difficult to control. Treatment should be supervised because the affected sites and blistering pattern influence the safest plan.

Seek prompt medical care for rapidly spreading blisters, painful open skin, fever, pus, or difficulty eating, drinking, urinating, or breathing. New eye symptoms need urgent assessment. Arrange dermatology review for persistent itchy bumps, recurrent blistering, or lesions in the mouth or genital area, even when relatives have a similar condition.

Could this be bullous lichen planus or another blistering disorder? Is a skin sample needed? Which areas should I protect? How should I use a topical or oral treatment, and what signs suggest infection?