Palmar lichen planus: what to know

Lichen planus is an inflammatory skin condition that can affect the palms with firm bumps, thicker plaques, scale, fissures, or tenderness. Palmar skin may not show the same purple tone seen elsewhere, so the surface and symptoms matter. Look for itch, pain with gripping, involvement of the wrists, ankles, legs, nails, scalp, mouth, or genital skin, and any new medicines or exposures. Other causes of palm bumps or thickening can look similar. A dermatologist may use the examination and, when needed, a small skin sample to distinguish them.

Use a fragrance-free cleanser, moisturise fissures with a plain ointment, and protect the hands from detergents and friction with suitable gloves. Keep nails short to limit injury from scratching, but do not cut or file plaques aggressively. Treatment depends on severity and location; a clinician may prescribe Topical Corticosteroids, and more extensive or resistant disease may lead to discussion of Oral Corticosteroid Treatment or another option. Use prescribed treatment exactly as directed and report worsening irritation, pain, or new mouth or nail symptoms.

Arrange an appointment for new palm bumps, persistent itch, thickening, painful cracks, or a rash that interferes with walking, gripping, or sleep. Seek prompt care for spreading redness, warmth, swelling, pus, or fever around broken skin. Ask for timely assessment if the mouth, eyes, genitals, nails, or scalp become involved. Urgent help is needed for facial swelling, breathing difficulty, or a rapidly widespread blistering reaction.

Could this be palmar lichen planus or another cause of bumps and thickening? Would examination or a skin sample help? Which topical treatment is suitable, how long should it be used, and what symptoms would warrant a review or a broader treatment?