What should you know about verrucous lichen planus?

The plaques are usually raised, firm, scaly, and deeply textured rather than smooth. They may be purple, reddish-brown, or darker than nearby skin, and persistent scratching can make the surface thicker. Verrucous lichen planus can be intensely itchy and may occur alongside other lichen planus patterns on the skin, mouth, nails, or genitals. A dermatologist may examine the whole skin surface and take a small biopsy if the appearance is atypical or does not respond as expected.

Keep nails short, use a bland moisturiser, and avoid scrubbing or picking the plaques. Fragrance-free cleansers and cool compresses may reduce irritation. Treatment is individualised: a clinician may prescribe Topical Corticosteroids for local inflammation or Oral Corticosteroid Treatment for broader or severe disease. Other approaches may be considered when plaques are extensive, recurrent, or resistant. Use medicines exactly as directed because prolonged steroid use can thin skin or cause other local effects.

Arrange a dermatology review for a new thick plaque, rapidly changing area, persistent ulcer, bleeding, pain, or a lesion that fails to heal. Seek advice if itch disrupts sleep, scratching causes open skin, or treatment causes marked burning or skin thinning. Mouth, genital, or nail changes also deserve assessment because lichen planus can affect these sites and may need different care.

Ask whether the diagnosis needs a biopsy, which areas should be checked, how long to use each medicine, and how to reduce scratching. Ask what improvement should look like and when a persistent or changing plaque needs reassessment.