If you’ve ever been ambushed by a seemingly benign rash during rounds and thought, “Huh, maybe it’s eczema?”, and then the derm resident rolls in saying “Classic lichen planus!” — welcome to the club. 🎓
Dermatology: where conditions rhyme, all look vaguely similar, and require more pattern recognition than a radiologist on Red Bull.
Thankfully, Lichen Planus is one of the few skin conditions that gives us a mnemonic on a silver platter — the 6 P’s.
Let’s break it down:
The 6 P’s of Lichen Planus: “6 P’s”
| P | Meaning | Clinical Pearls |
|---|---|---|
| Purple | Violaceous lesions | That classic violaceous hue — like bruises trying to be artistic. 🎨 |
| Polygonal | Angulated borders | Geometrically gifted. These aren’t your average nondescript papules. 📐 |
| Planar | Flat-topped | Not scaly like psoriasis — more like someone sanded them smooth. 🧱 |
| Papular | Small, raised lesions | Papules usually grouped and often itchy enough to make you question your humanity. |
| Pruritic | Very itchy | Pruritus that’s out of proportion to size. Ask anyone who’s scratched till they bled. 🥵 |
| Plaques | May coalesce into larger plaques | Especially on wrists, shins, or oral mucosa. Check the mouth — you’ll thank me. 👅 |
🩺 Seen in Clinic: From Mashkay, Balochistan
A 42-year-old schoolteacher from Mashkay came to my OPD with intensely itchy, purplish lesions on his flexor wrists and shins.
Dr. Basit Khan casually muttered, “Looks like LP.” I did the oral exam — classic Wickham striae on buccal mucosa. Skin biopsy confirmed the suspicion.
And yes, it was lichen planus — not the “fancy fungal rash” the local clinic had been treating with terbinafine for 3 months. 😑
I’ve seen patients from Awaran, Naushki, and even Pishin travel hundreds of kilometers for chronic skin itching that no local clinic could explain. One of them had erosive oral lichen planus — couldn’t eat roti without burning pain. We started systemic steroids, and within weeks, he messaged: “Doctor sahib, roti is no longer my enemy.” 😄
I hope that you find this medical useful in your studies/clinical practice. Happy learning! 🙂
Authored by:
Dr. Aurangzaib Qambrani
MBBS | PLAB | MRCP-UK
General Medicine, Gastroenterology & CCU
Sheikh Khalifa Bin Zayed Hospital, Quetta 🏥
