Lichen planus associated with chronic active hepatitis C

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Lichen planus is characterized by flat-topped violaceous pruritic papules with a generalized distribution.

We present the case of a 36-year-old patient diagnosed with chronic active hepatitis C 5 years ago, that associates lichen planus lesions. By inspecting the lower limbs, we observed multiple skin lesions, causing severe itching. These appeared purplish-coloured, with white streaks over and flat tops more pronounced in the lower right limb. The patient also complained of painful soreness caused by lacy-white lesions of the mouth (Fig. 1-3).

Lichen planus can be seen in patients with a variety of liver diseases, particularly advanced liver disease. Systematic reviews have shown that patients with oral lichen planus are approximately two to six times more likely to have reactive anti-HCV antibodies compared with the normal population, although there is substantial geographical heterogeneity to the findings [1]. In a list of studies, the prevalence of anti-HCV antibodies in patients with lichen planus ranges from 10% to 40% [2]. There is evidence of a genetic risk for HCV-associated lichen planus [3].

Because of the frequency with which HCV (hepatitis C virus) infection has been reported among patients with lichen planus in some geographic locations, we advise testing for HCV in patients with lichen planus.