扁平苔藓

目前病因不明，但是普遍认为与免疫反应有关。丙型肝炎还可能更改某些患者的细胞因子表达，从而诱发易感性。[24]Lodi G, Giuliani M, Majorana A, et al. Lichen planus and hepatitis C virus: a multicentre study of patients with oral lesions and a systematic review. Br J Dermatol. 2004;151:1172-1181.http://www.ncbi.nlm.nih.gov/pubmed/15606512?tool=bestpractice.com口腔过敏原可能在口腔损害中起到重要作用，而外源性抗原（例如，文身墨水中发现的过敏原）可能在文身部位促发疾病。[25]Kazandjieva J, Tsankov N. Tattoos: dermatological complications. Clin Dermatol. 2007;25:375-382.http://www.ncbi.nlm.nih.gov/pubmed/17697920?tool=bestpractice.com[26]Yiannias JA, el-Azhary RA, Hand JH, et al. Relevant contact sensitivities in patients with the diagnosis of oral lichen planus. J Am Acad Dermatol. 2000;42:177-182.http://www.ncbi.nlm.nih.gov/pubmed/10642670?tool=bestpractice.com

活化 T 淋巴细胞迁移至真皮与表皮交界处，诱发基底角质形成细胞凋亡。[1]Pittelkow MR, Daoud MS. Lichen planus. In: Wolff K, Goldsmith LA, Katz SI, et al, eds. Fitzpatrick's dermatology in general medicine. Vol One. 7th ed. New York, NY: McGraw-Hill Companies, Inc.; 2008:244-255.虽然 CD4+ 和 CD8+ T 淋巴细胞均存在，但是后者主要在较久的皮损中出现。[1]Pittelkow MR, Daoud MS. Lichen planus. In: Wolff K, Goldsmith LA, Katz SI, et al, eds. Fitzpatrick's dermatology in general medicine. Vol One. 7th ed. New York, NY: McGraw-Hill Companies, Inc.; 2008:244-255.普遍认为，ICAM-1 和 Th1 细胞因子（包括干扰素-γ、TNF-α和核因子 kappa B [NF-KB] 相关细胞因子）表达增加促使凋亡。[27]Sklavounou-Andrikopoulou A, Chrysomali E, Iakovou M, et al. Elevated serum levels of the apoptosis related molecules TNF-alpha, Fas/Apo-1 and Bcl-2 in oral lichen planus. J Oral Pathol Med. 2004;33:386-390.http://www.ncbi.nlm.nih.gov/pubmed/15250829?tool=bestpractice.com[28]Rhodus NL, Cheng B, Ondrey F. Th1/Th2 cytokine ratio in tissue transudates from patients with oral lichen planus. Mediators Inflamm. 2007;2007:19854.http://www.hindawi.com/journals/mi/2007/019854/abs/http://www.ncbi.nlm.nih.gov/pubmed/17497029?tool=bestpractice.com[29]Wenzel J , Tuting T. An IFN-associated cytotoxic cellular immune response against viral, self-, or tumor antigens is a common pathogenetic feature in "interface dermatitis". J Invest Dermatol. 2008;128:2392-2402.http://www.ncbi.nlm.nih.gov/pubmed/18418411?tool=bestpractice.com[30]Norris DA. Cytokine modulation of adhesion molecules in the regulation of immunologic cytotoxicity of epidermal targets. J Invest Dermatol. 1990;95:111S-120S.http://www.ncbi.nlm.nih.gov/pubmed/2258627?tool=bestpractice.com[31]Chen X, Liu Z, Yue Q. The expression of TNF-alpha and ICAM-1 in lesions of lichen planus and its implication. J Huazhong Univ Sci Technolog Med Sci. 2007;27:739-741.http://www.ncbi.nlm.nih.gov/pubmed/18231758?tool=bestpractice.com[32]Bennion SD, Middleton MH, David-Bajar KM, et al. In three types of interface dermatitis, different patterns of expression of intercellular adhesion molecule-1 (ICAM-1) indicate different triggers of disease. J Invest Dermatol. 1995;105:71S-79S.http://www.ncbi.nlm.nih.gov/pubmed/7616001?tool=bestpractice.com[33]Hussein MR. Evaluation of angiogenesis in normal and lichen planus skin by CD34 protein immunohistochemistry: preliminary findings. Cell Biol Int. 2007;31:1292-1295.http://www.ncbi.nlm.nih.gov/pubmed/17524679?tool=bestpractice.com其他证据提示，血管异生是重要的病理生理机制因素。[33]Hussein MR. Evaluation of angiogenesis in normal and lichen planus skin by CD34 protein immunohistochemistry: preliminary findings. Cell Biol Int. 2007;31:1292-1295.http://www.ncbi.nlm.nih.gov/pubmed/17524679?tool=bestpractice.com

皮损部位

皮肤[Figure caption and citation for the preceding image starts]: 皮肤扁平苔藓梅奥医学中心临床照片（经授权使用） [Citation ends].[Figure caption and citation for the preceding image starts]: Blaschkoid 扁平苔藓梅奥医学中心临床照片（经授权使用） [Citation ends].[Figure caption and citation for the preceding image starts]: Blaschkoid 扁平苔藓梅奥医学中心临床照片（经授权使用） [Citation ends].[Figure caption and citation for the preceding image starts]: 反相扁平苔藓梅奥医学中心临床照片（经授权使用） [Citation ends].[Figure caption and citation for the preceding image starts]: 增生性扁平苔藓梅奥医学中心临床照片（经授权使用） [Citation ends].[Figure caption and citation for the preceding image starts]: 增生性扁平苔藓梅奥医学中心临床照片（经授权使用） [Citation ends].

• 虽然可能存在多种形态，但经典表现为前臂和小腿屈侧瘙痒、紫罗兰色、多角形丘疹和斑块。[1]Pittelkow MR, Daoud MS. Lichen planus. In: Wolff K, Goldsmith LA, Katz SI, et al, eds. Fitzpatrick's dermatology in general medicine. Vol One. 7th ed. New York, NY: McGraw-Hill Companies, Inc.; 2008:244-255.[2]Boyd AS, Neldner KN. Lichen planus. J Am Acad Dermatol. 1991;25:593-619.http://www.ncbi.nlm.nih.gov/pubmed/1791218?tool=bestpractice.com

口腔[Figure caption and citation for the preceding image starts]: 口腔扁平苔藓梅奥医学中心临床照片（经授权使用） [Citation ends].

• 可能存在无症状性斑块或不适的白色网状斑块或伴有疼痛的侵蚀和溃疡。[3]Dissemond J. Oral lichen planus: an overview. J Dermatolog Treat. 2004;15:136-140.http://www.ncbi.nlm.nih.gov/pubmed/15204144?tool=bestpractice.com

生殖器黏膜[Figure caption and citation for the preceding image starts]: 生殖器扁平苔藓梅奥医学中心临床照片（经授权使用） [Citation ends].

• 可能与疼痛或瘙痒相关。[4]Goldstein AT, Metz A. Vulvar lichen planus. Clin Obstet Gynecol. 2005;48:818-823.http://www.ncbi.nlm.nih.gov/pubmed/16286828?tool=bestpractice.com

毛发扁平苔藓[Figure caption and citation for the preceding image starts]: 毛发扁平苔藓梅奥医学中心临床照片（经授权使用）。 [Citation ends].

• 累及头皮并常导致瘢痕性秃发。[5]Mehregan DA, Van Hale HM, Muller SA. Lichen planopilaris: clinical and pathologic study of forty-five patients. J Am Acad Dermatol. 1992;27:935-942.http://www.ncbi.nlm.nih.gov/pubmed/1479098?tool=bestpractice.com[6]Cevasco NC, Bergfeld WF, Remzi BK, et al. A case-series of 29 patients with lichen planopilaris: the Cleveland Clinic Foundation experience on evaluation, diagnosis, and treatment. J Am Acad Dermatol. 2007;57:47-53.http://www.ncbi.nlm.nih.gov/pubmed/17467854?tool=bestpractice.com

指/趾甲[Figure caption and citation for the preceding image starts]: 指/趾甲扁平苔藓梅奥医学中心临床照片（经授权使用） [Citation ends].[Figure caption and citation for the preceding image starts]: 指/趾甲扁平苔藓梅奥医学中心临床照片（经授权使用） [Citation ends].

• 可导致甲翼状胬肉、纵嵴、甲板变薄并且远端开裂。[7]Scott MJ Jr, Scott MJ Sr. Ungual lichen planus: lichen planus of the nail. Arch Dermatol. 1979;115:1197-1199.http://www.ncbi.nlm.nih.gov/pubmed/507861?tool=bestpractice.com

食管

• 极少，可导致吞咽困难或吞咽痛。[8]Harewood GC, Murray JA, Cameron AJ. Esophageal lichen planus: the Mayo Clinic experience. Dis Esophagus. 1999;12:309-311.http://www.ncbi.nlm.nih.gov/pubmed/10770369?tool=bestpractice.com

皮损分布

Blaschko 线样分布[Figure caption and citation for the preceding image starts]: Blaschkoid 扁平苔藓梅奥医学中心临床照片（经授权使用） [Citation ends].[Figure caption and citation for the preceding image starts]: Blaschkoid 扁平苔藓梅奥医学中心临床照片（经授权使用） [Citation ends].

• 皮损沿 Blaschko 线。[9]Ber Rahman S, Ul Bari A, Mumtaz N. Unilateral Blaschkoid lichen planus involving the entire half of the body, a unique presentation. Dermatol Online J. 2007;13:36.http://dermatology.cdlib.org/133/letters/blaschkoid/rahman.htmlhttp://www.ncbi.nlm.nih.gov/pubmed/18328230?tool=bestpractice.com[10]Rajeev S, Veena M, Mithilesh C. Unilateral multiple linear lichen planus along the lines of Blaschko: a report of two cases. Indian J Dermatol Venereol Leprol. 1999;65:225-226.[11]Kabbash C, Laude TA, Weinberg JM, et al. Lichen planus in the lines of Blaschko. Pediatr Dermatol. 2002;19:541-545.http://www.ncbi.nlm.nih.gov/pubmed/12437560?tool=bestpractice.com

带状疱疹样[Figure caption and citation for the preceding image starts]: 带状疱疹样扁平苔藓梅奥医学中心临床照片（经授权使用） [Citation ends].

• 皮损沿皮节分布。[12]Mohrenschlager M, Engst R, Hein R, et al. Primary manifestations of a zosteriform lichen planus: isotopic response following herpes zoster sine herpete? Br J Dermatol. 2008;158:1145-1146.http://www.ncbi.nlm.nih.gov/pubmed/18284381?tool=bestpractice.com

线性

• 皮损呈线形分布。[1]Pittelkow MR, Daoud MS. Lichen planus. In: Wolff K, Goldsmith LA, Katz SI, et al, eds. Fitzpatrick's dermatology in general medicine. Vol One. 7th ed. New York, NY: McGraw-Hill Companies, Inc.; 2008:244-255.[2]Boyd AS, Neldner KN. Lichen planus. J Am Acad Dermatol. 1991;25:593-619.http://www.ncbi.nlm.nih.gov/pubmed/1791218?tool=bestpractice.com

反相[Figure caption and citation for the preceding image starts]: 反相扁平苔藓梅奥医学中心临床照片（经授权使用） [Citation ends].

• 皱褶部位（腋下、腹股沟）存在皮损。可能无鳞屑。[1]Pittelkow MR, Daoud MS. Lichen planus. In: Wolff K, Goldsmith LA, Katz SI, et al, eds. Fitzpatrick's dermatology in general medicine. Vol One. 7th ed. New York, NY: McGraw-Hill Companies, Inc.; 2008:244-255.[2]Boyd AS, Neldner KN. Lichen planus. J Am Acad Dermatol. 1991;25:593-619.http://www.ncbi.nlm.nih.gov/pubmed/1791218?tool=bestpractice.com[13]Kashima A, Tajiri A, Yamashita A, et al. Two Japanese cases of lichen planus pigmentosus-inversus. Int J Dermatol. 2007;46:740-742.http://www.ncbi.nlm.nih.gov/pubmed/17614807?tool=bestpractice.com

皮损形态

肥厚性

• 角化过度性结节，最常分布在下肢远端。[1]Pittelkow MR, Daoud MS. Lichen planus. In: Wolff K, Goldsmith LA, Katz SI, et al, eds. Fitzpatrick's dermatology in general medicine. Vol One. 7th ed. New York, NY: McGraw-Hill Companies, Inc.; 2008:244-255.[2]Boyd AS, Neldner KN. Lichen planus. J Am Acad Dermatol. 1991;25:593-619.http://www.ncbi.nlm.nih.gov/pubmed/1791218?tool=bestpractice.com

大疱性

• 多角形丘疹伴相关水疱或大疱。[1]Pittelkow MR, Daoud MS. Lichen planus. In: Wolff K, Goldsmith LA, Katz SI, et al, eds. Fitzpatrick's dermatology in general medicine. Vol One. 7th ed. New York, NY: McGraw-Hill Companies, Inc.; 2008:244-255.[2]Boyd AS, Neldner KN. Lichen planus. J Am Acad Dermatol. 1991;25:593-619.http://www.ncbi.nlm.nih.gov/pubmed/1791218?tool=bestpractice.com

日光性

• 皮损按光暴部位分布（经常日晒部位）。[1]Pittelkow MR, Daoud MS. Lichen planus. In: Wolff K, Goldsmith LA, Katz SI, et al, eds. Fitzpatrick's dermatology in general medicine. Vol One. 7th ed. New York, NY: McGraw-Hill Companies, Inc.; 2008:244-255.[2]Boyd AS, Neldner KN. Lichen planus. J Am Acad Dermatol. 1991;25:593-619.http://www.ncbi.nlm.nih.gov/pubmed/1791218?tool=bestpractice.com

环状

• 皮损呈环状分布。[14]Peretz E, Grunwald MH, Halevy S. Annular plaque on the face. Actinic lichen planus (ALP). Arch Dermatol. 1999;135:1543;1546.http://www.ncbi.nlm.nih.gov/pubmed/10606067?tool=bestpractice.com

萎缩型

• 与色素沉着过度可能或可能不相关的萎缩斑块。[15]Morales-Callaghan A Jr, Martinez G, Aragoneses H, et al. Annular atrophic lichen planus. J Am Acad Dermatol. 2005;52:906-908.http://www.ncbi.nlm.nih.gov/pubmed/15858488?tool=bestpractice.com

侵蚀

• 皮肤或黏膜侵蚀或溃疡。[1]Pittelkow MR, Daoud MS. Lichen planus. In: Wolff K, Goldsmith LA, Katz SI, et al, eds. Fitzpatrick's dermatology in general medicine. Vol One. 7th ed. New York, NY: McGraw-Hill Companies, Inc.; 2008:244-255.[2]Boyd AS, Neldner KN. Lichen planus. J Am Acad Dermatol. 1991;25:593-619.http://www.ncbi.nlm.nih.gov/pubmed/1791218?tool=bestpractice.com

色素沉着

• 皮损伴相关性色素过度沉着。[13]Kashima A, Tajiri A, Yamashita A, et al. Two Japanese cases of lichen planus pigmentosus-inversus. Int J Dermatol. 2007;46:740-742.http://www.ncbi.nlm.nih.gov/pubmed/17614807?tool=bestpractice.com[15]Morales-Callaghan A Jr, Martinez G, Aragoneses H, et al. Annular atrophic lichen planus. J Am Acad Dermatol. 2005;52:906-908.http://www.ncbi.nlm.nih.gov/pubmed/15858488?tool=bestpractice.com