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Lichen Planus — SCE Dermatology MCQ

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ModerateInflammatory DermatosesLichen PlanusSCE Dermatology

A 25-year-old man presents with pruritic polygonal flat-topped violaceous papules on his wrists with oral white lacy patches. Biopsy is consistent with lichen planus. His hepatitis C serology returns positive. What is the recommended management regarding his hepatitis C?

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Correct answer: D — Refer for hepatitis C assessment and treatment; eradication of HCV may improve cutaneous LP

Lichen planus has a well-established association with hepatitis C virus (HCV), particularly in Mediterranean and Japanese populations. HCV testing is recommended in all LP patients. Successful HCV eradication with direct-acting antivirals (DAAs) may improve or resolve HCV-associated LP. Referral to hepatology for HCV assessment and treatment is essential. Historically, Interferon therapy for HCV was paradoxically associated with worsening LP (and could even trigger LP), but modern DAA regimens avoid this problem. Hepatitis C is also associated with other dermatological conditions including PCT, cryoglobulinaemic vasculitis, and pruritus.

Reference: BAD 2019 LP Guidelines; NICE HCV Pathway