Talk:Lichen planus

In
In the section labelled "treatment," I'm concerned by the lengthy endorsement of an alleged homeopathic "cure" for lichen planus that efectively is an ad for a commercial product that is sold over the internet from the site www.lichenplanus.com. All the other listed treatments get a single line entry, with links to other Wikipedia pages where they exist. Certainly homeopathic treatments can and should be acknowledged, but isn't the inclusion of what amounts to an infomercial for one specific "brand" problematic? I have visited the site I mention, and know that in addition to promoting the product mentioned, which is extremely expensive, all other effective treatments are criticized at great length. I am new to posting on Wikipedia but felt strongly enough that I opened an account today to ask: isn't this in violation to some Wikipedia policy? Is there a mechanism for reporting instances where Wikipedia is being used as an advertising medium? Dee Lilly 16:35, 19 March 2007 (UTC)
 * Agreed - I put up a citation tag. If there isn't a citation for this in a few days I will remove the offending passage.  I personally have never seen or heard of any effective homeopathic treatments for oral lichen planus (I am a dentist not a dermatologist), but I wouldn't be averse to reading articles published in reputable peer reviewed journals on this topic.  Also - please read your user page. Dr-G - Illigetimi non carborundum est. 17:13, 19 March 2007 (UTC)

Concur Lenrodman (talk) 01:18, 30 May 2011 (UTC)

Image
Are you sure that image isn't psoriasis? It doesn't really look very polygonal Lenrodman (talk) 01:18, 30 May 2011 (UTC)

Unreferenced information
This was added to the treatment section by an anonymous IP editor: "Raw Virgin Coconut Oil taken internally helps reduce inflammation and if used daily will keep the disease at bay." I've moved it here because its unreferenced and makes unsupported claims. Happy for it to be moved back if suitable references can be provided. Matto paedia  Say G'Day! 02:48, 15 March 2012 (UTC)

Lichen planus parent article
I propose that this article be kept focused on cutaneous lichen planus. Some of the content seems to focus on oral lichen planus, and since we have a separate article for OLP, this doesn't make sense. I have started expanding the classification section of this parent article, partly with stubs that I have merged and partly with new content. I think this would be a good template to follow: keep article generally about cutaneous LP, and use the subsections in the classification bit to talk about how those variants differ from cutaneous lichen planus generally. I also think that many of the morphological LP pages would benefit from being merged into this parent article too. As it is we have a herd of otherwise orphaned stubs, many of which are one or two sentences long, and a parent article that is not as useful as it could be because it is mostly made up of a list of stub pages. Content which arguably should be here... Lesion ( talk ) 02:09, 4 August 2013 (UTC)
 * Sounds reasonable. Let's see how the page looks after the merge. LT90001 (talk) 09:46, 4 August 2013 (UTC)

Layout
I've tweaked the layout so it is less of confusing. The subtypes that were merged are essentially forms of cutaneous lichen planus, so I put them in that section. Could do with consistent layout.

The mucosal lichen planus section could do with more details about conjunctival, nasal, otic, bladder involvement, etc but struggling to find MEDRS compliant sources.

I have put "genital lichen planus" in the mucosal section, but I think that the implication is that it can occur on the genital skin as well.

I put "nail lichen planus" in the skin LP section, for want of somewhere better to put it.

Left oral lichen planus unmerged, with rationale that I plan to expand that article a lot soon, so it might benefit with its own page which links back to this rather than break the flow of this parent page, but I'm happy to listen to other opinions. Lesion ( talk ) 19:17, 5 August 2013 (UTC)
 * Support. What do you think about a rename to mucosal lichen planus? I'm guessing as by affecting the mucosal LPs share a similar pathophysiology. Just floating an idea here, feel free to shoot it down.LT90001 (talk) 10:33, 6 August 2013 (UTC)

Does scalp LP = follicular LP? This source suggests not necessarily.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008038/full Lesion  ( talk ) 19:46, 5 August 2013 (UTC)
 * Wow, this article is looking much better! Your cutaneous/mucosal division is very easy to understand. It's starting to look good. No, I don't believe they're the same, although they certainly overlap - I'll reinstate the morphology/site divide to make that clear.LT90001 (talk) 10:33, 6 August 2013 (UTC)

Classification Changes. I've moved a lot of the data on classifications to different sections. Kind RegardsLT90001 (talk) 10:33, 6 August 2013 (UTC)
 * Lichenoid reactions are those with a known trigger, so this trigger could be discussed in the causes section.
 * A lot of the data about all the different sites in the classification section refer to how the rash presents in each section - this can be discussed more in the symptoms section with a simpler presentation as having a mucosal/cutaneous divide.
 * Also I think that 'palmar lichen planus' and those sort of conditions are quite clearly 'lichen planus' and secondarily 'cutaneous' affecting the palm, so I think that this move is acceptable and that the first word (palmar, linear) etc. can be treated like an adjective.
 * The article looks messier now, but I think it's more efficiently organised and certainly more contentful.

OK. I'm going to leave the article in this sorry state, apologies; will continue tomorrow. Would value your input on the changes. LT90001 (talk) 10:45, 6 August 2013 (UTC)

Merge
A vast array of lichen-planus articles are being proposed to be merged. These articles all have between 2-3 sentences and will be merged into this main article with no objection. Articles include: Morphology stubs:
 * Annular lichen planus
 * Linear lichen planus — Preceding unsigned comment added by LT910001 (talk • contribs) 09:34, 4 August 2013 (UTC)
 * Hypertrophic lichen planus
 * Atrophic lichen planus
 * Vesiculobullous lichen planus
 * Ulcerative lichen planus
 * Follicular lichen planus
 * Actinic lichen planus
 * Lichen planus pigmentosus

LT90001 (talk) 09:39, 4 August 2013 (UTC)

Special forms
 * Drug-induced lichen planus
 * Lupus erythematosus-lichen planus overlap syndrome
 * Lichen planus pemphigoides
 * Keratosis lichenoides chronica
 * Lichenoid reaction of graft-versus-host disease
 * Lichenoid keratosis
 * Lichenoid dermatitis

LT90001 (talk) 09:45, 4 August 2013 (UTC)


 * All the "special forms" are now under the lichenoid reactions section. Is this factually accurate, I'm not sure for some of them... It also occurred to me that if lichenoid reactions are to be dealt with in this page, most of the content will be put into the causes section, since lichenoid reactions have identifiable causes. This would be OK with me since we don't have a very long causes section currently, by virtue of LP being essentially idiopathic. Lesion  ( talk ) 19:17, 5 August 2013 (UTC)


 * Where to put content about oral lichenoid reactions? Lesion  ( talk ) 19:20, 5 August 2013 (UTC)
 * OK. I'm going to be [bold] and move them to this page, if it ends up looking shoddy we can move them to a separate page. (As a sidenote, looks like sarcoidosis has a similar classification problem.)LT90001 (talk) 10:33, 6 August 2013 (UTC)

Oral lichen planus
This appears to be one of the last lichen-planus articles not merged here. I propose a merge because:
 * The ICD codes are the same, so these are by at least one international standard recognised as the same entity.
 * The treatment remains the same
 * The differences appear to relate to typical presentation and prognosis, which can be covered here.
 * It is better to have a more in-depth explanation of pathology on this article than separate it into two, as the pathology is the same. LT90001 (talk) 23:13, 10 August 2013 (UTC)


 * OLP and cutaneous LP & other variants of LP are the same condition, but arguably there are enough sources (thousands) which focus on OLP to warrant a separate page. However, since we have merged other types of LP to the main page, and also lichenoid reactions, then there is less of a case to keep OLP separate. OLP is closer topic to LP generally than lichenoid reactions, imo. But I see the logic that the histologic & clinical appearance of lichenoid reactions is the same too, so separate pages would again duplicate some content there. It would be nice to see a large and detailed article one day with more detail about the subtypes. I plan to add content about OLP, but can't promise that this will be anytime soon. It might give excess weight to OLP on the LP page if everything is merged, but happy to wait and see how it looks. Merging will also solve the problem I was anticipating about where to talk about lichenoid reactions in the mouth. Lesion  ( talk ) 23:37, 10 August 2013 (UTC)

Oral lichen planus has been merged into this article. LT90001 (talk) 10:08, 14 August 2013 (UTC)

Cleanup issues
Hey, yep I've been trying to do this no spaces citing thing since you pointed that out, I hope that it's not giving you too much grief. I encourage you to update the source as you see fit, as I understand it for rarer diseases the guidelines are to use a relatively recent one. I look forward to your next copy-edit! LT90001 (talk) 12:03, 15 August 2013 (UTC)
 * It is my understanding that any editor (even those who have extensively been involved in editing the article) are free to change the class of articles if they see fit up to B grade, but a GA status requires a formal GA review...
 * Care is needed with choosing sources. Please see WP:MEDRS. One of the refs, fails WP:MEDDATE by a significant margin. The old source was 1960s, so at least is better, but we should aim not to include any source that is much older than 5 years. Not an absolute rule, but I think the majority of people would interpret 1985 as too old a source... This is for the list of histopathologic features. I will have a look in a modern oral pathology textbook and a dermatology textbook for these classically described features...most textbooks would likely list them. Note that MEDRS may not necessarily apply to the history section, after all it is natural to use older sources here. Similarly for society and culture section.
 * Care is needed when altering content that previous sources are supporting. Please see WP:INTEGRITY. E.g. the source Kerawala 2010. What the original source actually says is this: "Small risk of malignant change especially if erosive". In a previous version of the article, the content "Atrophic/erosive lichen planus is associated with a small risk of malignant transformation,[26] " was supported by Kerawala 2010. The same source has now been used to support the following content: "A biopsy can be used to rule out conditions that may resemble lichen planus, and can pick up any secondary malignancies. [25]" As far as I can see, the kerawala source does not support this content at all?
 * In the differential diagnosis section, note that "Candida" is not a diagnosis. Suggest "Oral candidiasis".
 * In the desire to see consistent referencing technique, I did look this up in the end. Per WP:CITEFOOT, reference tags should go immediately after punctuation with no space. As if a sign, a bot fixed this error on one of the pages on my watchlist today, which triggered me to look up the policy.
 * Aside from these minor points, article is looking better, agree. Lesion  ( talk ) 23:54, 14 August 2013 (UTC)
 * OK. I've fixed all the spaces, removed the unsourced treatments for oral candidiasis, candida -> candidiasis, and upgraded to B class. I won't be making any further thorough edits of this article, and it was a pleasure to edit collaboratively with you. LT90001 (talk) 03:53, 16 August 2013 (UTC)
 * Likewise, thank you. Unfortunately I've been busy recently, maybe at some point I will be able to expand the OLP content more. Hopefully in time the cutaneous LP details will be expanded too. Lesion  ( talk ) 22:27, 16 August 2013 (UTC)

granuloma annulare a type of lichen planus?
Not sure about this. I do not think it is correct. The source http://www.patient.co.uk/doctor/Granuloma-Annulare.htm lists granuloma annulare in the Ddx of lichen planus and vice versa. This suggests they are different conditions. Lesion ( talk ) 16:45, 19 January 2014 (UTC)
 * From my understanding they are distinct conditions. --LT910001 (talk) 03:00, 20 January 2014 (UTC)
 * Reverted this aspect of the recent IP edit. Lesion  ( talk ) 09:55, 20 January 2014 (UTC)
 * Also reverted addition of "Serpentine" since I could not find any source describing this as a recognized sub type of LP. Lesion  ( talk ) 09:59, 20 January 2014 (UTC)

Reverted edit on treatment
I reverted this edit and this edit on use of apremilast and acetretin to treat lichen planus, which was not sourced to WP:MEDRS standards and would have violated our Manual of Style with regard to drugs - specifically because this would be an investigational/off-label use; I find no evidence that this regimen is approved for treating lichen planus; it matters little that there are ongoing clinical trials, because (also per MEDMOS) we don't catalog trials in article space. &mdash; soupvector (talk) 17:04, 18 August 2019 (UTC)