The lichen-hepatitis syndrome. A case presentation and review of the literature

Recently some evidence has accumulated indicating that lichen ruber planus, especially in its erosive variety, may be an important indicator of chronic cirrhogenic hepatitis, either chronic active hepatitis or primary biliary cirrhosis. Usually the cutaneous lesions precede the obvious clinical features of liver disease by months or years and the erosive quality of the lesions usually indicates the presence of hepatic cirrhosis. A case is reported which had typical features of both lichen planus and erosivus and chronic active hepatitis and can be regarded as representative of this association. In Italy, possibly due to the high prevalence of hepatitis B virus infection, the lichen planus patients seem to have a higher probability to develop a chronic active hepatitis, whereas those in Great Britain and USA, for genetic reasons perhaps, seem to be associated with primary biliary cirrhosis. The distinction of the two hepatic diseases is difficult in the earliest stage, but it is very important, because their treatment are quite different. The association lichen planus-chronic active hepatitis appears not to be fortuitous and its possible pathogenetic mechanism is proposed.