Lichen Planus – Bullous Lichen Planus

Bullous Lichen Planus is a form of Lichen Planus in which bullae (blisters) accompany the lichenoid papules and plaques and I occasionally encounter this version in my The Woodlands dermatology and Conroe dermatology offices.  There are two versions of Bullous Lichen Planus: 1. Classic Lichen Planus with Bullae 2. Lichen Planus Pemphigoides.  Bullae can erupt in Classic Lichen Planus essentially from intense lichenoid inflammation below the epidermis that expands the overlying skin into a bulla.  Clinically, this appears as a blister in the center of a lichen planus papule or plaque.  In Lichen Planus Pemphigoides, patients develop bullae on normal skin and on their lichenoid lesions.  Lichen Planus Pemphigoides is very similar to the blistering disease Bullous Pemphigoid and results from an antibody attacking the Bullous Pemphigoid antigen at the hemidesmosome of the epidermis.  These antibodies are very similar to the Bullous Pemphigoid antibodies but bind to a slightly different area on the Bullous Pemphigoid antigen.  Fortunately, Lichen Planus Pemphigoides is less severe than Bullous Pemphigoid but usually requires treatment with systemic and topical corticosteroids.