Here is an article which makes one think that not all diagnoses of lichen planus are what they are recorded to be. Case in point is this report which does a host of immunological testing to find subtle differences (which would not be distinguishable by low mag microscopy and routine H&E pathology).

Just in case your thoughts go where mine do…. if a long list of drugs can cause lichen planus-like pathology, then that speaks to an environmental factor on many cases of ?? dare i say ??? mis-diagnosed lichen planus. Why not add to that a long list of environmental factors in a very similar disease a list of chemicals, such as cements, mortars, hair dyes, grouts, resins and other occupational factors that are increase one’s risk for developing lichen planus. Makes no sense why there is a line drawn between what we are prescribed by MDs, or exposed to in occupations. Just thinking here.

1) Whats more, in the cases this woman looked at, at least 25% were drug-induced… this is a huge percent which no one would argue as insignificant.
2) Orthokeratosis is hyperkeratosis without parakeratosis i.e. no nucleus is seen in the upper cells of the epidermis (the latter being typical).