When should I consider referring a patient with lichen planus to a dermatologist?

Consider referring a patient with lichen planus to a dermatologist if:

• There is diagnostic uncertainty about the condition.
• The disease is extensive, severe, or rapidly progressing.
• The lesions involve sensitive or complex areas such as the mucous membranes (oral, genital) or the face.
• There is suspicion of malignant transformation or premalignant changes, especially in oral lichen planus.
• Initial treatment in primary care has been unsuccessful or the patient experiences significant symptoms or distress.
• There are complications such as secondary infection or significant inflammation requiring specialist management.

Referral allows for specialist assessment, confirmation of diagnosis (including biopsy if needed), and consideration of advanced treatments such as systemic therapies or phototherapy.

These referral considerations align with general dermatology referral principles for inflammatory and potentially premalignant skin conditions, as well as expert opinion on managing complex or severe dermatological diseases.