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5 patients affected 46 Can be present with cutaneous lesions Can affect external auditory meatus tympanic membrane causing otorrhea and hearing loss 10 year Mayo clinic study showed topical tacrolimus best treatment 47 Malignant transformation of lesions increased risk with mucosal and or erosive lichen planus Lichen planopilaris See skin of color section on alopecia for more information Key DDx Consider nail matrix biopsy if no other evidence of lichen planus besides nails Work Up Pearls Biopsy can be diagnostic particularly for mucosal or nail Hepatitis C May need upper endoscopy to evaluate esophagus in symptomatic patients order cialis online A man needs to produce healthy sperm