Causes and Risk Factors

Doctors aren’t completely sure why LPLK occurs, but it seems to be an immune system reaction in the skin. Often, LPLK develops on a pre-existing harmless skin spot – for example, an “age spot” (solar lentigo) or a seborrheic keratosis (benign age-related wart) that starts to regress (fade) and gets inflamed [1]. In simple terms, a freckle or sun spot might “irritate” the immune system, causing a lichenoid (lichen planus-like) reaction in that area. The exact trigger is not always known, but possible triggers include:

• Sun exposure: UV light damage may play a role (many LPLK lesions occur on sun-exposed skin) [1][2].
  
  
• Minor skin injury or friction: Sometimes LPLK appears at sites of slight trauma or chronic rubbing.
  
  
• Certain medications or dermatitis: In some cases, these have been noted as potential triggers [1][2].
  
  

Who gets LPLK? It most often occurs in adults over 30, and it’s especially common in middle-aged to older adults. LPLK tends to appear more frequently in people with fair skin and a history of sun exposure (for example, Caucasian individuals who have spent a lot of time in the sun) [2]. Women seem to get LPLK about twice as often as men do [1][2]. However, it can affect anyone (both men and women, usually in their 40s, 50s, or 60s, but ranging roughly from 30 to 80 years of age) [1][2]. Having light-colored eyes or hair and a history of tanning or sunburns are also noted risk factors, likely because they indicate sun-sensitive skin [2].

Appearance and Symptoms

What does LPLK look like? A lichenoid keratosis usually starts as a flat or slightly raised spot on the skin that can be pink, red, or brown. Often it might begin as a brownish sun spot and then become inflamed, turning a reddish or pink color [3]. Many patients notice a spot that was there before (like a freckle or age spot) suddenly changes color or appearance. LPLK lesions are usually small (a few millimeters up to about 1 cm) and round or oval in shape [2]. The surface can vary – it might be smooth, or sometimes a bit scaly or rough to touch [2]. Over time, the color of an LPLK can change: for instance, a pink spot might deepen to purple, gray, or brown and then gradually fade to a normal skin tone as it resolves [2].

LPLK most commonly appears on sun-exposed areas of the body. Typical sites include:

• Chest and upper back – many lesions are found on the upper trunk [1][2].
  
  
• Shoulders and forearms – common areas since they get a lot of sun [2][3].
  
  
• Upper arms and hands – also frequently exposed to sunlight.
  
  
• Less commonly, it can occur on the neck or face.
  
  

Usually, there is only one lesion. In about 90% of people, LPLK presents as a single isolated spot on the skin [2]. Occasionally, a few lesions (perhaps a small cluster of 2–3) might be present, but having many at once is uncommon.

Symptoms: Lichenoid keratosis spots are often asymptomatic, meaning they don’t cause any trouble besides their appearance [4]. Many people don’t feel anything at all. However, some lesions can be a bit itchy or irritating. You might notice mild:

• Itching or tingling on the spot.
  
  
• Stinging or burning sensation.
  
  
• Tenderness or slight discomfort when touched.
  
  

These symptoms, if present, are usually minor. Some LPLK lesions may get a little dry or form a thin scab as they heal, which can cause slight irritation. In general, pain or bleeding is not typical for LPLK (if a spot is bleeding or very painful, that should be evaluated by a doctor to rule out other causes).

(Suggested Photo [2]: LPLK lesion in a later stage – a small patch with a brownish color and slight scale, showing how it can darken as it resolves.)

How is LPLK different from other skin lesions? One key difference is that LPLK is usually solitary and temporary. For example, lichen planus (the condition it’s named after) usually causes multiple purple, flat-topped itchy bumps (often on wrists, ankles, or inside the mouth), which is very different from a single LPLK spot on sun-exposed skin.

However, LPLK can sometimes mimic skin cancers in appearance – indeed, it has on occasion been mistaken for a basal cell carcinoma (a common type of skin cancer) or even a melanoma [6]. This may happen because LPLK lesions can have irregular color (pinkish, red-brown, or gray) and they change over time, which can resemble the appearance of a changing mole or other lesion [6]. The good news is that, unlike skin cancers, LPLK is benign. But because it can look similar to more serious lesions, doctors often investigate any new or changing skin spot (with dermoscopy or biopsy) to be sure of the diagnosis.

Diagnosis

Clinical examination: A dermatologist can often identify LPLK based on how it looks and its history. They will examine the spot visually (possibly with the aid of magnification) and ask how long it’s been there and if it has changed. Because LPLK can appear similar to other lesions, careful examination is important.

Dermoscopy: In many cases, a dermatologist will use a dermoscope – a special handheld microscope with light – to inspect the lesion. Dermoscopy is painless and non-invasive. The doctor might put a drop of oil or fluid on the spot and then look through the dermoscope to see detailed structures of the pigment and blood vessels in the skin. This can reveal certain patterns. LPLK often has subtle dermoscopic features (such as tiny gray dots or a faded network of pigment) that can hint at the diagnosis, whereas a melanoma or other skin cancer usually shows different patterns. Dermoscopy helps the doctor decide if the spot appears benign or if it has any suspicious features. It’s a useful tool that can often spare you an immediate biopsy if the lesion looks clearly like an LPLK under magnification.

Biopsy: If there is any uncertainty about the diagnosis, the doctor will perform a small skin biopsy. This involves numbing the area with a local anesthetic and then removing a small piece (or the entire lesion) by shaving or punching out a sample. The specimen is sent to a lab, where a pathologist examines it under a microscope. The biopsy can confirm LPLK by showing its characteristic lichenoid tissue pattern (a band of inflammatory cells under the epidermis, similar to what’s seen in lichen planus) [3]. More importantly, the biopsy rules out other conditions like skin cancers. Don’t be alarmed if your doctor suggests a biopsy – this is usually a precaution because, as noted, LPLK can look like other lesions. A biopsy is quick (done in-office) and generally heals with minimal scarring. It provides definitive answers, giving you and your doctor peace of mind that the spot is truly benign.

Treatment

Usually no treatment is needed. Lichenoid keratosis often goes away on its own over time [4]. It is an inflammatory process that tends to eventually burn itself out – the spot may slowly flatten and fade over several months. Because it is benign and often self-resolving, a common approach is simply to observe the lesion. Your dermatologist might document it with a photograph and check back after a few months to see if it’s fading as expected [1].

If the lesion is bothersome – for instance, if it’s itchy or you dislike the way it looks – there are treatment options available (though treating LPLK is usually optional since it’s not dangerous). Options include:

• Topical medications for symptoms: If the spot is inflamed or itchy, a doctor can prescribe a corticosteroid cream to reduce redness and itch. A steroid ointment or cream (for example, triamcinolone 0.1%) can calm the immune reaction in the skin and help the area feel better [2]. This doesn’t “cure” the LPLK instantly but can speed up the settling down of the inflammation.
  
  
• Removal procedures (for cosmetic or definitive treatment): If you want the lesion removed – for example, for cosmetic reasons or for absolute confirmation – a dermatologist can remove LPLK with a minor procedure. Common methods include cryotherapy (freezing the spot with liquid nitrogen) to quickly destroy the lesion, or a small curettage (using a tool to gently scrape the lesion off) often followed by cauterization to seal the area [1][2]. These procedures are quick (done with local numbing) and have a good chance of completely removing the spot. In some cases, a laser ablation can be used to vaporize the lesion, or radiofrequency ablation to burn it off – these are typically used if precision is needed or for cosmetic outcomes [5]. All of these methods have the goal of removing the LPLK and allowing new skin to heal in its place.
  
  
• Light-based therapies: Some dermatology clinics offer treatments like photodynamic therapy or LED light therapy for certain skin lesions. In LPLK, such light-based treatments are not standard first-line therapy, but if a lesion is persistent or cosmetically bothersome, a dermatologist might use them in select cases. Photodynamic therapy involves applying a special light-sensitizing medication to the spot and then exposing it to a particular wavelength of light (often an LED lamp), which can help destroy abnormal cells and reduce pigmentation. Laser therapy (for example, using a pigment laser or IPL – intense pulsed light) can also target any residual brown pigmentation. These interventions are considered when a patient is very concerned about the appearance of the lesion, and they should be done under the guidance of a dermatologist [5].
  
  

In rare situations where there are multiple LPLK lesions erupting (doctors sometimes call this an eruptive lichenoid keratosis, which is uncommon), more extensive treatments can be considered. Dermatologists have reported using oral retinoid medications (such as acitretin) or immune-modulating treatments for widespread cases [1]. Additionally, there have been case reports of using topical immune therapy (like imiquimod cream) successfully on LPLK [1]. These are not routine treatments but are options in unusual cases.

Home care: For a typical single LPLK, invasive treatment usually isn’t needed. It’s fine to keep the area moisturized and protected. Avoid picking at it, and protect it from excessive sun exposure which could aggravate the skin. Using sunscreen on and around the lesion is a good idea (not only for general skin health, but also because UV exposure could potentially trigger more inflammation or additional spots). There isn’t a known home remedy to make LPLK go away faster, but maintaining good skin care (gentle cleansers, moisturizers, sun protection) can help the natural healing process.

Prognosis

The prognosis for LPLK is excellent. LPLK is a completely benign condition – it does not turn into skin cancer, and in fact often disappears spontaneously given time [1][4]. Most lesions will resolve after a few months to a year, though some may take longer. There have been no reports of a lichenoid keratosis ever transforming into a malignant skin tumor [1]. Once an LPLK fades, it might leave a faint mark or slight discoloration for a while, but this too tends to improve with time.

LPLK is also not associated with any internal diseases or overall health problems. It’s essentially a surface skin issue only. Having an LPLK does not mean you have lichen planus (a different condition) or any other illness.

Importantly, LPLK is not contagious. You cannot spread it to other people by touch, and you didn’t catch it from someone else. It is a localized reactive process in the skin, not an infection.

Sometimes, people who have had one LPLK may develop another new one later on (especially if they have a lot of sun-damaged spots on their skin). If it happens, it’s usually just another isolated occurrence and not a sign of something worsening – you would handle it the same way (get it checked if it’s new, then observe or treat as needed). Having one LPLK does slightly indicate that your skin has had enough sun exposure to form sun spots, so it’s a reminder to be diligent with sun protection. But aside from that, there are no long-term issues to worry about with LPLK.

When to See a Doctor

Because LPLK can resemble other skin problems, it’s wise to involve a doctor when you notice any suspicious skin change. You should see a doctor (ideally a dermatologist) in the following situations:

• If you notice a new spot on your skin that is changing in color, shape, or size. Any evolving skin lesion should be evaluated. LPLK is just one possibility – your doctor will want to make sure it’s not something else (like a skin cancer or precancer). As a rule of thumb, if a “spot” is new or noticeably changing, get it checked.
  
  
• If you have a persistent red or brown patch that doesn’t go away after a few months. An LPLK typically will eventually start to fade; if a spot remains stubbornly present and irritated, it should be examined to confirm what it is.
  
  
• If the lesion has concerning features – for example, if it’s very dark or multi-colored, has irregular borders, is bleeding, or is rapidly growing. Those features are not typical of LPLK (which usually is uniform in color and slow to change). Such signs would warrant a prompt medical evaluation to rule out a skin cancer.
  
  
• Any time you are unsure or anxious about a skin lesion. It’s perfectly fine to see a doctor for peace of mind. If you’re worried, a quick check can confirm if it’s benign. As Healthline advises, if you notice any changes in your skin, you should always ask your doctor to have a look [2]. There’s no harm in being cautious.
  
  

Remember, dermatologists see LPLK fairly often and can usually recognize it (especially with tools like dermoscopy). They might perform a biopsy to be certain. This doesn’t mean they think it’s cancer – often they’re just being thorough. Once the diagnosis is made, no further treatment is necessary unless you want the spot removed.

If you’ve been diagnosed with LPLK and choose not to remove it, keep an eye on it over time. It should gradually lighten or shrink. If instead you notice rapid changes, or if a long-quiescent spot suddenly starts growing again, follow up with your doctor to reconfirm everything is okay. It’s unlikely to turn into anything bad, but any unusual change in a known lesion merits a check just to be safe.

Reassurance for Patients

Take-home message: Lichen planus-like keratosis may sound alarming, but it is a harmless skin quirk. It is not cancer, it’s not going to turn into cancer, and it’s not an infection. In fact, many LPLK lesions eventually disappear on their own without any treatment [1][4]. It’s understandable to feel concerned when you notice a new or changing spot on your skin – that’s a normal reaction. But once your doctor has evaluated it and perhaps done a biopsy to confirm the diagnosis, you can be reassured that LPLK is benign.

LPLK will not spread to other people. It’s not contagious, and it’s not caused by anything you did wrong. Think of it as an odd little inflammatory reaction that your skin decided to throw at an existing sun spot or wart. It might look a bit red or scaly for a while, but then it calms down and fades away. There are no lasting negative effects from LPLK. It doesn’t leave big scars (especially if not aggressively treated) and it does not predispose you to anything dangerous.

If the appearance bothers you, talk to your dermatologist – the lesion can be removed or treated to speed its disappearance. If it’s not bothering you, it’s perfectly reasonable to just keep an eye on it until it resolves naturally. Make sure to protect your skin from the sun (to prevent new sun spots and keep your skin healthy in general), but otherwise you don’t need to do anything special for LPLK.

Finally, always feel free to follow up with your doctor if you have concerns. Dermatologists would rather you come in and have a benign spot checked than sit at home worrying. Once an LPLK is identified, you can take comfort in knowing it’s nothing dangerous. Many patients find relief in hearing that a strange-looking lesion is “just a lichenoid keratosis,” which means it’s a benign peculiarity of the skin. In summary: LPLK is harmless – with time it often goes away, and it will not turn into something bad. Stay vigilant about your skin, but you can rest easy about this particular diagnosis.

Sources and References:

1. DermNet NZ – “Lichenoid keratosis” (Vanessa Ngan, 2006; updated by A/Prof Amanda Oakley, 2016 – DermNet revision Sept 2021). A dermatology information resource describing lichenoid keratosis (lichen planus-like keratosis) as a benign solitary inflamed macule or thin plaque on sun-exposed skin. Provides details on causes (often arising from a regressing solar lentigo or seborrhoeic keratosis), typical patient demographics (fair-skinned, ages 30–80, more common in females), clinical features (usually a single small inflamed spot that may be itchy or sting), and treatment options (not required unless desired, removal possible by cryotherapy, curettage, etc.).
   
   
2. Healthline – “Lichenoid Keratosis: Treatment, Dermoscopy, and Pictures” (Medically reviewed by Alana Biggers, M.D., MPH; written by Noreen Iftikhar, MD – Updated March 10, 2018). Patient-friendly article explaining what lichenoid keratosis is and emphasizing its harmless nature. Describes symptoms (often none, occasionally itching or burning), common locations (chest, back, arms, shoulders – usually in sun-exposed areas), risk factors (more common in Caucasian women in their 50s–60s, fair skin, history of sun exposure or tanning), and possible causes (inflammatory reaction possibly triggered by UV light, skin irritation, or medications). Outlines how it’s diagnosed with dermoscopy and biopsy if needed, and notes that lichenoid keratosis is sometimes mistaken for skin cancer, so any changing skin lesion should be checked by a doctor. Also covers treatment options (topical steroids for symptoms, cryosurgery, electrosurgery, curettage for removal) and clearly states that the condition is harmless, usually clearing up on its own and not associated with skin cancer.
   
   
3. Cleaver Medical Group Dermatology – “Benign Lichenoid Keratosis” (Practice information page, accessed 2025). A summary from a dermatology clinic describing lichenoid keratosis as a benign growth typically appearing on the trunk or arms of middle-aged and older adults. Notes that clinically it can be misinterpreted as a basal cell carcinoma due to similar appearance. Explains that usually a solitary brown sun spot turns red and becomes itchy, appearing on sun-exposed areas (forearms, hands, chest) of middle-aged fair-skinned individuals. Confirms that these lesions are benign and usually require no treatment beyond identification. (Provides patient-friendly reassurance that no further action is needed once diagnosed benign.)
   
   
4. VisualDx Clinical Summary – Lichenoid Keratosis (Dermatology decision support resource, 2021). Highlights that lichenoid keratoses are usually asymptomatic (with only occasional mild itching) and often discovered when patients notice a change in a pre-existing spot. Emphasizes the importance of distinguishing LPLK from malignant lesions. Notes that under dermatoscopic and histological examination, lichenoid keratosis shows a lichenoid tissue reaction pattern. This reference supports clinical points about lack of symptoms, benign course, and diagnostic approach. (Content derived from VisualDx and similar clinical resources, as cited in Healthline and DermNet.)
   
   
5. Spot Check Clinic (Melbourne, AUS) – “Lichenoid keratosis (LPLK)” (Skin cancer & aesthetics clinic resource, accessed 2025). Indicates that treatment of LPLK is typically done for cosmetic reasons if at all. Lists available aesthetic treatments for LPLK, including cryotherapy, laser ablation, and radiofrequency ablation to remove the lesion, as well as advanced options like photodynamic therapy and LED light therapy for skin lesions. This source reinforces that while medically not required, there are various procedures that can successfully eliminate an LPLK for patients who desire removal for appearance or comfort.
   
   
6. Maor et al., Clinical and Experimental Dermatology 42(6): 663–6 (2017) – “Lichenoid keratosis is frequently misdiagnosed as basal cell carcinoma.” A study of patients with lichenoid keratosis, highlighting that clinically these benign lesions were often mistaken for basal cell carcinoma, a type of skin cancer. This research underlines the importance of biopsy for accurate diagnosis. It provides evidence that LPLK can closely imitate the look of certain skin cancers, which is why dermatologists may err on the side of caution and biopsy such lesions. (This supports patient guidance that an LPLK diagnosis is confirmed by pathology and that initial concern for cancer is common but ultimately unfounded once the true diagnosis is made.)