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Lichen Planus

Title               

Ñ    Lichen Planus

Definition

Ñ    Pruritic inflammatory dermatosis

Ñ    Mucosal involvement common

Ñ    Nail dystrophy:

Rare

Ñ    Scarring alopecia:

Rare               

Pathogenesis

Causes

Ñ    Unknown

Ñ    Association with hepatitis C

Similar rash

Ñ    Drugs:

Levamisole, gold, penicillamine, antimalarials

Ñ    Graft versus host disease

Pathological Process

Ñ    T cell immune mechanism

Ñ    Mixed lymphohistiocytic infiltrate at the dermoepidermal junction

Ñ    Basal layer undergoes liquifactive degeneration

Ñ    Colloid bodies in the upper dermis

Ñ    Acanthosis and hyperkeratosis of the epidermis

Clinical Features

History

Age

Ñ    Any age

Ñ    Most cases 30-65 years

Sex

Ñ    Males = Females

IS

Ñ    Intense pruritus

Examination

IS

Skin

Ñ    Flat topped papules

Ñ    Polygonal in shape

Ñ    Papules may fuse to form plaques

Ñ    Purple

Ñ    Wickham’s striae:

Fine lacy white pattern on the surface

Ñ    Koebner’s phenomenon 

Ñ    Hyperpigmentation:

After resolution of lesions

Distribution

Ñ    Flexor aspects of wrists and legs:

Common

Ñ    Scratch marks:

Koebner phenomenon

Mucosa

Ñ    Mouth, oesophagus, anogenital involvement

Ñ    Mucosal lesions cause pain

Nails

Ñ    Dystrophic nail plate thinning with longitudinal grooving and ridging

Ñ    Hyperpigmentation

Ñ    Subungual hyperkeratosis

Ñ    Onycholysis

Hair

Ñ    Scarring alopecia

GIT

Lesions in:

Ñ    Mouth

Ñ    Oesophagus

Ñ    Anus

RAG

Lesions in:

Ñ    Vulva

Ñ    Vagina

Ñ    Male genitalia

Complications

GIT

Ñ    Ulcerative mucosal disease is premalignant

Investigations

Tissue diagnosis

Skin Biopsy

Ñ    If there is difficulty in making the diagnosis

Management

Control

Drugs

Ñ    Topical steroids

Ñ    Oral steroids

Ñ    Oral retinoids

Ñ    Azathioprine

Ñ    PUVA

Ñ    Topical tacrolimus:

Off license

Prognosis

Ñ    Clears in 18 months

Ñ    May recur

 

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