Transcript Document

Prognosis
• Typically LP persists for 1 to 2 years, but
it may follow a chronic, relapsing course
over many years
• Generalized eruptions tend to have a rapid
course and heal spontaneously faster than
limited cutaneous disease
• LP planopilaris is one of the most chronic
and often progressive disease variants
•
• Hypertrophic LP typically follows a
protracted, unremitting course
• The mean duration for oral LP is 5 years.
The reticular variant has a better
prognosis than erosive disease that does
not heal spontaneously
Special Forms of LP or
Lichenoid Eruptions
Drug-Induced LP
• This item describes a group of cutaneous
reactions identical to or similar to LP
• Lichenoid drug eruptions have been
reported after ingestion, contact, or
inhalation of certain chemicals e.g.
-Common drugs
Gold salts
β blockers
Antimalarials
Thiazide diuretics
-Less common drugs:
ACE inhibitors
Calcium channel blockers
Sulfonylurea
Nonsteroidal anti-inflammatory drugs
Ketoconazole
Tetracycline
- Topical agents:
Color film developers
Dental restorative materials
Musk ambrette
Nickle
-Inducers of oral LP& lichenoid eruptions:
Allopurinol
ACE inhibitors
Dental restorative materials
Ketoconazole
Nonsteroidal anti-inflammatory drugs
• A lichenoid drug eruption may be typical or
atypical for classic LP, with localized or
generalized eczematous papules and plaques
and variable desquamation
• Lichenoid drug eruptions
do not exhibit classic
Wickham striae
• Unlike the flexural distribution
• of classic LP, the eruptions
usually appear symmetrically
on the trunk and extremities
• The latency period for development of a
lichenoid drug eruption by these agents
varies from months to a year or more
based on the dosage, host response,
previous exposure, and concomitant drug
administration
• Resolution of the eruptions is quite
variable, but most disappear in 3 to 4
months. Resolution of a gold-induced
lichenoid eruption may require up to 2
years after discontinuation of the drug
Prognosis
• Typically LP persists for 1 to 2 years, but
it may follow a chronic, relapsing course
over many years
• Generalized eruptions tend to have a rapid
course and heal spontaneously faster than
limited cutaneous disease
• LP planopilaris is one of the most chronic
and often progressive disease variants
•
• Hypertrophic LP typically follows a
protracted, unremitting course
• The mean duration for oral LP is 5 years.
The reticular variant has a better
prognosis than erosive disease that does
not heal spontaneously
Special Forms of LP or
Lichenoid Eruptions
Drug-Induced LP
• This item describes a group of cutaneous
reactions identical to or similar to LP
• Lichenoid drug eruptions have been
reported after ingestion, contact, or
inhalation of certain chemicals e.g.
-Common drugs
Gold salts
β blockers
Antimalarials
Thiazide diuretics
-Less common drugs:
ACE inhibitors
Calcium channel blockers
Sulfonylurea
Nonsteroidal anti-inflammatory drugs
Ketoconazole
Tetracycline
• The latency period for development of a
lichenoid drug eruption by these agents
varies from months to a year or more
based on the dosage, host response,
previous exposure, and concomitant drug
administration
• Resolution of the eruptions is quite
variable, but most disappear in 3 to 4
months. Resolution of a gold-induced
lichenoid eruption may require up to 2
years after discontinuation of the drug
LP- Lupus Erythematosus
Overlap Syndrome
• This rare condition is characterized by
lesions that share features of
LP and lupus erythematosus
• There are atrophic plaques
and patches with hypopigmentation and a livid red
to blue-violet color with
telangiectasia and minimal
scaling
• Lesions may develop anywhere, but are
most common on the extremities
• Classic lesions of LP are not usually seen.
Photosensitivity, pruritus, and follicular
plugging are also not common
• Lesions may develop anywhere, but are
most common on the extremities
LP- Lupus Erythematosus
Overlap Syndrome
• This rare condition is characterized by
lesions that share features of
LP and lupus erythematosus
• There are atrophic plaques
and patches with hypopigmentation and a livid red
to blue-violet color with
telangiectasia and minimal
scaling
• Lesions may develop anywhere, but are
most common on the extremities
• Classic lesions of LP are not usually seen.
Photosensitivity, pruritus, and follicular
plugging are also not common
• Lesions may develop anywhere, but are
most common on the extremities
Graft-Versus-Host Disease
• It occurs in 20-80% of recipients after
bone marrow transplantation
• An acute form occurs after 3 weeks of
transplantation
• It is characterized by
fever, with an
erythematous macular
rash often beginning
on the face, neck and
shoulders, but
subsequently
spreading to the trunk
and limbs
• The mucous membranes are often
involved with xerostomia and oral
ulcerations
• Abdominal
symptoms develop
within days or weeks
with diarrhoea and
liver dysfunction
• Chronic GVHD occurs after 3 months of
transplantation and is often preceded by
the acute form
• The cutaneous eruption
is often widespread
and papular, and it
may closely resemble
LP
LP and the Liver
• LP is seen with increased frequency in
association with liver diseases such as
autoimmune chronic active hepatitis, primary
biliary cirrhosis
• HCV has also been implicated in triggering
LP
• Several reports described LP-like eruptions
after hepatitis B vaccination
Histopathology
1-compact orthokeratosis with very
few, if any, parakeratotic cells
2-Wedge-shaped
hypergranulosis
3-Irregular
acanthosis giving
rise to domeshaped dermal
papillae and to
pointed or sawtoothed rete
ridges
4-Vacuolar degeneration of basal layer and
apoptosis of the basal cells giving rise to the
characteristic round eosinophilic apoptotic bodies
(as colloid, hyaline, cytoid, or Civatte bodies)
5-A band-like dermal
lymphocytic infiltrate
which is composed
almost entirely of
lymphocytes
intermingled with
macrophages
Lichen planopilaris :
Follicular plugging,
hypergranulosis, and
dense band-like
perifollicular
lymphocytic infiltrate
that obscures the
infundibular
epithelium
Hypertrophic LP:
Marked irregular
acanthosis,
hypergranulosis, and
compact orthokeratosis.
The vacuolar alteration
and the lymphocytic
inflammatory infiltrate is
accentuated at the base
of the rete ridges
LP- Lupus Erythematosus Overlap Synd.
• Histologically, a lichenoid reaction typical for
lichen planus and histologic features of lupus
erythematosus are usually present in the
same biopsy
Treatment
• For limited lesions: Potent topical steroids (e.g.
clobetasol) are useful, with or without occlusion,with
oral sedating antihistamines
• For severe cases where the irritation is
interfering with the patient's life, where
ulcerative mucous membrane lesions have
occurred or where there is progressive nail
destruction: Systemic steroids (e.g. 5-20mg
daily)for about 6 weeks and then tapered
• Some relapse is liable to occur on
discontinuation of systemic steroids, but
the disease is self-limiting and
corticosteroid therapy eases the patient
through the worst part of its course
• Remission and marked improvement was
achieved with 30 mg/day of acitretin for 8
weeks
• Photochemotherapy is usually successful
in generalized LP
• For recalcitrant cases: Systemic
cyclosporine(3-10 mg/kg/day) has been used
successfully. Pruritus usually disappears after 1
to 2 weeks. Clearance of the rash is seen in 4 to
6 weeks
• Azathioprine is useful in recalcitrant, generalized
cutaneous lichen planus. Similar results are
seen with mycophenolate mofetil at a dose of
1500 mg twice daily
• For Hypertrophic LP: Intralesional
triamcinolone (10mg/ml) is useful
• For oral & mucosal LP:
• Replacement of amalgam or gold dental
restorations with composite material is
frequently of considerable benefit
• Topical steroids are the first-line therapy in
mucosal LP. Use of occlusive materials
suitable for mucous membranes, such as
Orabase, may provide sustained tissue
contact with the steroid, as well as alleviate
the discomfort associated with erosive
lesions
• Glucocorticoids can be administered by
intralesional injection
• Topical anesthetics also provide
symptomatic benefit for patients with
difficulty eating and chewing
• Systemic steroids are effective in a dose
range from 30 to 80 mg/day, tapered over 3
to 6 weeks. Relapses are common after
dose reduction or discontinuation