Transcript 10__LICHEN_PLANUS_1_

LICHEN PLANUS
(LP)
Overview
Lichen planus is an inflammatory disease that affects the
skin and the oral mucosa.
Cause
The cause of lichen planus is not known; however, there
are cases of lichen planus-type rashes (known as
lichenoid reactions) occurring as allergic reactions to
medications for high blood pressure, heart disease and
arthritis. These lichenoid reactions are referred to as
lichenoid mucositis (of the mucosa) or dermatitis (of the
skin). Lichen planus has been reported as a complication
of chronic hepatitis c virus infection and can be a sign of
chronic graft-versus-host disease of the skin.
It has been suggested that true lichen
planus may respond to stress, where
lesions may present on the mucosa or skin
during times of stress in those with the
disease. Lichen planus affects women
more than men (at a ratio of 3:2), and
occurs most often in middle-aged adults.
Lichen planus in children is rare.
C/P
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The typical rash of lichen planus is well-described by the "5 P's":
well-defined pruritic, planar, purple, polygonal papules.
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Flexor surfaces especially wrists, flanks, medial thighs, shins of
tibia, glans penis, nails, scalp & oral mucosa.
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Pruritus; rubbing than scratching.
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Koebner’s phenomenon (isomorphic response).
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After lesions subside, post lichen hyperpigmentation occurs.
Koebner's Phenomenon
Hypertrophic Lp
Lichen planopilaris
Lichen Planopilaris is the specific name
given to lichen planus on the scalp that
may cause permanent, scarring alopecia.
LP of Scalp  Cicatricial Alopecia
Oral LP
Oral lichen planus may present in one of three forms.
The reticular form is the most common presentation and
manifests as white lacy streaks on the mucosa (known
as Wickham's striae) or as smaller papules (small raised
area). The lesions tend to be bilateral and are
asymptomatic. The lacy streaks may also be seen on
other parts of the mouth, including the gingiva (gums),
the tongue, palate and lips.
The bullous form presents as fluid-filled vesicles which
project from the surface.
The erosive form presents with erythematous (red)
areas that are ulcerated and uncomfortable. The
erosion of the thin epithelium may occur in
multiple areas of the mouth, or in one area,
such as the gums, where they resemble
desquamative gingivitis. Wickham's striae may
also be seen near these ulcerated areas. This
form may undergo malignant transformation.
LP of oral mucosa
LP of the Tongue
Complications of LP
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Squamous cell carcinoma in oral ulcerative lesions.
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Cicatricial alopecia in scalp LP.
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Postinflammatory hyperpigmentation.
Differential Diagnosis
The clinical presentation of lichen planus may also
resemble other conditions, including:
 Lichenoid drug reaction
 Discoid Lupus Erythematosus
 Chronic Ulcerative Stomatitis
 Pemphigus Vulgaris
 Benign Mucous Membrane Pemphigoid
 Oral leukoplakia
 Frictional keratosis
A biopsy is useful in identifying histological features that
help differentiate lichen planus from these conditions.
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Treatment
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Currently there is no cure for lichen planus but there are
certain types of medicines used to reduce the effects of
the inflammation. Lichen planus may go into a dormant
state after treatment. There are also reports that lichen
planus can flare up years after it is considered cured.
Medicines used to treat lichen planus include:
Oral and topical steroid
Oral retinoids
immunosuppressant medications
Hydroxychloroquin
Tacrolimus
dapson
PITYRIASIS ROSEA (PR)
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An inflammatory non-infectious scaly erythematous eruption.
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An exanthematous reaction to an upper respiratory viral infection.
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Highest between 15-40 years.
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More prevalent in spring & autumn.
Etiology
Human herpes virus (HHV)-6 & -7.
C/P
Primary Lesion: Herald patch
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Single oval lesion with three different zones.
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Starts on one side of the trunk with its longitudinal axis // to ribs.
C/P (cont.)
Secondary Eruption:
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Occurs after 1-2 weeks from the onset of herald patch.
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Similar to herald patch, but smaller & multiple.
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Distributed along long axis of ribs (Christmas tree pattern).
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Located on the trunk & proximal parts of the limbs; flannel
area giving picture of jacket with short sleeves.
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Itching.
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Spontaneously heal within 4-8 weeks.
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Recurrences are not common.
Herald Patch
Secondary Eruption
DD: Tinea circinata (by CP & scraping).
Treatment
1.
Patient reassurance.
2.
Avoid skin irritation.
3.
Soothing lotions, e.g. calamine lotion.
4.
Oral antihistamines, mild topical corticosteroids & UVB.
THANKS FOR YOUR ATTENTION