Lichen Planus

Lichen planus
  • It is a cell-mediated immune response of unknown origin.
  • It may be found with other diseases of altered immunity, such as ulcerative colitis, alopecia areata, vitiligo, dermatomyositis, morphea, lichen sclerosis, and myasthenia gravis.May occur in Hepatitis C patient
  • Spontaneous remissions seen in 6 month to 2 years.
Site:
  • Lichen planus may be categorized as affecting mucosal or cutaneous surfaces.
Cutaneous Lesions can affect the:
  1. Extremities (face, dorsal hands, arms, and nape of neck). Palms and soles
  2. Intertriginous areas of the skin. This is also known as "Inverse lichen planus."
  3. Nails
  4. Hair and Scalp.
  • Mucosal forms are those affecting the lining of the gastrointestinal tract (mouth, pharynx, esophagus, stomach, anus), larynx, and other mucosal surfaces including the genitals, peritoneum, ears, nose, bladder and conjunctiva of the eyes.
Lesion morphology
  • This description is known as the characteristic "6 Ps" of lichen planus: planar (flat-topped), purple, polygonal, pruritic, papules, and plaques.
  • Most characteristic Feature of lichen planus is Wickham Striae(white lines which traverse the surface of the papules.)
Nail involvement
  • The nail plate tends to thin and may become longitudinally grooved and ridged.
  • The nail may darken, thicken up or lift off the nail bed (onycholysis).
  • Sometimes the cuticle is destroyed and forms a scar (pterygium)-diagnostic.
  • The nails may shed, stop growing altogether and rarely, completely disappear. Beau's lines are transverse grooves that appear simultaneously on all nails
Diagnosis:
  • Direct immunofluorescence study reveals globular deposits of immunoglobulin M (IgM) and complement mixed with apoptotic keratinocytes.
  • Hyperkeratotic epidermis with irregular acanthosis and focal thickening in the granular layer
  • Basal Cell Degeneration.Degenerative keratinocytes (colloid or Civatte bodies) in the lower epidermis.
  • Linear or shaggy deposits of fibrin and fibrinogen in the basement membrane zone
  • In the upper dermis, a bandlike infiltrate of lymphocytic (primarily helper T) and histiocytic cells with many Langerhans cells.
Management:
  • Cutaneous lichen planus: Topical steroids(first-line treatment); systemic steroids; oral regimens like metronidazole, acitretin, methotrexate, hydroxychloroquine, griseofulvin, and sulfasalazine .
  • Lichen planus of the oral mucosa: Topical steroids; topical calcineurin inhibitors; oral or topical retinoids (with close monitoring of lipid levels
  • Patients with widespread lichen planus may respond to the following:
  • Narrow-band or broadband UV-B radiation
  • Psoralen with UV-A (PUVA) radiation.
Exam Question
  • A combination therapy with steroids and Dapsone is used in generalised Lichen Planus.
  • LP is characterized by shiny, violaceous, flat-topped polygonal papules which retain the skin lines.
  • Wickham’s striae are white lines which traverse the surface of the papules.
  • A focal increase in thickness of the granular layer and infiltrate corresponds to the presence of Wickham’s striae.
  • Mouth lesions are seen in Lichen Planus.
  • Skin, hair and oral mucosa commonly involved in Lichen Planus.
  • Features of Lichen planus are Pruritus, Purple, Papule
  • Max. Joseph's space is a histopatho-logical feature of Lichen Planus.
  • Civatte bodies are found in Lichen Planus.
  • Following is seen in a case of Leprosy:Basal cell degeneration; Colloid bodies seen; Epidermal hyperplasia in chronic cases.
  • A young lady presents with lacy lesions in oral cavity and genitals, and her proximal nail fold has extended onto the nail bed. Lichen Planus is the likely diagnosis.
  • A 30 year old male present with pruritic flat-topped polygonal, shiny violaceous papules with flexural distribution. the most likely diagnosis is Lichen Planus.
  • Lymphatic infiltration in supradermal layer is seen in Lichen Planus.
  • Lichen Planus may be associated with Hepatitis 'C.
  • Topical Steroids are the mainstay of therapy in Lichen Planus.
  • Spontaneous remissions may be seen in 6month to 2 years.
  • Characterstic nail finding in lichen planus is Pterygium.
  • Most characteristic Feature of lichen planus is Wickham Striae.
  • The most characteristic finding In lichen planus is Basal Cell Degeneration.
  • Nail deformity commonly seen in lichen planus are Pterygium ,Longitudnal grooves ,Oncholysis.
  • Wood's lamp is not used for diagnosing Lichen Planus.
  • Lichen planopilaris ,Lichen hypertrophica , Lichen pigmentosa are the types of Lichen Planus.
  • Lichen scrofulosorum is a type of cutaneous TB, not the lichen planus.
  • Koebner phenomenon may be seen in Lichen Planus.
  • The role of Lichen Planus in predisposing Squamous cell carcinoma of Oral cavity is uncertain.
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