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Lichen Planus

Lichen Planus

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Lichen Planus

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  1. Lichen Planus

  2. Definition • Lichen Planus is a common inflammatory disorder of skin characterized clinically by distinctive, violaceous, flat topped papules; and histologically by a band like lymphocytic infiltrate at the dermo-epidermal junction.

  3. Aetiology • Exact cause unknown • Probably immunologically mediated • Genetic predisposition: HLA-B7, HLA-DR1, HLA-DR10 • Associations: ulcerative colitis, alopecia areata, vitiligo, hepatitis, and primary biliary cirrhosis. • Drugs: NSAIDs, Chloroquine, ACE inhibitors, hypoglycaemic agents Mercury, gold, nickel sensitivity seen in oral lichen planus

  4. Clinical features • Lichen planus can involve skin, mucous membranes, genitalia, nails and scalp. • Associated with pruritus • Commonly affects young adults • Males and females equally affected • Various clinical types seen • Characteristic papules/ plaques of Lichen planus : Violaceous, erythematous, flat topped, shiny, and polygonal; varying in size from 1 mm to greater than 1 cm in diameter. They can be discrete or arranged in groups of lines or circles.

  5. Classical LP

  6. Clinical features • Wickham’s striae: fine, criss-cross white lines, made prominent by oil application • Koebner’s phenomenon: Development of lesions in previously normal skin that has been subjected to trauma

  7. Clinical types • Acute wide spread: involving flexor surface of wrists, forearms, shins, ankles, dorsae of feet, anterior thighs and flanks • Chronic localized: around ankle & wrist. • Hypertrophic: extensor surfaces of lower extremities • Actinic: nummular patches with a hypopigmented zone surrounding a hyperpigmented center • Lichen PlanusPigmentosus: Diffuse macular, slate grey or brownish pigmentation of face, neck, upper limbs

  8. Acute widespread LP

  9. Acute widespread LP

  10. Acute widespread LP

  11. Acute widespread LP

  12. Hypertrophic LP

  13. Actinic LP

  14. Clinical types • Annular: buccal mucosa and the male genitalia. • Linear: zosteriform lesion on extremities • Vesicular and bullous: lower limbs, oral cavity • Atrophic: resolution of annular or hypertrophic lesions. • Erosive: mucosal surfaces • Follicular: Lichen planopilaris ; more common in women than in men, scarring alopecia may result. • Oral: reticular( white lace-like), atrophic, erosive, plaque • Genital : common in men; typically annular lesion on glans seen • Nail: thin striated nails with pterygium

  15. Oral LP

  16. Oral LP

  17. Genital LP

  18. Biopsy • Hyperkeratosis, focal wedge shaped hypergranulosis, acanthosis, saw-toothed rete ridges, basal cell degeneration • Band like lymphocytic infiltrate at dermoepidermal junction

  19. Histopathology

  20. Differential diagnosis • Disseminated Eczema • Scabies • Drug eruption • PityriasisRosea • Psoriasis • Prurigonodularis • Secondary syphilis • Mucosal lesions: candidiasis, leukoplakia, pemphigus

  21. Treatment • Lichen Planus is a self-limited disease that usually resolves within 8-12 months. • Topical: Calamine lotion, Steroids, Cyclosporin, Tacrolimus • Systemic: Antihistaminics, Steroids, Dapsone, Griseofulvin, Retinoids, PUVA, Cyclosporin Acute widespread LP: • Prednisolone 0.5-1 mg/kg/ day tapered over few weeks for symptomatic control and rapid resolution. Monitoring of side-effects & judicious use recommended.

  22. Treatment Mild cases & localised lesions : • Antihistamines • Topical steroids eg: Fluocinoloneacetonide, Betamethasonevalerate Hypertrophic Lichen Planus: • Topical clobetasol propionate • Intralesional injection of triamcinoloneacetonide (40mg/ml) Oral Lichen Planus: • Topical steroids in orabase • Tacrolimus, cyclosporin • Systemic steroids • Dapsone

  23. Prognosis / Complications • Lesions resolve with pigmentation that may last for many months • Recurrent episodes can occur • Oral lesions may be premalignant • Scarring alopecia

  24. PityriasisRosea

  25. Definition • Acute self limiting disease, probably infective in origin affecting mainly children and young adults and characterized by distinctive skin eruptions and minimal constitutional symptoms.

  26. Aetiology • Exact cause uncertain • Probably viral infection- HHV 7, HHV 6 • Drugs - Metronidazole, Isotretinoin, Arsenic,Bismuth, Barbiturates, Clonidine, Captopril, Gold

  27. Clinical features • Commonly seen in children and young adults (10-35 yrs) • Males & females equally affected • More common in winter • Constitutional symptoms mild • First manifestation: • Herald patch Large, well demarcated, Round or oval scaly macule or plaque commonly seen on thigh, upper arm, trunk, neck. Contd…

  28. Clinical features Widespread eruptions: • Appear 5-15 days after herald patch • Christmas tree pattern on upper chest and back • Discrete oval macules • Collarette of scales Contd…

  29. Clinical features • Mild pruritus • Oral mucosa- congested • Constitutional symptoms present • Lesions last for 3-6 weeks, self limiting • Lesions heal with hypo/hyperpigmentation or no pigmentation Contd…

  30. Clinical features Atypical presentation • Papular • Papulovesicular • Vesicular • Purpuric • Lichenoid • Urticarial • Distribution • Inverse distribution • Unilateral • Few lesions around herald patch • VidalsPityriasisRosea - axilla , groin

  31. Differential diagnosis • TineaCorporis • Guttate Psoriasis • Parapsoriasis (small plaque) • Secondary Syphilis • Seborrheic Dermatitis • Pityriasis alba • Pityriasislichenoideschronica

  32. Treatment • Self limiting condition • Treatment modalities: • Sunlight • Oral Erythromycin • Topical steroids • UVB • PUVA • Systemic Steroids in severe cases

  33. Thank you