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Lichen planus

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Lichen planus

  1. 1. LICHEN PLANUS Dr. Angelo Smith WHPL
  2. 2.  Overview Lichen planus has been described as an  autoimmune disease,  a dermatosis,  a papulosquamous disorder,  a mucocutaneous disease, and  an inflammatory disease.
  3. 3. Lichen planus lesions are so called because of their "lichen- like" appearance
  4. 4. 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.
  5. 5.  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.
  6. 6. C/P  The typical rash of lichen planus is well- described by the "5 P's": well-defined  pruritic,  planar,  purple,  Polygonal,  papules  Flexor surfaces especially wrists, flanks, medial thighs, shins of tibia, glans penis, nails, scalp & oral mucosa.
  7. 7. Pruritus; rubbing than scratching.  Koebner’s phenomenon (isomorphic response).  After lesions subside, post lichen hyperpigmentation occurs.
  8. 8. Koebner's Phenomenon
  9. 9. Hypertrophic Lp •This condition appears as thick, reddish-brown lesions that are covered with scales. •These spots tend to be on the shins, but they can occur anywhere on the body. •This is an especially itchy and persistent (chronic) variant of lichen planus.
  10. 10. Lichen planopilaris Lichen Planopilaris is the specific name given to lichen planus on the scalp that may cause permanent, scarring alopecia
  11. 11. 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
  12. 12.  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.
  13. 13. LP of oral mucosa
  14. 14. LP of the Tongue
  15. 15. Complications of LP  Squamous cell carcinoma in oral ulcerative lesions.  Cicatricial alopecia in scalp LP.  Post inflammatory hyper pigmentation.
  16. 16. 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.
  17. 17. Course and Outcome  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