Dermatology

1. LICHEN PLANUS
Dr. Angelo Smith
WHPL

2.  Overview
Lichen planus has been described
as an
 autoimmune disease,
 a dermatosis,
 a papulosquamous disorder,
 a mucocutaneous disease, and
 an inflammatory disease.

3. Lichen planus lesions are so
called because of their "lichen-
like" appearance

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.

7.  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.

10. 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.

13. Pruritus; rubbing than
scratching.
 Koebner’s phenomenon
(isomorphic response).
 After lesions subside, post
lichen hyperpigmentation
occurs.

17. Koebner's Phenomenon

18. 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.

19. Lichen planopilaris
Lichen Planopilaris is the specific name given
to lichen planus on the scalp that may
cause permanent, scarring alopecia

20. 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

22.  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.

23. LP of oral mucosa

24. LP of the Tongue

25. Complications of LP
 Squamous cell carcinoma in oral
ulcerative lesions.
 Cicatricial alopecia in scalp LP.
 Post inflammatory hyper pigmentation.

26. 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.

27. 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