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    أحمد عبد الوهاب
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    Lichen planus is a chronic inflammatory skin condition characterized by flat-topped, violaceous papules that typically affect the wrists, ankles, and other areas. It results from a T cell-mediated autoimmune reaction against skin cells. Oral lichen planus lesions occur in over 50% of cases and can cause pain or burning. Treatment involves topical or oral corticosteroids to reduce inflammation. For resistant or widespread cases, phototherapy, retinoids, or immunosuppressants may be used. Lichen planus usually follows a chronic waxing and waning course over several years.

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    Lichen planus is a chronic inflammatory skin condition characterized by flat-topped, violaceous papules that typically affect the wrists, ankles, and other areas. It results from a T cell-mediated autoimmune reaction against skin cells. Oral lichen planus lesions occur in over 50% of cases and can cause pain or burning. Treatment involves topical or oral corticosteroids to reduce inflammation. For resistant or widespread cases, phototherapy, retinoids, or immunosuppressants may be used. Lichen planus usually follows a chronic waxing and waning course over several years.

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    302 views6 pages

    Lichen Planus

    Uploaded by

    أحمد عبد الوهاب
    Lichen planus is a chronic inflammatory skin condition characterized by flat-topped, violaceous papules that typically affect the wrists, ankles, and other areas. It results from a T cell-mediated autoimmune reaction against skin cells. Oral lichen planus lesions occur in over 50% of cases and can cause pain or burning. Treatment involves topical or oral corticosteroids to reduce inflammation. For resistant or widespread cases, phototherapy, retinoids, or immunosuppressants may be used. Lichen planus usually follows a chronic waxing and waning course over several years.

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    Lichen planus

    DEFINITION
    Lichen planus is an idiopathic inflammatory disease of skin
    and mucous membrane . It is characterized by itchy, flat,
    violaceous skin papules that favors exteremeties .It comes in
    episodes lasting months to years. The onset may be gradual
    or quick.
    Epidemiology
    LP affects up to 1% of population
    All racial groups are affected .
    Age group 30-60 years.
    Children and elderly are rarely affected.
    Women : men approximately 2:1.
    .Familial cases are rare.
    Actinic form is common in middle east countries.
    Aetiology
    Lichen planus (LP) is thought to be caused by a T cell–mediated
    autoimmune reaction against basal epithelial keratinocytes in
    .people with genetic predisposition
    :Triggering factors
    • Infection :virus or bacteria..
    • Emotional factors appear to be sometimes of
    importance.
    • Exposure to sun,especialy in the actinic or
    photosensetive type.
    • Trauma.

    • Hepatitis C infection.
    • Certain types of vaccines . hepatitis B
    • Nonsteroidal anti-inflammatory drugs.
    • Certain medications for heart disease, high blood
    pressure or arthritis
    • Allergic reactions to amalgam fillings may contribute
    to oral lesions
    CLINICAL FEATURES
    The disease is characterized by itchy papular lesions located
    at: the wrist region ,flexor aspect of the forearm,
    ankles, legs , neck , genital and sacral regions.

    Mucous membrane lesions occur in more than 50% of cases


    ;scalp,the palms, soles and nails can be involved
    Signs and symptoms of lichen planus vary depending on what
    parts of the body are affected.
    MORPHOLOGY
    The lesion is a papule which is characterized by being flat
    topped,polygonal in shape,violacious in color ,has glistening
    surface,and shows central umblication and fine arborisations
    which are called ‘Wickhams striae.there may be fine adherent
    scales on its surface.
    Koebner phenomenon is commonly seen in LP.
    The lesions may be few,numerous, disceret or coalising
    together giving rise to plaques.
    The rash tends to heal with prominent blue-black or brownish
    discoloration that persists for a long time
    CLINICAL VARIETIES
    CHRONICITY 1
    Acute Lichen planus <6 monthes
    Lesions are widely distributed and dissemenate rapidly
    commonly in trunk,inner aspect of wrist and dorsum of the
    feet. Lesions resolve with hyper pigmentation within 3-9
    .mths
    .Chronic Lichen planus> 6 monthes

    Morphology 2
    • The classical type.
    • Annular type
    • Linear type.
    • Atrophic type.
    • Hypertrophic type.
    • Bullous type.
    Hypertrophic lichen planus
    This condition appears as thick, reddish-brown lesions that
    are covered with scales. These lesions 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.
    Localization 3
    • Lichen planus of the mucous membrane.
    • Actinic or photosensitive type .
    • Genital lichen planus.
    • Licken planus of the scalp Lichen plano-pilaris .
    • Lichen planus of the nails,
    • Lichen planus of palms and soles
    • Inverse lichen planus.

    (Mucous membrane of the mouth( 50%


    1. Reticular pattern : more common,patches of lacy white
    lines that appear most often on the inside of cheeks. The
    gums, lips and tongue also may be affected
    Usually.‘asymptomatic.
    2. Erosive form: sores or ulcers that appear in the mouth.
    These tend to cause pain or a burning sensation , malignant
    change is a possibility.

    Actinic lichen planus


    • LP- Tropics
    • Photosensitive type
    Scalp lesion: lichen planopilaris
    Lichen planus affecting the scalp is relatively rare. The name
    given for this condition is lichen planopilaris. The lesions
    may result in:
    • Temporary or permanent hair loss
    • Scarring or discoloration of the scalp after healing.
    Nails
    • Ridges running the length of the nail
    • Thinning or splitting of the nail
    • Temporary or permanent nail loss
    GENITALIA
    Men. Annular and itchy lesion most often affect the tip of the
    penis (glans).
    Women. Lichen planus can cause purplish skin lesions and
    itching on the external genitalia (vulva) or painful, burning
    sores on the mucous membrane lining the vagina. .

    Tests and diagnosis


    Biopsy. A punch biopsy may be necessary to confirm the
    diagnosis or to rule out another cause.
    . Hepatitis C test.

    Histopathology
    • Hyperkeratosis without parakeratosis
    • Hypergranulosis : which is sometimes irrigular and
    this is responsible for wikham’s striae .
    • Irregular acanthosis: Development of a "saw-tooth"
    appearance .
    • Liquifaction degeneration of basal cell layer resulting
    in Vacular changes within basal cell layer and
    separation between dermis and epidermis (max- Joseph
    spaces)
    • Civatte or colloid body formation. These result from
    degenerating of keratinocytes .
    • Band like Infiltration of lymphocytic inflammatory
    cells into the subepithelial layer of connective tissue
    DIFFERENTIAL DIAGNOSIS
    • Psoriasis
    • Lichenoid drug eruption
    • Chronic eczem
    • Pityriasis rosea
    • Leucoplekia
    • Lichen amyloidosis
    • Plaques of Verruca vulgaris
    COURSE AND PROGNOSIS
    • Lichen planus, usually runs a chronic course with
    remission and excerbation . The average duration of the
    condition is 3-6 years, being longer in hypertrophic
    lesions and mucous membrane involvement . The
    prognosis of the acute variety is better than chronic type
    and response to treatment is better .
    • Spontaneous resolution has been observed in more
    than half of the patients after one year,mean duration of
    oral lichen is about 5 years.
    Triggers
    • Drugs. Possibility of drug intake should be
    considered .
    • Exposure to sun. protection
    • Stress assurance
    • Hepatitis C. referre to a specialist in liver disease
    (hepatologist) for further diagnostic evaluation and
    disease management
    Medications

    • Topical and Oral steroids.


    • Topical and Oral retinoids )
    • Antihistamines
    • Grisofulvin .
    • Immunosuppressive drugs

    • PHOTOTHERAPY.

    Corticosteroids
    Corticosteroids improves inflammation associated with lichen
    planus.
     Topical,topical under occlusion.
     Intralesional
     Oral .
    Antihistamine
    Antihistamines act against a protein called histamine that is
    involved in inflammatory activity, they relieve itching
    associated with lichen planus.
    Retinoids
    • Retinoids are synthetic versions of vitamin A that
    can be applied topically or taken orally for treatment.
    • Because both topical and oral retinoids can cause
    birth defects, the drugs shouldn't be used by women
    who are pregnant or planning to become pregnant in the
    near future
    • Immunosuppressive drugs
    • Oral Cyclosporins in resistant cases not responding
    to corticosteroids and retinoids
    Phototherapy
     Light therapy, or phototherapy, may help clear up
    lichen planus affecting the skin. In loalized resistant or
    hypertrophic cases.
    phototherapy

     UVB
    The most common phototherapy for lichen planus uses
    ultraviolet B (UVB) light, which penetrates only the upper
    layer of skin (epidermis).
     UVA
    ultraviolet A (UVA) light, which penetrates deep into the
    skin. This therapy is usually used in combination with oral
    or topical psoralen.

    ***Short-term side effects of this therapy may include


    nausea, headache and itching. To avoid sunburns, avoid sun
    exposure for a couple of days after taking psoralen

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