JNUH

Lichen Planus

  • Lichen planus (LP) is a chronic inflammatory disease of unknown etiology affecting skin and mucous membranes, hair and nail.
  • Clinically characterized by pruritic, pink, polygonal, violaceous, flat topped, papular lesions.
Lichen Planus
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  • Mild to severe pruritus.
  • Small polygonal, violaceous, flat topped, papules.
  • The surface is transparent with a network of fine white striations (criss-cross lines).
  • These lines are called “Wickham’s striae”
  • These papules are widespread as clusters or coalesce into large plaques.
  • Koebner’s phenomenon is commonly seen. Development of lesions along the lines of trauma over the normal skin.
  • Common sites – flexor surface of wrists, forearms, hands, legs, neck and sacral areas.
  • Other sites – oral mucosa, genitalia, scalp and nails.

Lichen planus represents:

  • T-cell mediated autoimmune damage to basal keratinocytes.
  • An increased association with other autoimmune disorders like ulcerative colitis, myasthenia gravis, lupus erythematosus, alopecia areata and diabetes.
  • Exact nature of LP antigen is unknown.
  • Increased frequency of HLA-B27, HLA-B51,HLA-BW57,HLA-DR1,HLA-DR4,HLA-DR6.
  • In genetically predisposed person, the antigen can be self peptide or various exogenous agents like drugs, contact allergens, viruses or bacteria and mechanical trauma.
  • Viruses – Hepatitis C (HCV)-Common in oral LP
  • Human herpes virus (HHV-6)
  • Vaccinations – HBV, Killed influenza, MMR,DPT
  • Helicobacter. pylori
  • Contact allergens – dental amalgams(mercury),copper and gold
  • Incidence – 0.2% - 1%
  • No racial predilection
  • Seen in all age groups and both sexes
  • More common in 30-60 years age group
  • Familial cases are reported

How is it diagnosed?

Histopathology
  • Compact Hyperkeratosis
  • Focal wedge shaped Hypergranulosis
  • Acanthosis
  • Saw toothed rete ridges
  • Liquefaction degeneration of basal cell layers
  • >Band-like lymphocytic infiltrate is presnt in papillary dermis.
  • Colloid or civatte bodies – dyskeratotic keratinocytes – lower epidermis and upper dermis
Lichen Planus

How is it treated?

For localised lichen planus lesions

  • Topical potent corticosteroids
  • Topical tacrolimus or pimecrolimus or cyclosporine – oral lichen planus and genital lichen planus
  • Intralesional corticosteroids – hypertrophic lichen planus or oral lichen planus.

Generalised lichen planus

  • Narrowband UVB (NBUVB)
  • PUVA
  • UVA1
  • 308nm excimer laser for oral lichen planus

For acute generalised lichen planus and recalcitrant forms.

  • Antihistamines
  • Systemic corticosteroids – acute,generalised lichen planus
  • Oral prednisolone – 0.5-1 mg/kg for 2-6wks
  • Inj. triamcinolone acetonide IM (0.5-1mg/kg/month × 3-6months) for nail LP
  • Acitretin- 30-50mg/day
  • Griseofulvin –1 gm/day 3-6months
  • Metronidazole- 500mg BD daily for 20-60days

Consult with experienced Doctors

JNU is home to some of the most eminent doctors in the world, most of whom are pioneers in their respective arenas and are renowned for developing innovative and revolutionary procedures
Gajanand Ojha

Dr. Gajanand Ojha

Professor

Qualification

MBBS, MD

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Priyanka Sharma

Dr. Priyanka Sharma

Associate Professor

Qualification

MBBS, MD

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Neha Agarwal

Dr. Neha Agarwal

Assistant Professor

Qualification

MBBS, MD

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Vikarn Garg

Dr. Vikarn Garg

Assistant Professor

Qualification

MBBS, MD

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Amit Kumar Malhotra

Dr. Amit Kumar Malhotra

Assistant Professor

Qualification

MBBS, MD

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