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.
  • 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

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

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