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Lichen Planus

Lichen Rubra Planus

Lichen planus, abbreviated as LP, is the development of a pruritic rash on the skin and inside the mouth. It is thought to be an autoimmune disorder which has primarily no cure.


Presentation

Lichen planus presents with the development of purple colored pruritic rash with flat tops. In many cases, the rashes have lacy white lines running through them known as Wickham’s striae. The rashes most commonly develop on the wrists, ankles and lower back. However, they can occur almost in any area of the body. In addition, LP may cause dry mouth, nail abnormalities, loss of hair and development of metallic taste in mouth.

Lichen planus often develops at the site of skin injury and may appear as a single lesion or in clusters. The lesions gradually increase in size and can sometimes turn painful [6].

Rigor
  • More severe forms may require a rigorous treatment regime. When rashes have developed inside the mouth, then individuals are given lidocaine mouthwashes to relieve the symptoms.[symptoma.com]
  • Rigorous evaluation of efficacy is often lacking, since efficacy criteria were mainly based on imprecise global evaluation.[doi.org]
Short Stature
  • The treatment of TS differs according to age and Recombinant Human Growth Hormone (RHGH) therapy is usually given for the treatment of short stature in girls with TS in childhood.[ncbi.nlm.nih.gov]
Pediatric Disorder
  • Although LP is more common in adults, it has become an established pediatric disorder. Its classic presentation is characterized by 4 p's: purple, polygonal, pruritic papules. Histopathologic examination reveals characteristic interface dermatitis.[ncbi.nlm.nih.gov]
Strabismus
  • Copyright 2015 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.[ncbi.nlm.nih.gov]
Eruptions
  • Cutaneous lesions can be localized or eruptive [9]. “Eruptive” or “exanthematous” LP is a uncommon variant of LP and it is rarely reported in the English-language literature, especially among adults [1].[doi.org]
  • Here we present a patient of Egyptiandecent with a lacy reticulated LPP eruption on theface.[ncbi.nlm.nih.gov]
  • Abstract Lichen planus-like eruptions are known to be caused by occupational exposure to colour film developing agents that are derivatives of p-phenylenediamine (PPDA), e.g. CD-2 and CD-3.[ncbi.nlm.nih.gov]
  • Lichen planus (LP) is a papulosquamous eruption of the skin, scalp, nails, and mucous membranes. Although LP is more common in adults, it has become an established pediatric disorder.[ncbi.nlm.nih.gov]
Alopecia
  • Recently, there have been25 cases reported in the literature of lichen planuspigmentosus (LPPi) that preceded the developmentof frontal fibrosing alopecia (FFA), which is a variantof lichen planopilaris (LPP).[ncbi.nlm.nih.gov]
  • Frontal Fibrosing Alopecia – Women’s Receding Hairline New Lupus Treatment May Help With Hair Loss[belgraviacentre.com]
  • Abstract We present the case of a 72-year-old Caucasian woman with frontal fibrosing alopecia of one year's duration. Eighteen months later, she presented with sudden hyperpigmentation on the submental area, neck and upper chest.[ncbi.nlm.nih.gov]
  • A scarring alopecia may result. A variant of lichen planopilaris is frontal fibrosing alopecia.[emedicine.medscape.com]
  • White net-like patches or ulceration of mucous membranes, nail deformity, scarring alopecia, and other types of skin lesions may also occur. Most patients develop the disease between ages 30 and 60 years.[online.epocrates.com]
Pruritus
  • Abstract Hypertrophic lichen planus (HLP) is a variant of lichen planus characterized by marked epidermal hyperplasia and severe pruritus.[ncbi.nlm.nih.gov]
  • Pruritus is a constant feature. Lesions do heal with marked residual hyperpigmentation. There is no report so far of the "subtropical" (actinic) Lichen Planus in West Africa.[ncbi.nlm.nih.gov]
  • She reported pruritus, burning, and discomfort. Her medical history included type 2 diabetes mellitus, hypertension, and asthma with no history of skin rashes.[ncbi.nlm.nih.gov]
  • Dermatological adverse events such as pruritus and rash have been reported in various clinical trials. We report three cases of anti-PD1-induced bullous lichen planus (LP)-like reactions encountered in our institution.[ncbi.nlm.nih.gov]
  • Lichen planus • clinical features of lichen planus can be summarized by the five "P’s" - papules (usually 2-5 mm size) - pruritus (intense) - purple - polygonal - planar (flat-topped) - in addition, individual lesions may show fine white lines on the[dermweb.com]
Koebner Phenomenon
  • .  Koebner’s phenomenon (isomorphic response).  After lesions subside, post lichen hyperpigmentation occurs. 8. Koebner's Phenomenon 9. Hypertrophic Lp •This condition appears as thick, reddish-brown lesions that are covered with scales.[de.slideshare.net]
  • phenomenon: new lesions at sites of trauma Lichen planopilaris: primary site of involvement is the epithelium of hair follicles, causing alopecia Wickham straie: white dots or lines within papules Variants: atrophic, bullous, follicular, hypertrophic[pathologyoutlines.com]
  • This is called “the Koebner phenomenon”. When the spots resolve they generally leave brown stains called post-inflammatory hyperpigmentation which take months to resolve.[dermcoll.edu.au]
  • phenomenon Download Figure: 6 Lichen planus, post-inflammatory At this stage lesions are not active, do not itch and should not be treated with topical steroid Download Figure: 7 Lichen planus, post-inflammatory Download Figure: 8 Lichen planus in dark[pcds.org.uk]
  • This so-called Koebner phenomenon may appear as a line of flat-topped, red-to-purple bumps on the skin.[skinsight.com]
Pruritic Rash
  • Lichen planus, abbreviated as LP, is the development of a pruritic rash on the skin and inside the mouth. It is thought to be an autoimmune disorder which has primarily no cure.[symptoma.com]
  • ., and Jusleen Ahluwalia, M.D. 2 Citing Articles A 69-year-old man presented to the dermatology clinic with a 2-month history of a pruritic rash.[nejm.org]
Anger
  • Masoumeh Mehdipour, Ali Taghavi Zenouz, Alireza Farnam, Rana Attaran, Sara Farhang, Maryam Safarnavadeh, Narges Gholizadeh and Saranaz Azari-Marhabi , The Relationship between Anger Expression and Its Indices and Oral Lichen Planus , Chonnam Medical Journal[doi.org]

Workup

A preliminary physical examination of the rash is enough to diagnose lichen planus. In addition, various other tests may also be required to confirm the condition. These include:

  • Laboratory studies such as the direct immunofluorescence study which shows presence of globular deposits of IgM along with apoptotic keratinocytes.
  • Skin biopsy is also necessary to rule out associated skin diseases.
  • Blood tests are also conducted to look for hepatitis.

Treatment

Lichen planus cannot be cured; the symptoms can however be well managed with appropriate treatment regime which includes [7]:

  • Antihistamines are prescribed if the rash has developed due to allergic reactions.
  • Corticosteroid creams are employed to be applied on the rash to relieve redness and swelling [8].
  • PUVA therapy is a kind of light therapy employed to treat skin rashes.
  • Retinoic acid is a medication which can either be taken orally or can be applied on the rash.
  • Lidocaine mouthwashes are prescribed when LP has developed inside mouth.
  • Other topical ointments such as tacrolimus and pimecrolimus are employed to be applied on the rashes [9].
  • Oral metronidazole and acitretin have proved to be effective against lichen planus [10].

Prognosis

The prognosis of lichen planus is quite favorable if treatment is initiated on right time. The rash usually clears up within 18 months; however individuals may continue to experience recurrent attacks of LP for several years. In conditions when allergic reactions to certain medications causes LP then the rash gets corrected once the medication is stopped.

Etiology

Lichen planus is thought to be an autoimmune disease. The particular factor that causes the immune system to behave in such a fashion is unknown. However, certain risk factors have been identified to play a role in causation of LP. These include viral diseases such as hepatitis C, exposure to certain medications, chemical and dyes. All these factors can predispose an individual to develop lichen planus. Medications that are taken for treating blood pressure and heart disease can trigger an attack of LP [2].

Epidemiology

The exact incidence of lichen planus is unknown. With the available data it can be stated that about 1% of new patients at health care clinics suffer from LP in the United States. Some reports point towards the fact that LP occurs more frequently during the months of December and January. Such a type of skin disorder is more common in individuals aged 40 years and above [3].

Sex distribution
Age distribution

Pathophysiology

Certain types of disease condition of altered immunity are known to trigger the development of lichen planus. Such type of disease conditions include vitiligo, ulcerative colitis, dermatomyositis, myasthenia gravis, lichen sclerosis and alopecia areata.

Researchers have pointed towards a strong link between lichen planus and hepatitis C, primary biliary cirrhosis and chronic active hepatitis. Statistics have shown that about 16% patients with lichen planus also suffered from hepatitis C virus infection. This in turn indicates that individuals with liver anomalies fall easy prey to LP [4].

Stress is yet another factor that is known to trigger attacks of LP. It either aggravates the existing condition or induces the development of characteristic skin rashes [5].

Prevention

So far there are no guidelines to prevent the development of lichen planus. Individuals allergic to certain medications can avoid the use of such drugs to prevent development of rashes.

Summary

Lichen planus (LP) cannot be cured, but can be well managed with an appropriate treatment regime. Symptoms are gradually brought under control with medications and therapies. Lichen planus is a non–infectious skin disease and the rash develops in the areas of arms, legs, trunk, mouth, nails, scalp, vulva, vagina and penis [1].

Lichen planus is not a serious condition; however, in some rare cases, the rashes may itch and certain types of this skin condition can give rise to serious and debilitating symptoms. Middle aged populations are most affected by this skin disorder.

Patient Information

Definition

Lichen planus is defined as the development of itchy skin rashes on the skin. It is a chronic skin condition with no cure. The symptoms can be managed with appropriate treatment regime. In rare cases, the symptoms may exacerbate and turn serious. Individuals tend to get recurrent bouts of lichen planus.

Cause

The exact cause of lichen panus is not known. It is thought to occur due to allergic reaction or immune response to certain conditions. Research has also proved that certain underlying disease conditions such as hepatitis C, primary biliary cirrhosis and chronic active hepatitis. Stress has also been identified as a potential risk factor for development of lichen planus.

Symptoms

The rashes manifest as round shaped purple colored lesions having sharp borders. In many cases, the lesions may get covered with white marks or lines known as Wickham’s striae. The rashes may develop as a single lesion or may in multiple numbers. The rashes turn itchy and painful making conditions worse for the affected individuals.

Diagnosis

Diagnosis of lichen planus is done through a preliminary physical examination of the rash. In addition, blood tests are carried out to asses liver functioning. Skin biopsy may also be required to rule out associated disorders.

Treatment

There is no absolute cure for lichen planus. The condition can be managed with appropriate medications and topical ointments. In many instances, light therapy has been found to be helpful in treatment of lichen planus. Fluorinated topical steroids are helpful for treating mild symptoms. More severe forms may require a rigorous treatment regime. When rashes have developed inside the mouth, then individuals are given lidocaine mouthwashes to relieve the symptoms.

References

Article

  1. Wagner G, Rose C, Sachse MM. Clinical variants of lichen planus. J Dtsch Dermatol Ges 2013; 11:309.
  2. Bigby M. The relationship between lichen planus and hepatitis C clarified. Arch Dermatol. Sep 2009;145(9):1048-50.
  3. Lehman JS, Tollefson MM, Gibson LE. Lichen planus. Int J Dermatol 2009; 48:682.
  4. Chuang TY, Stitle L, Brashear R, Lewis C. Hepatitis C virus and lichen planus: A case-control study of 340 patients. J Am Acad Dermatol. Nov 1999;41(5 Pt 1):787-9.
  5. Manolache L, Seceleanu-Petrescu D, Benea V. Lichen planus patients and stressful events. J Eur Acad Dermatol Venereol. Apr 2008;22(4):437-41.
  6. Scully C, el-Kom M. Lichen planus: review and update on pathogenesis. J Oral Pathol 1985; 14:431.
  7. Cribier B, Frances C, Chosidow O. Treatment of lichen planus. An evidence-based medicine analysis of efficacy. Arch Dermatol. Dec 1998;134(12):1521-30.
  8. Thongprasom K, Dhanuthai K. Steriods in the treatment of lichen planus: a review. J Oral Sci 2008; 50:377.
  9. Radfar L, Wild RC, Suresh L. A comparative treatment study of topical tacrolimus and clobetasol in oral lichen planus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 105:187.
  10. Rasi A, Behzadi AH, Davoudi S, Rafizadeh P, Honarbakhsh Y, Mehran M, et al. Efficacy of oral metronidazole in treatment of cutaneous and mucosal lichen planus. J Drugs Dermatol. Oct 2010;9(10):1186-90.

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Last updated: 2018-06-22 12:09