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Rare Cutaneous Lichen Planus

Rare LP


Presentation

  • No history of any preceding drug intake, contact with chemicals, perfumes or plants was present.[pigmentinternational.com]
  • About half of the patients with skin lesions have oral lesions, whereas about 25% present with oral lesions alone. [2, 3] Cutaneous lesions typically present as small (2 mm) pruritic, white to violaceous flat-topped papules, which can increase in size[jnsbm.org]
  • LP is an idiopathic disorder that presents mainly with cutaneous and mucous membrane manifestations.[jdeonline.in]
  • At presentation, her skin lesions had relapsed. On gynecological examination, there was a whitish ulceration measuring 1.5 1 cm in the posterior lip of cervix at the 5 o'clock position. Her vulvovaginal examination was normal [Figure 1] .[ijdvl.com]
  • Treatment is based on the signs and symptoms present in each person; however, intervention is not always necessary as some cases of rare LP resolve on their own. [1] [2] Last updated: 9/10/2015 Research helps us better understand diseases and can lead[rarediseases.info.nih.gov]
Pharyngitis
  • Dysphagia due to pharyngeal and oesophageal lichen planus. J Laryngol Otol 1982;96:567-71. [ PUBMED ] 2. Abraham SC, Ravich WJ, Anhalt GJ, Yardley JH, Wu TT. Esophageal lichen planus: Case report and review of the literature.[jdeonline.in]
Progressive Dysphagia

Workup

  • A 4-mm punch biopsy of perilesional skin for direct immunofluorescence may be added to the workup when bullous lesions, pemphigus, or bullous pemphigoid is present.[aafp.org]
  • Hematological Investigations Blood biochemistry and full blood examination (FBE) should also be included in the full patient workup.[ncbi.nlm.nih.gov]

Treatment

  • Management includes avoiding things that make it worse in each case, such as sun exposure or friction in body folds (via weight loss or wearing loose clothing). [5] No treatment options have shown consistent responses, and evidence of successful treatment[rarediseases.info.nih.gov]
  • Significant updates on bariatric surgery, Barrett's esophagus, endoscopic ultrasound, endosonography, treatment of liver disease, and much more keep you current on the latest advances.[books.google.com]
  • Mucosal lichen planus: an evidence-based treatment update. American Jurnal of Clinical Dermatology. 2014;15(3):181-195. Gorouhi F, Davari P, & Fazel N.[rarediseases.org]
  • Lichen planus pigmentosus is an uncommon variant of LP, for which no effective treatment is available.[pigmentinternational.com]

Prognosis

  • Cutaneous and mucosal lichen planus: a comprehensive review of clinical subtypes, risk factors, diagnosis, and prognosis. The Scientific World Journal. Volume 2014, Article ID 742826. Manousaridis I, Manousaridis K, Peitsch WK & Schneider S W.[rarediseases.org]
  • In other cases, pigmentation persists for years. [1] [5] Last updated: 2/22/2017 The long-term outlook ( prognosis ) for people with lichen planus pigmentosus (LPP) is generally good.[rarediseases.info.nih.gov]
  • The patient was counseled regarding the nature of the disease and its prognosis. He was advised topical treatment with hydroquinone plus retinoid and tacrolimus ointments; however, he failed to show up for follow-up, persistent counseling.[pigmentinternational.com]
  • What is the long-term prognosis of lichen planus? Lichen planus usually goes away by itself in time. Some drugs can produce rashes that are similar in appearance to lichen planus.[medicinenet.com]
  • Prognosis Lichen nitidus is a benign disease with no associated mortality or complications. Lichen nitidus may remain active for several years; however, spontaneous resolution usually occurs. Bettoli V, De Padova MP, Corazza M, Virgili A.[emedicine.medscape.com]

Etiology

  • There are several oral lesions that resemble lichen planus or that even are indistinguishable from lichen planus clinically and histopathologically, but having a distinct etiology.[jnsbm.org]
  • J Dig Endosc 2016;7:33-5 Introduction Esophageal ulcerations have various etiologies, common being reflux esophagitis and candidiasis.[jdeonline.in]
  • The etiology is unknown but various factors (e.g., viral infections and certain topical agents including mustard oil, amla oil, and henna hair dyes) can act as a trigger. Sunlight probably plays a role in inciting LPP.[pigmentinternational.com]
  • Although the exact etiology of this disease is still unknown, but some factors are associated with it.[ncbi.nlm.nih.gov]

Epidemiology

  • Epidemiology Frequency The frequency of lichen nitidus is unknown because of its uncommon occurrence.[emedicine.medscape.com]
  • Epidemiological relationship of oral lichen planus to hepatitis C virus in an Indian population. Oral Health Dent Manag. 2012; 11 :199–205. [ PubMed ] [ Google Scholar ] 46. Abbate G, Foscolo AM, Gallotti M, Lancella A, Mingo F.[ncbi.nlm.nih.gov]
  • An epidemiologic study of 2071 patients and a review of the literature. Arch Dermatol 1991;127:1684-8. 5. Prajapati V, Barankin B. Answer: Answer to dermacase. Can Fam Physician 2008; 54(10):1392-3. 6. Bhat RM, Chathra N, Dandekeri S, Devaraju S.[ayujournal.org]
  • Community Dentistry and Oral Epidemiology. 15 (1): 52–6. PMID 3467894. Alabi GO, Akinsanya JB (June 1981). "Lichen planus in tropical Africa". Tropical and Geographical Medicine. 33 (2): 143–7. PMID 7281214. Bouquot JE, Gorlin RJ (April 1986).[en.wikipedia.org]
  • Lichen planus and hepatitis C virus infection: an epidemiologic study. Int J Clin Pract. 2004;58(12):1118–1119. 5. Kraft R, Usatine RP. Lichen planus. In: The Color Atlas of Family Medicine.[aafp.org]
Sex distribution
Age distribution

Pathophysiology

  • "Pathophysiology, etiologic factors, and clinical management of oral lichen planus, part I: facts and controversies". Clinics in Dermatology. 28 (1): 100–8. doi : 10.1016/j.clindermatol.2009.03.004.[en.wikipedia.org]
  • Pathophysiology The skin is the primary organ system affected. Mucous membranes and nails [1] also might be involved. Lichen planus can clinically mimic lichen nitidus and can sometimes coexist with lichen nitidus.[emedicine.medscape.com]
  • Lichen planus is a chronic, inflammatory, autoimmune disease 1 occurring in 0.1 to 4 percent of the general population, most often in perimenopausal women. 2 Lichen planus can appear at any age, but most cases occur between 30 and 60 years of age. 2 Pathophysiology[aafp.org]

Prevention

  • How do you Prevent Lichen planus? Lichen planus is not a preventable condition. But, since the triggering factors are identified measures are to be taken to prevent the triggers. Identifying the allergen and prevent contact with the allergens.[medindia.net]
  • EMUAID stimulates blood flow to rapidly promote the growth of new healthy skin cells and prevent scar tissue from forming. It also creates an occlusive barrier that prevents excess moisture from building on the recovering skin tissue.[emuaid.com]
  • Robert Katz will give you skin screening to prevent this kind of disease.[katzdermatology.com]
  • There are no effective means to either predict or to prevent such event. Clinically, OLP present as bilateral symmetrical lesion and hence lichen planus isolated to a single oral site other than the gingiva is very uncommon.[jnsbm.org]
  • If you have lichen planus on your scalp, treatment is important to prevent permanent hair loss. Lichen planus has no cure, but different treatments can help relieve your symptoms and speed healing.[hopkinsmedicine.org]

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