LICHEN PLANUS LICHEN PLANUS (LP)(LP)

OverviewOverviewLichen planusLichen planus is is an inflammatory disease an inflammatory disease that affects the skin that affects the skin and the oral mucosaand the oral mucosa..CauseCause The cause of lichen planus is not known; however, there are The cause of lichen planus is not known; however, there are cases of lichen planus-type rashes (known as lichenoid cases of lichen planus-type rashes (known as lichenoid reactions) occurring as allergic reactions to medications for reactions) occurring as allergic reactions to medications for high blood pressure, heart disease and arthritis. These high blood pressure, heart disease and arthritis. These lichenoid reactions are referred to as lichenoid mucositis (of lichenoid reactions are referred to as lichenoid mucositis (of the mucosa) or dermatitis (of the skin). Lichen planus has been the mucosa) or dermatitis (of the skin). Lichen planus has been reported as a complication of chronic hepatitis c virus infection reported as a complication of chronic hepatitis c virus infection and can be a sign of chronic graft-versus-host disease of the and can be a sign of chronic graft-versus-host disease of the skinskin..

It has been suggested that true lichen It has been suggested that true lichen planus may respond to stress, where planus may respond to stress, where lesions may present on the mucosa or lesions may present on the mucosa or skin during times of stress in those with skin during times of stress in those with the disease. Lichen planus affects women the disease. Lichen planus affects women more than men (at a ratio of 3:2), and more than men (at a ratio of 3:2), and occurs most often in middle-aged adults. occurs most often in middle-aged adults. Lichen planus in children is rareLichen planus in children is rare . .

C/PC/P The typical rash of lichen planus is well-described by the The typical rash of lichen planus is well-described by the

"5 P's": well-defined pruritic, planar, purple, polygonal "5 P's": well-defined pruritic, planar, purple, polygonal papules.papules.

Flexor surfaces especially wrists, flanks, medial thighs, Flexor surfaces especially wrists, flanks, medial thighs, shins of tibia, glans penis, nails, scalp & oral mucosa.shins of tibia, glans penis, nails, scalp & oral mucosa.

Pruritus;Pruritus; rubbing rubbing than scratching. than scratching.

Koebner’s phenomenon Koebner’s phenomenon (isomorphic response).(isomorphic response).

After lesions subside, post lichen hyperpigmentation After lesions subside, post lichen hyperpigmentation occurs.occurs.

Koebner's PhenomenonKoebner's Phenomenon

Hypertrophic LpHypertrophic Lp

Lichen planopilarisLichen planopilaris

Lichen Planopilaris is the specific name Lichen Planopilaris is the specific name given to lichen planus on the scalp given to lichen planus on the scalp that that ..may cause permanent, scarring may cause permanent, scarring alopeciaalopecia

LP of Scalp LP of Scalp Cicatricial Alopecia Cicatricial Alopecia

Oral LPOral LPOral lichen planus may present in one of three formsOral lichen planus may present in one of three forms . .

The reticular form is the most common presentation The reticular form is the most common presentation and manifests as white lacy streaks on the mucosa and manifests as white lacy streaks on the mucosa (known as Wickham's striae) or as smaller papules (known as Wickham's striae) or as smaller papules (small raised area). The lesions tend to be bilateral (small raised area). The lesions tend to be bilateral and are asymptomatic. The lacy streaks may also be and are asymptomatic. The lacy streaks may also be seen on other parts of the mouth, including the seen on other parts of the mouth, including the gingiva (gums), the tongue, palate and lipsgingiva (gums), the tongue, palate and lips . .

The bullous form presents as fluid-filled vesicles The bullous form presents as fluid-filled vesicles which which ..project from the surfaceproject from the surface

The erosive form presents with The erosive form presents with erythematous (red) areas that are erythematous (red) areas that are ulcerated and uncomfortable. The erosion ulcerated and uncomfortable. The erosion of the thin epithelium may occur in of the thin epithelium may occur in multiple areas of the mouth, or in one multiple areas of the mouth, or in one area, such as the gums, where they area, such as the gums, where they resemble desquamative gingivitis. resemble desquamative gingivitis. Wickham's striae may also be seen near Wickham's striae may also be seen near these ulcerated areas. This form may these ulcerated areas. This form may undergo malignant transformationundergo malignant transformation . .

LP of oral mucosaLP of oral mucosa

LP of the TongueLP of the Tongue

Complications of LPComplications of LP

Squamous cell carcinoma in oral ulcerative lesions.Squamous cell carcinoma in oral ulcerative lesions.

Cicatricial alopecia in scalp LP.Cicatricial alopecia in scalp LP.

Postinflammatory hyperpigmentation.Postinflammatory hyperpigmentation.

Differential DiagnosisDifferential Diagnosis The clinical presentation of lichen planus may also The clinical presentation of lichen planus may also

resemble other conditions, including: resemble other conditions, including: Lichenoid drug reaction Lichenoid drug reaction Discoid Lupus Erythematosus Discoid Lupus Erythematosus Chronic Ulcerative Stomatitis Chronic Ulcerative Stomatitis Pemphigus Vulgaris Pemphigus Vulgaris Benign Mucous Membrane Pemphigoid Benign Mucous Membrane Pemphigoid Oral leukoplakiaOral leukoplakia Frictional keratosisFrictional keratosisA biopsy is useful in identifying histological features that A biopsy is useful in identifying histological features that

help differentiate lichen planus from these conditions. help differentiate lichen planus from these conditions.

TreatmentTreatment Currently there is no cure for lichen planus but there Currently there is no cure for lichen planus but there

are certain types of medicines used to reduce the are certain types of medicines used to reduce the effects of the inflammation. Lichen planus may go into effects of the inflammation. Lichen planus may go into a dormant state after treatment. There are also reports a dormant state after treatment. There are also reports that lichen planus can flare up years after it is that lichen planus can flare up years after it is considered cured. considered cured.

Medicines used to treat lichen planus include: Medicines used to treat lichen planus include: Oral and topical steroidOral and topical steroid Oral retinoidsOral retinoids immunosuppressant medications immunosuppressant medications Hydroxychloroquin Hydroxychloroquin TacrolimusTacrolimus dapsondapson

PITYRIASIS ROSEA (PR)PITYRIASIS ROSEA (PR)

An inflammatory non-infectious scaly erythematous eruption. An inflammatory non-infectious scaly erythematous eruption.

An exanthematous reaction to an upper respiratory viral An exanthematous reaction to an upper respiratory viral infection.infection.

Highest between 15-40 years.Highest between 15-40 years.

More prevalent in spring More prevalent in spring && autumn. autumn.

EtiologyEtiology

Human herpes virus (HHV)-6 & -7.Human herpes virus (HHV)-6 & -7.

C/PC/P

Primary LesionPrimary Lesion:: Herald patchHerald patch

Single oval lesion with three different zones.Single oval lesion with three different zones.

Starts on one side of the trunk with its longitudinal axis Starts on one side of the trunk with its longitudinal axis //// to ribs. to ribs.

C/P C/P (cont.(cont.)) Secondary EruptionSecondary Eruption::

Occurs after 1-2 weeks from the onset of Occurs after 1-2 weeks from the onset of herald patch. herald patch.

Similar to Similar to herald patch,herald patch, but smaller but smaller & & multiple. multiple.

Distributed along long axis of ribs Distributed along long axis of ribs (Christmas tree (Christmas tree pattern).pattern).

Located on the trunk Located on the trunk && proximal parts of the limbs; proximal parts of the limbs; flannel flannel area area giving picture of giving picture of jacket with short sleeves. jacket with short sleeves.

Itching.Itching.

Spontaneously heal within 4-8 weeks.Spontaneously heal within 4-8 weeks.

Recurrences are not common. Recurrences are not common.

Herald PatchHerald Patch

Secondary Secondary EruptionEruption

DDDD:: Tinea circinata Tinea circinata (by CP (by CP & & scraping).scraping).

TreatmentTreatment

1.1. Patient reassurance.Patient reassurance.

2.2. Avoid skin irritation.Avoid skin irritation.

3.3. Soothing lotions, e.g. calamine lotion.Soothing lotions, e.g. calamine lotion.

4.4. Oral antihistamines, mild topical corticosteroids & Oral antihistamines, mild topical corticosteroids & UVB. UVB.

THANKS FOR YOUR ATTENTIONTHANKS FOR YOUR ATTENTION