Lichen planus

slideshare for lichen planus
includes
1 defination
2 causes
3 clinical feature
4 types
5 treatment

1. Lichen planus By: Akanksha singh 3 rd BDS

2. Lichen planus Lichen planus  ( LP ) is a chronic inflammatory and immune mediated disease that affects the skin, nails, hair, and mucous membranes . Hence it can be cutaneous or mucosal or both It is a pre cancerous condition which is T-cell mediated and targets the basal keratinocytes.

3. It is named so because it appears like lichens on the rock and planus because they are flat. The lesion is an inflammatory process usually consists of purple papules, polygonal and pruritic flat top and favors the flexor surface of the skin with an overlying network of white lines called WICKHAM’S STRIAE.

4. etiology Cell mediated immune response: It is associated with lymphocyte-epidermal interaction. This occurs due to alteration of the keratinocytes as a result of unknown events resulting in antigenic alteration of these cells stimulating the immunological reaction. Auto immunity: The T lymphocytes also secrete gamma interferon which induce keratinocytes to produce HLA-DR & increase their rate of differentiation leading to formation of the thickened surface. Immunodeficiency : there has been report of decrease in the serum levels of IgA, IgM, IgG in lichen planus and the possibility of it as a manifestation of immunodeficiency has been raised.

5. Infection : Bacterial infection can be the etiology but the results are not confirmed. Spirochetes and other rod like bodies resembling bacteria are reported Psychological factors: P eople with high stress, emotional disturbances and over work have been reported to suffer from lichen planus. Habits: Individuals having the habit of tobacco chewing have been reported to suffer from the disease. Miscellaneous: Occurrence of lichen planus is seen in the patients with vitamin B12 deficiency, anxiety, secondary syphilis, myasthenia gravis etc.

6. Clinical features Age and sex: The disease can occur at any age however two third it is seen in the age group between 35-55 and the ratio of female: male in occurrence of the disease is 3:2 Site: It is mostly on the flexor surface of the skin eg . Wrists whereas in oral lesion it seen on the buccal mucosa and lesser extend on lips, gingiva, tongue and floor of mouth. Symptoms: the chief complain of the skin lesion is usually intense pruritis whereas in the oral mucosa there are not symptoms except the patient complaints of burning sensation.

7. Color : The lesions are sharply demarcated from surrounding skin which are red in color in the beginning but soon takes reddish violet or violacious blue color and then changes to dirty brown color and the centre of the papule is umblicated. The surface is covered with grayish white lines called the WICKHAM’S STRIAE. The 6P’s for the characterization of the lesion is purple, pruritic, papule, plaque, polygonal and planer.

8. Oral manifestations The majority patients with dermal lichen planus have associated oral lesions. If there is only oral lesions than it is called ‘Isolated lichen planus’ In the oral cavity the disease assumes a somewhat different clinical appearance than on the skin and is classified into following types: 1, Reticular lichen planus : they are the most common type of the lesions and are bilateral along with the Wickham's striae. They are usually thread like papules in a linear, annular or retiform arrangement. A tiny white dot is seen at the intersection of white lines.

9. 2, Papular lichen planus : white elevated lesions of 0.5-1mm in size usually present on highly keratinized parts of the oral mucosa. They are also seen on the periphery of reticular pattern.

10. 3, P laque: They are mostly seen on the dorsum of the tongue and buccal mucosa. In the case of plaque on the tongue the disappearing of the papilla is seen. They are pearly white or grayish white in color. 4, Atrophic form: They appear as smooth, red, poorly defined areas but not always with the peripheral striae. The attached gingiva is frequently involved here and hence it also known as desquamative gingivitis pattern.

11. 5, B ullous form: It consists of bulla and vesicles which are short lived but once they are ruptured they leave a ulcerated but extremely uncomfortable surface. They are usually present on the buccal mucosa and on the lateral margins of the tongue. 6, Hypertrophic form: G enerally appearing as a well-circumscribed, elevated white lesion resembling leukoplakia.

12. 7, Annular form: T hey appear as round or ovoid , white outline with either pink or reddish centre. 8, Erosive form : Eroded ulcerative lesions are irregular in size and shape and are painful in the same area of reticular sites. Despite of the erosion of mucosa, the characteristics radiating striae maybe noted at periphery of lesion.

13. histopathology Hyperparakeratosis Hyperorthokeratosis with thickening of granular layer. Acanthosis Saw tooth appearance at rete pegs Liquefaction degeneration of basal layer Colloid bodies present in epithelium

14. diagnosis Clinical diagnosis: Interlacing white striae appearing bilaterally (Wickham’s striae). Laboratory diagnosis: There is Hyperparakeratosis, Hyperorthokeratosis, Acanthosis with intercellular edema in basal layer and lamina propria. Immunofluorescence test: Positive Immunofluorescence test with IgA, IgM, IgG antiserum.

15. Differential diagnosis Leukoplakia: occurs mostly in males unlike lichen planus. Also here Wickham’s striae is absent/ Candidiasis: pseudo membrane can be rubbed off in this case. Pemphigus: White striation are also present here. Diagnosis can be done only by microscopic examination of acantholysis. Lupus Erythmatous: Flaky & feathery appearance of lupus lesions Drug induced: History of drug is taken. Lichenoid reaction: Removal of the cause leads to the regression of the lesion. Cheek biting: History of trauma is usually given.

16. Thank you