Lichen Planus disease - Dermatology speciality

Lichen planus (LP) is an inflammatory disorder of the skin and mucous membranes with no known cause. It appears as pruritic, violaceous papules and plaques most commonly found on the wrists, lower back, and ankles. A lattice-like network of white lines called Wickham striae overlies the lesions but is most easily observed on the buccal mucosa where erosions can also be present. Drug-induced lichen planus, or lichenoid drug eruption, is frequently photo distributed but may be indistinguishable from idiopathic LP. The natural history of LP varies significantly. The majority of patients with cutaneous lesions spontaneously clear within 1 to 2 years after initial presentation. However, recurrences are common, and residual hyperpigmentation of the skin frequently results. By contrast, oral LP is a chronic disease that may or may not remit. Drug-induced LP gradually resolves after removal of the causative medication. This activity describes the interprofessional team's role in the evaluation and management of lichen planus.

Lichen planus is a rash that can affect different parts of your body, including the inside of your mouth. See a GP if you think you might have it.

Lichen planus (LP) is a chronic inflammatory condition affecting the skin and mucosal surfaces.

Lichen planus is a non-infectious, itchy rash that can affect many areas of the body.

Affected areas can include the:

arms, legs and trunk
mouth (oral lichen planus)
nails and scalp
vulva, vagina and penis
The exact cause of lichen planus is unknown. However, the condition isn’t infectious and doesn’t usually run in families. It can’t be passed on to other people, including sexual partners.

A GP can usually diagnose lichen planus by examining the rash and asking about your symptoms. Oral lichen planus is often diagnosed by a dentist during routine dental check-ups.

Lichen planus is a condition that forms a very itchy rash on the skin or in the mouth.Lichen planus is a non-infectious, itchy rash that can affect many areas of the body.

Affected areas can include the:

arms, legs and trunk
mouth (oral lichen planus)
nails and scalp
vulva, vagina and penis
The exact cause of lichen planus is unknown. However, the condition isn’t infectious and doesn’t usually run in families. It can’t be passed on to other people, including sexual partners.

A GP can usually diagnose lichen planus by examining the rash and asking about your symptoms. Oral lichen planus is often diagnosed by a dentist during routine dental check-ups.Lichen planus (LP) is a chronic inflammatory condition affecting the skin and mucosal surfaces. Lichen planus (LP) is an inflammatory disorder of the skin and mucous membranes with no known cause. It appears as pruritic, violaceous papules and plaques most commonly found on the wrists, lower back, and ankles. A lattice-like network of white lines called Wickham striae overlies the lesions but is most easily observed on the buccal mucosa where erosions can also be present.

1. Lichen Planus (LP)
Prof. Omer Kombali
Consultant of Dermatology & Andrology

2. Definition:
•Lichen planus (LP) is a chronic inflammatory condition affecting
the skin and mucosa.
•Self limiting condition.

3. Who gets
lichen
planus?
Affects approximately 1% of
the population worldwide.
Mostly adults aged between
30 -60 years
No strong racial predilection.

4. What causes
lichen
planus? A T-cell mediated autoimmune
disorderin which inflammatory
cells attack an unknown protein
within the skin and mucosal
keratinocytes.
Unknown?

5. Contributing
factors:
•Genetic predisposition
•Physical and emotional stress
•Injury to the skin; lichen planus often appears
where the skin has been scratched or after surgery
(koebnerisation)
•Localisedskin disease such as herpes zoster
•Systemic viral infection, such as hepatitis C.
•Contact allergy, such as to metal fillings in oral lichen
planus (rare) and colourphotographic developers
•Drugs: gold, quinine, quinidine.
•Lichenoid inflammation is also notable in graft-
versus-host disease.
•Vitamin Ddeficiency may be associated with oral
lichen planus.

6. What is the primary lesion in lichen
planus?
•Skin:
Six Ps of LP:
purple, polygonal, planar,
pruritic papules, and
plaques.
shiny, and reddish-purple.

7. •Mucosa:
Reticulated, lacy, bluish
white, linear lesions
(Wickham striae)are a
hallmark of oral lichen planus,
especially on the buccal
mucosae.

8. What are
the clinical
features of
lichen
planus?
•Cutaneous LP
•Oral LP
•Vulval LP
•Penile LP
•Lichen planopilaris
•Nail LP
•LP pigmentosus
•LP Actinicus
•Lichenoid drug eruption
•BulousLP & LP pemphigoides

28. Oral LP

36. •Lichen
planopilaris

37. •Lichen planopilaris

38. PenilLP

41. Vulvar LP

42. BollousLP

43. BollousLP

44. BollousLP

45. BollousLP

46. Actinic LP

47. Actinic LP

48. What are the
complications of
lichen planus?
May resemble squamous cell carcinoma
(hypertrophic LP)
Cancer is more common in smokers, those
with a history of cancer in mucosal sites,
and those who carry sexually acquiredand
oncogenichuman papillomavirus.
Oesophageallichen planus can cause
dysphagia, strictures, and possibly
squamous cell carcinoma.

49. How is lichen planus diagnosed?
CLINICALLY SKIN BIOPSY

50. What is the treatment for lichen planus?
Topical:
Corticosteroids
Calcineurin inhibitors
Tacrolimus & Pimecrolimus
Retinoids
IL steroid injection

51. What is the treatment for
lichen planus?
Systemic:
•Systemic steroids
•Acitretin (Neotigason)
•Hydroxychloroquine
•Methotrexate
•Azathioprine (Imuran)
•Mycophenolate mofetil
•Phototherapy

52. General measures
Avoid soaps and shower gels that
will exacerbate scaling.
Use emollientsregularly.

53. What is the outcome for lichen planus?
LP have a chronic remitting and relapsing course.
Cutaneous lesions tend to clear within a couple of years in most people,
but post-inflammatory pigmentation may take years to subside.
Mucosal lichen planus is more likely to persist for a decade or longer.
Scarring alopecia.

54. Thank you