LICHEN PLANUS.presentation ( Skin dieases in deramatology)

Presentation on skin desease

1. BY Dr:ANIL SAWLANI LICHEN PLANUS

2. DEFINATION: L.P is chronic inflammatory disease, characterized by flat top, shiny papular eruption on skin and oral mucosa with unknown cause. LICHENOID REACTION: lesions have same clinical features in other diseases.

3. CLINICAL PICTURE: The typical rash of lichen planus is well-described by the "5 P's": well-defined puritic , planar, purple, polygonal papules and plaques, vary in size form pinpoint to a centimeter or more across. White lines, known as WICKHMAS’S striae may transverse the surface of the papules. Flexor surfaces especially wrists, flanks, medial thighs, shins of tibia, glens penis, nails, scalp and oral mucosa.

4. Linear lesions often appear along scratch marks( koebner phenomenon).

5. KOBNER’S PHENOMENON

6. PATHOGENESIS: Immunological aspects: immunological mediated disorder Genetics: susceptibility to idiopathic l.p Familial incidence of 10.7% is quoted in series Reported in monozygotic twins Association with HLA-3 & HLA-5 3. viruses: A epidemiological association of l.p with hepatitis C virus(HCV), as hep C (RNA) is isolated form lesional skin papule of the patient

7. 4 .Dental amalgam: mercury and gold are the ingredient of dental amalgam, which may lead to oral lichen plannus . 5.Drug induced: heavy metals, antiepileptics , antihypertensives , isoniazid (ATT). 6.Miscellanneous: radiotherapy, anxiety, depression, stress are risk factors of develop l.p …

8. Varients of lichen plannus 1)ORAL L.P(principally involving mucous membrane). 15% of l.p is confined to the mouth only, Lessions donot differ form those found in connection with skin lession . Reticular, atrophic, hypertrophic and erosive forms are well recoganised and differentiated.

9. 2.HYPERTROPHIC L.P

10. 3.Follicular l.p (lichen planopilaris ) lichen Planopilaris is the specific name given to lichen planus on the scalp that may cause permanent, scarring alopecia. It involves hair follicles with perivescular and perifollicular lymphocytic infiltration in reticular dermis histologicaly . Graham little- piecordi lassueur syndrome is traid of multifocal scalp cicatrical alopecia, non scarring allopecia of axillae /groin and keratotic lichenoid follicular papules.

11. LICHEN PLANOPILARIS

12. 4.Linear l.p

13. 5.Actinic l.p (lichen plannus subtropicus ) Lesion occur on exposed skin, like face. Occurs in children and young adults. Lesion are well defined annular or discoid patches which have deeply hyperpigmented .

14. 6.Annular l.p Lessions are found on the penis. Associated with buccal mucosa.

15. 7.Atrophic and hypertorphic l.p Atrophic may be result of faded annular lessions . Hpertrophic l.p is hypertrophy of lessions . 8 .GUTTATE L.P: 9.l.p of palms and soles.

16. Flexural l.p Lesion appears on the flexures.

17. BULLOUS LICHEN PLANUS

18. NEKAM’S DISEASE: When lichen plannus is associated with seborrhoeic dermatitis is called nekam’s disease…

19. HISTOPATHOLOGY IgM antibodies directed against keratinocytes . Liquifactive degeneration of DEJ. Saw tooth appearcense of DEJ Dead keratinocytes drop into the dermis called cytoid bodies. Melanocyte drop into the dermis taken up by macrophages(MELANOPHAGES) the process is called pigmentary incontinence i -e fixed pigmentation.

20. Immunoflorecense findings: IgM antibodies along cytoid bodies.

21. NAIL CHANGES: Vertical ridges, bluish or black discoloration of nail plate. Lamellar desquamation( onychoschezia ) and pterygium .

22. HAIR CHANGES: Atophic cicatrical alopecia results form follicular destruction. Graham little- piecordi - lassuerur , parbi macularis and alopecia pseudopallade syndormes are associated.

23. MUCOUS MEMBERANE: Squamous cell cancer is reported in oral lichen planus due to high expression of cyclo-oxigenase (cox-2), especially with ulceration of oral mucosa.

24. TREATMENT: Currently there is no cure for lichen planus but there are certain types of medicines used to reduce the effects of the inflammation. Lichen planus may go into a dormant state after treatment. There are also reports that lichen planus can flare up years after it is considered cured. Medicines used to treat lichen planus include: Oral and topical steroid Oral retinoids immunosuppressant medications Hydroxychloroquin Tacrolimus dapson

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