Related Subjects:
|Nikolsky's sign
|Koebner phenomenon
|Erythema Multiforme
|Pyoderma gangrenosum
|Erythema Nodosum
|Dermatitis Herpetiformis
|Lichen Planus
|Acanthosis Nigricans
|Acne Rosacea
|Acne Vulgaris
|Alopecia
|Vitiligo
|Urticaria
|Basal Cell Carcinoma
|Malignant Melanoma
|Squamous Cell Carcinoma
|Mycosis Fungoides (Sezary Syndrome)
|Xeroderma pigmentosum
|Bullous Pemphigoid
|Pemphigus Vulgaris
|Seborrheic Dermatitis
|Pityriasis/Tinea versicolor infections
|Pityriasis rosea
|Scabies
|Dermatomyositis
|Toxic Epidermal Necrolysis
|Stevens-Johnson Syndrome
|Atopic Eczema/Atopic Dermatitis
|Psoriasis
๐ About Lichen Planus
- Lichen Planus is a chronic inflammatory dermatosis, more common in females, presenting with intensely pruritic (itchy) papules.
- ๐ Can be triggered by drugs โ โlichenoid drug reactionโ (culprits: tetracyclines, penicillamine, thiazides, ฮฒ-blockers, NSAIDs).
- ๐ค Associated with autoimmune processes and systemic conditions (e.g. hepatitis C, alopecia areata, myasthenia gravis).
๐ฉบ Clinical Features
- ๐ฃ Intensely pruritic, violaceous (purple) flat-topped papules.
- ๐ Common sites: wrists, forearms, ankles, lumbar region, genitalia.
- ๐ฉน Koebner phenomenon: new lesions appear at trauma sites.
- ๐ธ Wickhamโs striae: fine, white, lace-like lines on papules.
- ๐จ Post-inflammatory hyperpigmentation may persist (esp. in darker skin).
- ๐ Oral involvement: reticular white striae on buccal mucosa ยฑ erosions/ulcers โ pain with spicy foods.
- ๐
Nails: thinning, ridging, pterygium formation (rare but exam-worthy).
๐ฌ Investigations
- ๐งช Skin biopsy: Dense band-like T-cell infiltrate at dermoepidermal junction; โsaw-toothโ acanthosis of rete ridges.
- ๐งพ Exclude triggers: Review medications, screen for autoimmune disease, check for hepatitis C (classic association).
๐ Management
- ๐งด Topical corticosteroids: First-line (potent for skin; very potent for oral/genital mucosa).
- ๐ Oral disease: Steroid gels/rinses (e.g. betamethasone soluble tablets). Severe cases โ systemic steroids or immunosuppressants (azathioprine, ciclosporin, mycophenolate).
- ๐ก Phototherapy: PUVA (psoralen + UVA) for widespread disease.
- ๐ค Pruritus relief: Antihistamines for itch control.
- ๐ Monitoring: Chronic erosive oral/genital LP has small โ risk of SCC โ long-term follow-up recommended.
๐ง Mnemonic
โ6 Ps of Lichen Planusโ โจ
- ๐ฃ Pruritic
- ๐ Purple
- ๐ท Polygonal
- โฌ Planar (flat-topped)
- ๐ Papules
- ๐ชต Plaques
