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
📖 About Lichen Planus
- Lichen Planus is a chronic inflammatory disorder affecting the skin, mucous membranes, nails, and hair follicles.
- It is believed to be an immune-mediated disease involving T-cell attack on basal keratinocytes at the dermoepidermal junction.
- 💊 Some medications can trigger a similar eruption called a lichenoid drug reaction. Reported triggers include thiazide diuretics, β-blockers, NSAIDs, penicillamine, antimalarials, and some antibiotics.
- 🤝 Associations include autoimmune diseases. A link with hepatitis C is reported internationally but is relatively uncommon in the UK population.
🩺 Clinical Features
- 😣 Intensely pruritic, violaceous (purple) flat-topped papules.
- 📍 Typical sites include flexor wrists, forearms, ankles, lumbar region, and genitalia.
- 🩹 Koebner phenomenon: lesions may appear along lines of trauma or scratching.
- 🕸 Wickham’s striae: fine white lace-like lines on the surface of papules.
- 🎨 Post-inflammatory hyperpigmentation can persist after lesions resolve.
- 👄 Oral lichen planus: reticular white striae on the buccal mucosa are common; erosive disease may cause pain and ulceration.
- 💅 Nail involvement: thinning, ridging, longitudinal splitting, or pterygium formation in severe disease.
🔬 Investigations
- 🧪 Skin biopsy (if diagnosis uncertain): band-like lymphocytic infiltrate at the dermoepidermal junction with basal cell degeneration and “saw-tooth” rete ridges.
- 🧾 Medication review: identify possible drug triggers.
- 🧬 Screening tests: hepatitis C testing may be considered depending on clinical context and risk factors.
💊 Management
- 🧴 Topical corticosteroids: first-line therapy (potent preparations typically used for cutaneous disease).
- 👄 Oral disease: topical corticosteroid gels, mouthwashes, or soluble steroid tablets used as rinses.
- 💡 Phototherapy: narrowband UVB or PUVA may be used for widespread disease.
- 💊 Severe or refractory disease: systemic treatments may include oral corticosteroids or immunosuppressants such as azathioprine, ciclosporin, or mycophenolate under specialist supervision.
- 🤕 Pruritus relief: antihistamines may help symptom control, particularly at night.
- 🔎 Monitoring: chronic erosive oral or genital disease carries a small increased risk of squamous cell carcinoma, so long-term follow-up is recommended.
🧠 Mnemonic
“6 Ps of Lichen Planus” ✨
- 😣 Pruritic
- 💜 Purple
- 🔷 Polygonal
- ⬛ Planar (flat-topped)
- 📍 Papules
- 🪵 Plaques
📚 Guideline References
