32 - Lichen Planus Flashcards
1
Q
Four Ps
A
- Purple
- Polygonal
- Pruritic
- Papules
2
Q
_____ immunity plays a major role in lichen planus and _____ immunity is most likely a secondary response
A
Cell-mediated
Humoral
3
Q
Three stages in the pathogenesis of lichen planus
A
- Antigen recognition
- Lymphocyte activation
- Keratinocyte apoptosis
- Resolution*
4
Q
Effector cell of lichen planus
A
CD8-positive T-cytotoxic cells
5
Q
Contact sensitizers such as _____ could act as haptens and elicit an immunologic response in lichen planus
A
Metals
6
Q
Fundamentally involved in the upregulation of cellular adhesion molecules and subsequent migration of lymphocytes to the dermal-epidermal junction
A
IFN-gamma
7
Q
Gene expression profiling of lichen planus, identified the expression of the _____ as the most specific marker
for lichen planus
A
CXCR-3 ligand, CXCL-9
8
Q
Peak onset of lichen planus between _____ years
A
55 and 74
9
Q
The age of onset of lichen planus is earlier in
A
Women
10
Q
HLA-_____ is more common in patients with oral lichen planus alone
A
B8
11
Q
HLA-_____ is more common in patients with cutaneous lichen planus alone
A
Bw35
12
Q
Fine, white and adherent reticulate scale highly characteristic of lichen planus
A
Wickham striae
13
Q
Wickham striae are more easily visualized with
A
Dermoscopy
14
Q
Histologic findings of Wickham striae
A
Orthokeratosis, epidermal thickening, increased granular layer
15
Q
Dull red-violet color of lichen planus correlates with _____ histologically
A
Vascular dilatation and pigment incontinence
16
Q
Most common areas of involvement of lichen planus
A
Flexural wrists
Arms
Legs
17
Q
Involvement of the _____ and _____ are atypical for classic lichen planus
A
Face
Palms
18
Q
The degree of pruritus appears to directly correlate with the extent of involvement except in
A
Hypertrophic lichen planus - often affects limited areas, such as the lower extremities, and is extremely pruritic
19
Q
Annular lichen planus are more common on the
A
Penis
Scrotum
20
Q
Actinic lichen planus is frequently _____ in shape
A
Annular
21
Q
Type of lichen planus that is highly pruritic, refractory to treatment, and associated with relapse
A
Hypertrophic lichen planus
22
Q
Hypertrophic lichen planus occurs most commonly on
A
Anterior shins
Interphalangeal joints
23
Q
Some believe that this type of lichen planus occurs in late-stage resolved disease and is not a true variant of lichen planus
A
Atrophic lichen planus
24
Q
Atrophic lichen planus is most common on the
A
Proximal lower extremity
Trunk
25
Occur secondary to an exuberant inflammatory response and an exaggerate Max-Joseph space
Vesiculobullous lichen planus
26
Lichen planus pemphigoides vs cesiculobullous lichen planus
Lichen planus pemphigoides has classic lesions of lichen planus separated from lesions of bullous pemphigoid and positive bullous pemphigoid antibodies and immunofluorescence
27
Vesiculovullous lichen planus is more common on the
Lower extremities
28
Erosive and ulcerative lichen planus is more common on the
Feet
| Oral cavity
29
Follicular lichen planus occurs most commonly on the
Scalp
30
Three distinct variants of follicular lichen planus
Lichen planopilaris
Frontal fibrosing alopecia
Gram-Little- Piccardi-Lassueur syndrome (GLPLS)
31
Characterized clinically by pruritic, red-violet pseudo-tumoral facial and posterior auricular plaques with yellow cysts
Lichen planus follicularis tumidus
32
Lichen planus pigmentosus
and _____ have significant overlapping features and likely represent a phenotypic spectrum based on genetic and environmental factors
Ashy dermatosis or erythema dyschromicum perstans
33
Actinic lichen planus has a predilection for the
Face
34
Lesions of actinic lichen planus are (minimally/extremely) symptomatic
Minimally
35
Lichen planopilaris has a (male/female) predominance
Female
36
Classic lichen planopilaris affects the _____ scalp
Vertex
37
The most active lesions of lichen planopilaris are found
Within the hair-bearing areas at the edge of the alopecic patch
38
Characterized by progressive frontotemporal recession caused by inflammatory destruction of the hair follicles
Frontal fibrosing alopecia
39
Up to 75% of women with frontal fibrosing alopecia report concomitant loss of
Eyebrows
40
Frontal fibrosing alopecia is more common in
Postmenopausal women
41
Characterized by cicatricial alopecia of the scalp, nonscarring alopecia of the axilla and groin, and follicular papules on the trunk and extremities
Gram-Little- Piccardi-Lassueur syndrome (GLPLS)
42
End stage of follicular fibrosis caused by a primary inflammatory dermatosis; distinct pathologic features are absent
Pseudopelade of Brocq
43
Most common form of oral lichen planus
Reticular form
44
Most common site of involvement of reticular oral lichen planus
Buccal mucosa
45
Oral lichen planus that is most common on the tongue and is extremely painful
Erosive and ulcerative
46
Oral lichen planus is the most common cause of desquamative gingivitis, accounting for _____% of cases
75
47
Similar clinically and histologically to oral lichen planus; however, with an identifiable cause
Oral lichenoid reactions
48
Usually seen on the buccal mucosa adjacent to amalgam dental fillings; patch tests frequently show positive
reactions to mercury, gold, and other metals
Oral lichenoid reactions
49
Unique lichenoid eruption described on the tongues of individuals with HIV usually follows _____ intake
Zidovudine
| Ketoconazole
50
Esophageal lichen planus most often affects the _____ and is most common in
Proximal esophagus
| Middle-aged women
51
Y/N: Vulvar and vaginal lichen planus is often asymptomatic
Yes
52
In cases with severe oral and ocular disease and a
| lichenoid infiltrate on biopsy, one should also consider
Paraneoplastic autoimmune multiorgan syndrome
| Cicatricial pemphigoid
53
Three major forms of nail lichen planus
Classic nail lichen planus
20-nail dystrophy
Idiopathic atrophy of the nails
54
Pterygium or forward growth of the eponychia with adherence to the proximal nail plate is a classic finding in nail lichen planus involving the _____
Matrix
55
Y/N: Dorsal pterygium is a reversible process.
No
56
Characterized by an abrupt onset and rapidly progressive thinning of the nails with subsequent loss and scarring
Idiopathic atrophy of the nails
57
Inverse lichen planus vs lichen planus pigmentosus
Absence of involvement in sun-exposed areas in inverse lichen planus
58
Four patterns of palmoplantar lichen planus
Plaque type
Punctate
Diffuse keratoderma
Ulcerated
59
Absence of Wickham striae in this type of lichen planus
Palmoplantar
60
Lesions of palmoplantar lichen planus are commonly seen on the
Internal plantar arch
| Thenar and hypothenar eminence
61
In palmoplantar lichen planus, involvement of the _____ is uncommon
Fingertips
62
Most lichenoid drug eruptions resolve in 3 to 4 months except
Gold-induced lichenoid drug eruption
63
Lichen planus pemphigoides vs concomitant lichen planus and bullous pemphigoid
Lichen planus pemphigoides is most common in younger individuals in the fourth to fifth decades of life
64
Characterized by lichenoid, keratotic papules and plaques in a seborrheic distribution with characteristic linear or reticulate pattern
Keratosis lichenoides chronica (Nekam disease)
65
Immune response in acute vs chronic GVHD
Acute: Th2
Chronic: Th1/Th17
66
Lichenoid GVHD vs lichen planus histologically
Lichenoid GVHD: satellite cell necrosis, plasna cells, eosinophils
67
Single, nonpruritic, brown to red, scaling, flat-topped plaque on sun-exposed skin of the extremities
Lichenoid keratosis
68
Differential diagnosis of lichenoid dermatitis
```
Dermatitis
Drug eruption
Lupus erythematosus
Lichen planus
Cutaneous T-cell lymphoma
```
69
Hepatitis infection associated with lichen planus
Hepatitis C
70
Found in up to 34% of patients with lichen planopilaris
Thyroid dysfunction, most commonly hypothyroidism
71
Seen in up to 16% of patients with oral lichen planus
Lichen sclerosus et atrophicus
72
Most common site for cancer in lichen planus
Tongue
73
Two major pathologic findings in lichen planus
Basal epidermal keratinocyte damage
| Lichenoid-interface lymphocyte reaction
74
Features absent in the histopathology of lichen planus
Parakeratosis
| Eosinophils
75
Multiple apoptotic cells seen at the DEJ in lichen planus
Colloid-hyaline (Civatte) bodies
76
Separation of the epidermis in small clefts in lichen planus
Max Joseph cleft
77
The initial inflammation in lichen planopilaris is at the level of
Isthmus and infundibulum
78
Histopathologically, hypertrophic lichen planus can be mistaken as
SCC
79
DIF criterion for lichen planus
Basement membrane zone and colloid bodies with one or more conjugate(s)
80
Biopsy site for cutaneous lichen planus
Proximal trunk with avoidance of the distal extremities
81
Biopsy site for lichen planopilaris
Dermoscopy: perifollicular erythema and scaling
82
Biopsy site for nail disease with trachyonychia and pitting
Matrix
83
Biopsy site for nail disease with chromonychia, nail plate fragmentation, splinter hemorrhage, onycholysis, and subungual debris
Nail bed
84
DIF for lichen planus has the highest sensitivity on
Mouth floor
| Ventral side of tongue
85
Most cutaneous lichen planus resolves within
1-2 years
86
(Generalized/Localized) disease tends to resolve more quickly
Generalized
87
First line therapy for limited cutaneous lichen planus
High-potency topical corticosteroids
88
Second-line topical agent often used in conjunction with topical steroids in refractory cases of limited cutaneous lichen planus
Topical calcineurin inhibitors
89
First-line systemic agents for lichen planus
Oral corticosteroids
90
Third-line corticosteroid-sparing agent for lichen planus
Cyclosporine
91
Drugs that target lymphocytes more specificially
Methotrexate
Mycophenolate mofetil
Azathioprine
92
Drugs that target lymphocytes more specificially are of higher utility in
Refractory and ulcerative disease
93
Drugs acting indirectly on lymphocytes
Sulfasalazine
| Metronidazole
94
Drugs acting on cellular differentiation
Acitretin
95
Drugs acting indirectly on lymphocytes are more effective for
Generalized disease
96
Drugs acting on cellular differentiation are more effective for
Hypertrophic disease
97
Y/N: Monotherapy with oral corticosteroids is the gold standard in the management of lichen planus.
No - Long-term monotherapy with oral corticosteroids is not recommended.
98
Has the highest level of evidence of efficacy for lichen planus
Sulfasalazine
99
Agranulocytosis and elevated liver function tests can occur with
Sulfasalazine
100
Often considered the first-line nonimmunosuppressive systemic agent
Metronidazole
101
Patients on metronidazole should be monitored for possible
Sensory peripheral neuropathy
102
Second-line agent in cutaneous lichen planus and first-line agent in actinic lichen planus
Hydroxychloroquine
103
Cornerstone of treatment in oral lichen planus
Good oral hygiene with regular professional dental cleanings
104
First-line therapy in oral lichen planus
Topical steroids
105
Common adverse event of topical calcineurin inhibitors
Transient burning
106
Preferred systemic therapies in oral lichen planus
Acitretin - antiproliferative effects
| HCQ and MTX - less immunosuppressive agents
107
Preferred systemic therapy for oral erosive disease
MMF
| Methotrexate
108
Preferred systemic therapy for noneroded and hyperkeratotic disease
Acitretin
109
High-potency topical corticosteroids have been shown to be ineffective in this type of lichen planus
Frontal fibrosing alopecia
110
Most commonly used and most effective drugs in frontal fibrosing alopecia
Finasteride or dutasteride
