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FD9 > 32 - Lichen Planus > Flashcards

32 - Lichen Planus Flashcards

1
Q

Four Ps

A
  1. Purple
  2. Polygonal
  3. Pruritic
  4. Papules
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2
Q

_____ immunity plays a major role in lichen planus and _____ immunity is most likely a secondary response

A

Cell-mediated

Humoral

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3
Q

Three stages in the pathogenesis of lichen planus

A
  1. Antigen recognition
  2. Lymphocyte activation
  3. Keratinocyte apoptosis
  4. Resolution*
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4
Q

Effector cell of lichen planus

A

CD8-positive T-cytotoxic cells

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5
Q

Contact sensitizers such as _____ could act as haptens and elicit an immunologic response in lichen planus

A

Metals

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6
Q

Fundamentally involved in the upregulation of cellular adhesion molecules and subsequent migration of lymphocytes to the dermal-epidermal junction

A

IFN-gamma

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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

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8
Q

Peak onset of lichen planus between _____ years

A

55 and 74

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9
Q

The age of onset of lichen planus is earlier in

A

Women

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10
Q

HLA-_____ is more common in patients with oral lichen planus alone

A

B8

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11
Q

HLA-_____ is more common in patients with cutaneous lichen planus alone

A

Bw35

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12
Q

Fine, white and adherent reticulate scale highly characteristic of lichen planus

A

Wickham striae

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13
Q

Wickham striae are more easily visualized with

A

Dermoscopy

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14
Q

Histologic findings of Wickham striae

A

Orthokeratosis, epidermal thickening, increased granular layer

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15
Q

Dull red-violet color of lichen planus correlates with _____ histologically

A

Vascular dilatation and pigment incontinence

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16
Q

Most common areas of involvement of lichen planus

A

Flexural wrists
Arms
Legs

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17
Q

Involvement of the _____ and _____ are atypical for classic lichen planus

A

Face

Palms

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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

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19
Q

Annular lichen planus are more common on the

A

Penis

Scrotum

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20
Q

Actinic lichen planus is frequently _____ in shape

A

Annular

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21
Q

Type of lichen planus that is highly pruritic, refractory to treatment, and associated with relapse

A

Hypertrophic lichen planus

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22
Q

Hypertrophic lichen planus occurs most commonly on

A

Anterior shins

Interphalangeal joints

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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

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24
Q

Atrophic lichen planus is most common on the

A

Proximal lower extremity

Trunk

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25
Q

Occur secondary to an exuberant inflammatory response and an exaggerate Max-Joseph space

A

Vesiculobullous lichen planus

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26
Q

Lichen planus pemphigoides vs cesiculobullous lichen planus

A

Lichen planus pemphigoides has classic lesions of lichen planus separated from lesions of bullous pemphigoid and positive bullous pemphigoid antibodies and immunofluorescence

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27
Q

Vesiculovullous lichen planus is more common on the

A

Lower extremities

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28
Q

Erosive and ulcerative lichen planus is more common on the

A

Feet

Oral cavity

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29
Q

Follicular lichen planus occurs most commonly on the

A

Scalp

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30
Q

Three distinct variants of follicular lichen planus

A

Lichen planopilaris
Frontal fibrosing alopecia
Gram-Little- Piccardi-Lassueur syndrome (GLPLS)

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31
Q

Characterized clinically by pruritic, red-violet pseudo-tumoral facial and posterior auricular plaques with yellow cysts

A

Lichen planus follicularis tumidus

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32
Q

Lichen planus pigmentosus
and _____ have significant overlapping features and likely represent a phenotypic spectrum based on genetic and environmental factors

A

Ashy dermatosis or erythema dyschromicum perstans

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33
Q

Actinic lichen planus has a predilection for the

A

Face

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34
Q

Lesions of actinic lichen planus are (minimally/extremely) symptomatic

A

Minimally

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35
Q

Lichen planopilaris has a (male/female) predominance

A

Female

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36
Q

Classic lichen planopilaris affects the _____ scalp

A

Vertex

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37
Q

The most active lesions of lichen planopilaris are found

A

Within the hair-bearing areas at the edge of the alopecic patch

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38
Q

Characterized by progressive frontotemporal recession caused by inflammatory destruction of the hair follicles

A

Frontal fibrosing alopecia

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39
Q

Up to 75% of women with frontal fibrosing alopecia report concomitant loss of

A

Eyebrows

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40
Q

Frontal fibrosing alopecia is more common in

A

Postmenopausal women

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41
Q

Characterized by cicatricial alopecia of the scalp, nonscarring alopecia of the axilla and groin, and follicular papules on the trunk and extremities

A

Gram-Little- Piccardi-Lassueur syndrome (GLPLS)

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42
Q

End stage of follicular fibrosis caused by a primary inflammatory dermatosis; distinct pathologic features are absent

A

Pseudopelade of Brocq

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43
Q

Most common form of oral lichen planus

A

Reticular form

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44
Q

Most common site of involvement of reticular oral lichen planus

A

Buccal mucosa

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45
Q

Oral lichen planus that is most common on the tongue and is extremely painful

A

Erosive and ulcerative

46
Q

Oral lichen planus is the most common cause of desquamative gingivitis, accounting for _____% of cases

A

75

47
Q

Similar clinically and histologically to oral lichen planus; however, with an identifiable cause

A

Oral lichenoid reactions

48
Q

Usually seen on the buccal mucosa adjacent to amalgam dental fillings; patch tests frequently show positive
reactions to mercury, gold, and other metals

A

Oral lichenoid reactions

49
Q

Unique lichenoid eruption described on the tongues of individuals with HIV usually follows _____ intake

A

Zidovudine

Ketoconazole

50
Q

Esophageal lichen planus most often affects the _____ and is most common in

A

Proximal esophagus

Middle-aged women

51
Q

Y/N: Vulvar and vaginal lichen planus is often asymptomatic

A

Yes

52
Q

In cases with severe oral and ocular disease and a

lichenoid infiltrate on biopsy, one should also consider

A

Paraneoplastic autoimmune multiorgan syndrome

Cicatricial pemphigoid

53
Q

Three major forms of nail lichen planus

A

Classic nail lichen planus
20-nail dystrophy
Idiopathic atrophy of the nails

54
Q

Pterygium or forward growth of the eponychia with adherence to the proximal nail plate is a classic finding in nail lichen planus involving the _____

A

Matrix

55
Q

Y/N: Dorsal pterygium is a reversible process.

A

No

56
Q

Characterized by an abrupt onset and rapidly progressive thinning of the nails with subsequent loss and scarring

A

Idiopathic atrophy of the nails

57
Q

Inverse lichen planus vs lichen planus pigmentosus

A

Absence of involvement in sun-exposed areas in inverse lichen planus

58
Q

Four patterns of palmoplantar lichen planus

A

Plaque type
Punctate
Diffuse keratoderma
Ulcerated

59
Q

Absence of Wickham striae in this type of lichen planus

A

Palmoplantar

60
Q

Lesions of palmoplantar lichen planus are commonly seen on the

A

Internal plantar arch

Thenar and hypothenar eminence

61
Q

In palmoplantar lichen planus, involvement of the _____ is uncommon

A

Fingertips

62
Q

Most lichenoid drug eruptions resolve in 3 to 4 months except

A

Gold-induced lichenoid drug eruption

63
Q

Lichen planus pemphigoides vs concomitant lichen planus and bullous pemphigoid

A

Lichen planus pemphigoides is most common in younger individuals in the fourth to fifth decades of life

64
Q

Characterized by lichenoid, keratotic papules and plaques in a seborrheic distribution with characteristic linear or reticulate pattern

A

Keratosis lichenoides chronica (Nekam disease)

65
Q

Immune response in acute vs chronic GVHD

A

Acute: Th2
Chronic: Th1/Th17

66
Q

Lichenoid GVHD vs lichen planus histologically

A

Lichenoid GVHD: satellite cell necrosis, plasna cells, eosinophils

67
Q

Single, nonpruritic, brown to red, scaling, flat-topped plaque on sun-exposed skin of the extremities

A

Lichenoid keratosis

68
Q

Differential diagnosis of lichenoid dermatitis

A 
Dermatitis
Drug eruption
Lupus erythematosus
Lichen planus
Cutaneous T-cell lymphoma
69
Q

Hepatitis infection associated with lichen planus

A

Hepatitis C

70
Q

Found in up to 34% of patients with lichen planopilaris

A

Thyroid dysfunction, most commonly hypothyroidism

71
Q

Seen in up to 16% of patients with oral lichen planus

A

Lichen sclerosus et atrophicus

72
Q

Most common site for cancer in lichen planus

A

Tongue

73
Q

Two major pathologic findings in lichen planus

A

Basal epidermal keratinocyte damage

Lichenoid-interface lymphocyte reaction

74
Q

Features absent in the histopathology of lichen planus

A

Parakeratosis

Eosinophils

75
Q

Multiple apoptotic cells seen at the DEJ in lichen planus

A

Colloid-hyaline (Civatte) bodies

76
Q

Separation of the epidermis in small clefts in lichen planus

A

Max Joseph cleft

77
Q

The initial inflammation in lichen planopilaris is at the level of

A

Isthmus and infundibulum

78
Q

Histopathologically, hypertrophic lichen planus can be mistaken as

A

SCC

79
Q

DIF criterion for lichen planus

A

Basement membrane zone and colloid bodies with one or more conjugate(s)

80
Q

Biopsy site for cutaneous lichen planus

A

Proximal trunk with avoidance of the distal extremities

81
Q

Biopsy site for lichen planopilaris

A

Dermoscopy: perifollicular erythema and scaling

82
Q

Biopsy site for nail disease with trachyonychia and pitting

A

Matrix

83
Q

Biopsy site for nail disease with chromonychia, nail plate fragmentation, splinter hemorrhage, onycholysis, and subungual debris

A

Nail bed

84
Q

DIF for lichen planus has the highest sensitivity on

A

Mouth floor

Ventral side of tongue

85
Q

Most cutaneous lichen planus resolves within

A

1-2 years

86
Q

(Generalized/Localized) disease tends to resolve more quickly

A

Generalized

87
Q

First line therapy for limited cutaneous lichen planus

A

High-potency topical corticosteroids

88
Q

Second-line topical agent often used in conjunction with topical steroids in refractory cases of limited cutaneous lichen planus

A

Topical calcineurin inhibitors

89
Q

First-line systemic agents for lichen planus

A

Oral corticosteroids

90
Q

Third-line corticosteroid-sparing agent for lichen planus

A

Cyclosporine

91
Q

Drugs that target lymphocytes more specificially

A

Methotrexate
Mycophenolate mofetil
Azathioprine

92
Q

Drugs that target lymphocytes more specificially are of higher utility in

A

Refractory and ulcerative disease

93
Q

Drugs acting indirectly on lymphocytes

A

Sulfasalazine

Metronidazole

94
Q

Drugs acting on cellular differentiation

A

Acitretin

95
Q

Drugs acting indirectly on lymphocytes are more effective for

A

Generalized disease

96
Q

Drugs acting on cellular differentiation are more effective for

A

Hypertrophic disease

97
Q

Y/N: Monotherapy with oral corticosteroids is the gold standard in the management of lichen planus.

A

No - Long-term monotherapy with oral corticosteroids is not recommended.

98
Q

Has the highest level of evidence of efficacy for lichen planus

A

Sulfasalazine

99
Q

Agranulocytosis and elevated liver function tests can occur with

A

Sulfasalazine

100
Q

Often considered the first-line nonimmunosuppressive systemic agent

A

Metronidazole

101
Q

Patients on metronidazole should be monitored for possible

A

Sensory peripheral neuropathy

102
Q

Second-line agent in cutaneous lichen planus and first-line agent in actinic lichen planus

A

Hydroxychloroquine

103
Q

Cornerstone of treatment in oral lichen planus

A

Good oral hygiene with regular professional dental cleanings

104
Q

First-line therapy in oral lichen planus

A

Topical steroids

105
Q

Common adverse event of topical calcineurin inhibitors

A

Transient burning

106
Q

Preferred systemic therapies in oral lichen planus

A

Acitretin - antiproliferative effects

HCQ and MTX - less immunosuppressive agents

107
Q

Preferred systemic therapy for oral erosive disease

A

MMF

Methotrexate

108
Q

Preferred systemic therapy for noneroded and hyperkeratotic disease

A

Acitretin

109
Q

High-potency topical corticosteroids have been shown to be ineffective in this type of lichen planus

A

Frontal fibrosing alopecia

110
Q

Most commonly used and most effective drugs in frontal fibrosing alopecia

A

Finasteride or dutasteride

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