Ch 10. Lichen plans and other lichenoid dermatoses Flashcards
What is typical age of onset for Lichen Planus?
5th-6th decade
2/3 onset between 30-60
rare in kids
How common is LP? Oral LP?
LP up to 1%
Oral LP 1-4%
What % patients with cutaneous LP will get oral involvement
75%
What % of patients presenting with only oral LP will go on to get cutaneous LP
10-20%
Name 4 categories of triggers for LP
- VIRUSES
-Hep C big one, most associated with oral
-HHV6/7, HSV, VZV, HPV - Vaccines
- Contact allergens
-amalgam (mercury), copper, and gold - Drugs-see later cards
Name the top 5 drugs to cause lichenoid drug
Gold
ACEi
Thiazide diuretics
Anti-malarial
Quinidine
What are the classic sites of prediction for classic LP
Wrists-flexor
Forearm-flexor
Dorsal hands
Shins
Pre-sacral
Glans penis
Name 6 classic characteristics of lichen planus
Polygonal
Violaceous
Flat toppes
Papules
Whickams striae-lacy reticulate network fine lines
Pruritic
PIH common
Koebner
Sometimes widely disperse, sometimes coalesced
What 4 subtypes of LP tend to ne more persistent throughout life
Hypetrophic
Oral
Annular
Ulcerative oral
Name 10 variants of lichen
Annular
Atrophic
Actinic
Acute/exanthematous
Hypertrophic
Eosive/ulcerative
Bullous LP
LP pemphigoides
Linear
Lichen planopilaris
Lichen Plans pigmentosus
Oral
Nail
Inverse
Vulvovaginal
DLE/LP overlap
What is the natural course of eruptive/acute LP
Acute onset generalized eruption mostly on classic sites though, trunk, inner wrists, dorsal feet
Self resolves 3-9 months with hyperpigmentation
What are the clinical features of actinic LP
red–brown plaques with an annular configuration, but melasma-like hyperpigmented patches have been observed
Sun exposed areas-face, dorsal arms, neck
Spring/summer
Where are the top 4 sites of annular LP
Axilla>penis >extremity> groin
Where does atrophic LP occur? What is likely happening? What do they look like?
intertriginous and lower extremities
likely resolving LP, maybe be exacerbated by TCS
papules coalesce to form larger plaques that over time become atrophic centrally, with residual hyperpigmentation.
What is the difference between bullous LP and LP pemphigoides
Bullous LP–> vesicles and bullae develop within pre-existing lesions of LP as a result of intense lichenoid inflammation and significant epidermal damage
LP pemphigoides have circulating IgG autoantibodies directed against the 180 kDa BP antigen (BP180; BPAG2), as in idiopathic BP.
Compared to BP though, bullae can arise either within LP lesions or previously uninvolved skin, but the diagnosis of LP usually precedes the LP pemphigoides
Where does hypertrophic LP occur? What does it look like?
Extremely pruritic, thick, hyperkeratotic plaques are seen primarily on the shins or dorsal aspect of the feet and may be covered by a fine adherent scale.
Name a feature on path that may help differentiate hypertrophic LP
increased eosinophils