Chapter 32 :: Lichen Planus Flashcards
Consistent features of lichen planus: 1. ________ cells in the dermis despite disease chronicity and 2. ________ cells in close proximity to dam- aged basal keratinocytes
- CD4-positive T-helper (CD4-Th) cells
- CD8-positive T-cytotoxic (CD8-Tc) cells
The ________ is the effector cell of lichen planus.
CD8-Tc cell
Upon costimulation by _______, CD4-Th cells release inflamma- tory cytokines, including _______, which leads to _______ activation and additional oligoclonal expansion.
LCs
IFN-γ
CD8- Tc
Enhanced lym- phocyte reactivity to _______, a component of ________, has been found in patients with oral LTRs.
inorganic mercury
dental amalgam
Modern theories encompass three major stages in the development of LP:
- antigen recognition,
- lymphocyte activation,
- keratinocyte apoptosis.
A fourth stage, resolution, is a new and emerging facet of the disease
Describe the epidemiology of LP.
Nearly two thirds of cases of lichen planus present between the ages of 30 and 60 years with a peak onset between 55 and 74 years.
Lichen planus is less com- mon at the extremes of age.
There is no clear sexual or racial predilection in lichen planus.
The age of onset is earlier in women.
Describe the epidemiology of childhood LP.
Childhood lichen planus accounts for only 1% to 5% of the total lichen planus cases in the general popu- lation.
In Pacific Indians, childhood lichen planus is more common and accounts for nearly 20% of all cases.
No sexual predilection.
Peak onset 8-12 yo.
______ is the most specific marker for lichen planus.
CXCL-9
Characteristics of familial LP.
early onset
widespread
erosive or ulcerative disease
mucosal involvement
frequent relapses
Multiple HLA haplotypes have been reported in famil- ial lichen planus, including ___ (4 items). In nonfamilial cases, ___ (6 items) are more common.
- HLA-B27, Aw19, -B18, and -Cw8
- HLA-A3, -A5, -A28, -B8, -B16, and Bw35
___ is more common in patients with oral lichen planus alone, and ___ is more common with cutane- ous lichen planus alone. (HLA Types)
HLA-B8
HLA-Bw35
___, fine, white and adher- ent reticulate scale, are noted in well-developed lesions.
Wickham striae
The classic cutaneous lesions of lichen planus are ___ (describe).
well- marginated, dull red-violet, flat-topped, polygonal papules
Clinical features of lichen planus correlate with the characteristic histological findings of lichen planus. Wickham striae correlate with ___. The dull red-violet color correlates with the ___.
orthokeratosis, epider- mal thickening, and an increased granular layer
combination of vascular dilation and pigment incontinence
Distribution of LP
Symmetric over the extremities. The most common areas of involvement are the flexural wrists, arms, and legs. The proximal thighs, trunk, and neck are other common sites of involvement.
Atypical areas for LP
face and palms
Inverse lichen planus commonly involves the ___ (3).
axillae, groin, and inframammary region
The presence of (characteristic) _________ should prompt consideration of an alternative diagnosis.
hypopigmentation
Characteristic of hypertrophic LP
affects limited areas, such as the lower extremities, and is extremely pruritic
Dermoscopic features of lichen planopilaris include: (6)
- absence of follicular opening,
- cicatricial white patches,
- peripilar casts and perifollicular scale,
- blue-gray dots,
- perifollicular erythema,
- polytrichia (two or three hairs)
Histopathology of Actinic Lichen Planus:
- a more brisk LTR relative to lichen planus pigmento- sus,
- vacuolar changes,
- pigment incontinence
Hypertrophic Lichen Planus (verrucous) ddx:
- keratinocyte carcinomas,
- rupioid psoriasis,
- rupioid syphilis,
- reactive arthropathy,
- cutaneous lupus ery- thematosus.
___ is commonly among individuals with hypertrophic lichen planus
Chronic venous insufficiency
Atrophic Lichen Planus ddx: (2)
lichen sclerosus et atrophicus
mycosis fungoides (MF)
Hypertrophic Lichen Planus common sites:
anterior shins and interphalangeal joints
Atrophic Lichen Planus common sites:
proximal lower extremity and trunk
Vesiculobullous Lichen Planus occurs sec- ondary to an exuberant ___ and an exaggerated ___.
inflammatory response
Max-Joseph space
Vesiculobullous Lichen Planus common sites:
lower extremities
Erosive and Ulcerative Lichen Planus common sites:
feet
oral cavity
___has been described in chronic lesions of ulcerative oral lichen planus.
SCC
Follicular lichen planus occurs most commonly on the scalp and occurs in three distinct variants: (3)
lichen planopilaris,
frontal fibrosing alopecia,
Gram-Little-Piccardi- Lassueur syndrome (GLPLS)
Lichen Planus Pigmentosus histopathology:
epidermal atrophy, a lymphocyte poor LTR, and pigment incontinence
Lichen planus pigmentosus and ___ have significant overlapping features.
ashy dermatosis, or erythema dyschromicum per- stans
Actinic Lichen Planus epidemiology:
young individuals of Middle Eastern descent and is most common in the spring and summer months
Actinic LP most common sites:
- face
- dorsal hands, arms, and nape of the neck
Actinic LP histopath:
a more brisk LTR relative to lichen planus pigmento- sus, vacuolar changes, and pigment incontinence
Classic lichen planopilaris affects the __ scalp and consists of ___.
vertex
diffuse erythema with perifollicular hyperkeratosis and livid erythema
GLPLS is a rare subtype characterized by __, __, __.
cicatricial alopecia of the scalp
nonscarring alopecia of the axilla and groin
follicular papules on the trunk and extremities
__ is the end stage of follicular fibrosis caused by a primary inflammatory dermatosis such as lichen planus, lupus erythematosus, pustular scarring forms of folliculitis, fungal infections, sclero- derma, and sarcoidosis.
pseudopelade of Brocq
Mucosal Lichen Planus common sites:
mouth, genitalia
most common form of oral LP
reticular form
most common site of reticular form of oral lichen planus
buccal mucosa > tongue > gingiva
Erosive and ulcerative oral lichen planus is most on the ___
tongue
___ is the most common cause of desquamative gingivitis
oral LP
__ are similar clinically and histologically to oral lichen planus; however, with an identifiable cause
Oral lichenoid reactions (OLRs)
A unique lichenoid eruption has been described on the tongues of individuals with HIV. This reaction is characterized by ___. The eruption usually follows ___ or ___ intake
bilateral reticular keratotic or atro- phic changes of the buccal mucosa and lichenoid atro- phic patches over the dorsal tongue
zidovudine, ketoconazole
