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Interface Dermatitis > Lichen Planus > Flashcards

Lichen Planus Flashcards

1
Q

most common age of onset of LP:

A
  • middle aged adults (peaks at 40-50)
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2
Q

Male/female predominance

A

F>M

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3
Q

Pathogenesis:

A
  • auto reactive T-lymphocytes attack basal keratinocytes in the skin, mucous membranes, hair follicles and/or nail units. - viruses, medications, and contact allergens have been implicated as cause of this reaction.
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4
Q

_____ is implicated in subset of oral ulcerative/erosive LP

A

Hepatitis C virus

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5
Q

_____ is associated with oral LP, and bullous LP in children (otherwise uncommon presentation)

A
  • Hepatitis B (vaccine)
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6
Q

Contact allergens a/w oral LP:

A
  • mercury amalgam, copper and gold
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7
Q

treatment for oral LP caused by contact allergen?

A
  • remove the allergen (mercury amalgam, copper, gold)
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8
Q

Most common drugs implicated in drug induced LP:

A
  • HCTZ, B-Blockers, ACE inhibitors, antimalarials, gold salts.
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9
Q

Classic finding on lesions of LP:

A
  • Wickham striae
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10
Q

Drug induced LP clinically presents as_____ and spares the ______ regions of body

A
  • more generalized, eczematous lesions, in a photo distribution - spares the oral mucosa and genitals
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11
Q

Look for ______ on histopath for drug induced LP.

A
  • eosinophils
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12
Q

How long after drug can drug induced LP appear?

A
  • up to one year!!
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13
Q

LP presents clinically as:

A
  • purple, pruritic, planar, papules and plaques
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14
Q

LP lesions may exhibit______ phenomenon

A
  • Koebner
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15
Q

Most common sites of LP:

A
  • oral mucosa is #1!!! - ventral wrists/forearms #2 - dorsal hands, shins, genitalia, presacral area and neck
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16
Q

Histopathology of LP:

A
  • wedge shaped hypergranulosis - orthohyperkeratosis - irregular acanthuses w/ “saw-toothed” rate ridges - vacuolar degeneration of the basal layer - apoptotic keratinocytes confined to basal layer with some in superficial dermis (Civatte bodies) - superficial dermal band-like (lichenoid) lymphocytic infiltrate
17
Q

With exception of drug induced and hypertrophic LP, histopath will lack _____.

A
  • eosinophils
18
Q

With exception of drug-induced LP and oral LP, histopath will lack _____

A
  • parakeratosis
19
Q

Graham-Little-Piccardi-Lasseru syndrome presents with:

A
  • scarring alopecia of scalp caused by LPP - non-scarring hair loss at pubic and axillary regions - follicular papule that appear as keratosis pillars - and classic LP lesions of skin and mucosa Picture B.Little eating a Graham cracker with these symptoms.
20
Q

LP variants by location:

A
  • genital - mucosal LP - nail LP - Inverse LP - palmoplantar LP - Lichen planopilaris
21
Q

___ % of patients with cutaneous LP will have oral lesions.

A
  • 50%
22
Q

nail LP will present as:

A
  • lateral thinning of nails - longitudinal ridges - pitting - dorsal pterygium
23
Q

LPP presents as:

A
  • erythema and perifollicular scale around hair follicle that can lead to scarring alopecia
24
Q

LP variants based on appearance:

A
  • classic - annular - atrophic - hypertrophic - ulcerative - linear - bulls - pemphigoides - pigmentosus
25
Q

Annular LP typically affects the ____ or ____

A
  • penis or axilla
26
Q

atrophic LP usually occurs on ____ as ____

A
  • legs - depressed or hyper pigmented lesions
27
Q

Ulcerative LP affects the ____

A
  • palmoplantar surfaces
28
Q

Hypertrophic LP commonly occur on the _____ and are ____ (symmetric or asymmetric)

A
  • shins and dorsal feet - symmetric - can be VERY PRURITIC
29
Q

Bullous LP presents as:

A
  • blisters that arise within chronic LP lesions
30
Q

LP pemphigoides presents with blisters on ____ 2/2 ___ autoantibodies targeting ____

A
  • blisters on uninvolved skin - IgG autoantibodies against BPAG 2
31
Q

LP pigmentosus presents as_____, and typically occurs in Fitzpatrick type ___ skin

A
  • grey brown macule on sun exposed areas of face and neck - type 3/4 skin
32
Q

LP variants by cause:

A
  • Actinic LP - Drug-induced LP
33
Q

Actinic LP occurs in _____ patient population and presents as:

A
  • young middle eastern adults - red/brown plaques on sun-exposed areas of face, neck and extremities
34
Q

What do you NOT see on histology?

A
  • parakeratosis or eosinophils - think of LP as the strict parent that does not let para or eos around!
35
Q

LP histology

A

Interface Dermatitis (12 decks)

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