Lichen Planus

Question 1

what are lichenoid basal layer damage conditions characterised by

Answer 1

damage between dermis and epidermis

Question 2

what can be mistaken for lichenoid eruptions

Answer 2

lichenoid drug eruptions - take careful drug history

Question 3

lichen planus - describe lesions

Answer 3

purple, pruritic, planar papules with white lacy markings on the surface of lesions

Question 4

where do lichen planus lesions tend to appear

Answer 4

wrist, ankles

50% have mucosal involvement - mouth is most common

Question 5

what are the white lacy markings called

Answer 5

wickhams striae

Question 6

what are the scalp lesions like

Answer 6

scaly with marked follicular plugging that can result in scarring alopecia

Question 7

lichen planus histology

Answer 7

• Band of chronic inflammatory infiltrate (T cells) that destroys the DEJ, with formation of cytoid bodies
• Saw tooth appearance of rete ridges

Question 8

nail involvement

Answer 8

dystrophy

can be lost altogether in severe disease

Question 9

lichen planus management

Answer 9

topical steroids or oral steroids if extensive

Question 10

which conditions exhibit the Koebner phenomenon

Answer 10

lichen planus, psoriasis and vitiligo

Question 11

what disease is lichen planus associated with

Answer 11

Hep C

Question 12

what can exacerbate mouth lesions

Answer 12

spicy food

Question 13

lichenoid drug eruption

Answer 13

Lichen planus like rash caused by medications. Asymptomatic/itchy plaques arise on trunk of mucosal membranes.

• Gold e.g. gold tooth
• Anti-malarials e.g. hydroxychloroquine
• ACEi