Lichen Planus

Question 1

What is lichen planus

Answer 1

• idopathic inflammatory eruption of the skin, hair, nails, and mucous membranes
• characterized by shiny, flat topped purple papules and plaques of the wrists, ankles, genitalia

Question 2

7 Ps of lichen planus

Answer 2

• planar (flat)
• purple
• polygonal
• pruritic
• papules
• plaques
• postinflammatory hyperpigmentation

Question 3

what is the suspected cause of lichen planus?

Answer 3

-T cell mediated immune response to self Ags on damaged keratinocytes

Question 4

common patient that presents w/ lichen planus?

Answer 4

middle aged adults, namely women who tend to get LP in the mouth

Question 5

What other condition is LP associated with?

Answer 5

-hep C (esp. if widespread)

Question 6

Other things associated w/ LP

Answer 6

• exposure to thiazides
• furosemide
• beta-blockers
• sulfa
• tattoo pigments
• graft vs host dz
• lupus

Question 7

S/S of LP

Answer 7

• small flat skin lesions that are angular, red-to-violaceous, shiny and pruritic
• have fine white lines (Whickham striae**)
• gray-white puncta

Question 8

where is LP most commonly found?

Answer 8

• flexor surfaces of upper extremeties (wrists)
• extensor surfaces of lower extremities (ankles)
• lower back
• genitalia
• mucous membranes

Question 9

papules in LP

Answer 9

1 to 10 mm, small, shiny, flat-topped, angular, lesions that occur in crops; lesions may have a fine scale

Question 10

color in LP

Answer 10

purpuric, violaceous, with white lacelike pattern (Wickham striae) on surface of papules. Wickham striae are best seen after topical application of mineral oil and, if present, are virtually pathognomonic for LP

Question 11

shape in LP

Answer 11

polygonal or oval. Annular lesions may appear on trunk and mucous membranes. Various shapes and sizes may be noted (polymorphic)

Question 12

Koebner phenomenon (isomorphic response)

Answer 12

New lesions may be noted at sites of minor injuries, such as scratches or burns

Question 13

postinflammatory hyperpigmentation in LP

Answer 13

Lesions typically heal, leaving darkly pigmented macules in their wake

Question 14

duration of LP

Answer 14

• usually goes away w/i 2 yrs
• 1/5 have a 2nd outbreak
• can come and go for years

Question 15

prevalence of oral LP

Answer 15

• 40-60% of those w/ skin lesions have oral lesions

- 20% have mucous membrane lesions w/o skin involvement

Question 16

Describe oral LP

Answer 16

• MC: asx nonerosive milky white lines w/ lacy/netlike pattern
• usually seen on bucal mucosa but can be on tongue, gingiva, palate, or lips
• rarely develop into SCC

Question 17

Nail LP

Answer 17

• often on just a few nails or can have all 20

- nail dystrophy w/ splitting and thinning and loss of nail

Question 18

scalp LP

Answer 18

• rare

- often presents as redness or irritation w/ tiny bumps and thinning hair or patches of hair loss

Question 19

dx of LP

Answer 19

• usually a clinical dx
• skin bx should be done if in doubt
• if indicated: serology for hep C and LFTs

Question 20

tx of LP

Answer 20

• no cure, often goes away on its own
• topical steroids for itching
• intralesionsal steroids for lesions reduction
• system steroids: for when LP lasts a long time or w/ many painful bumps

Question 21

tx of severe chronic LP

Answer 21

• cyclosporine

- PUVA (UV radiation / phototherapy)