Lichen planus etc Dan Flashcards
T/F
Skin LP is more common than mucosal LP
False
skin 1% of population
mucosa 1-4%
oral LP is thought to be up to 8x more common than skin disease
T/F
Lichen planus affects 10% of first degree relatives of a patient
True
T/F
LP mainly affects middle eastern peoples?
False
No racial predisposition
But childhood LP has higher prevalence in arab populations
T/F
75% of pts with mucosal LP get skin lesions
False
75% of those with skin LP get mucosal lesions1
5% of those with oral LP get skin lesions
T/F
Oral LP is often present in isolation
True
T/F
Annular lesions occur in 10% of cases of LP
True
T/F
Exanthematous LP disseminates rapidly but lasts for years
False
Acute/exanthematous LP onset in weeks and usuallly resolves in 3-9 months or up to 1 year
T/F
LP involves the penis in 10% of cases and often ulcerates
False
25% of men with LP elsewhere
almost never ulcerates
is usually annular LP
T/F
Linear LP has later onset than classical LP
Linear LP is usually zosteriform
False any age but Ave earlier than classic - 20s-30s (classic 30s-60s) False Is Blaschkoid rather than zosteriform
T/F
50% of pts with follicular LP (LPP) have LP lesions elsewhere
True
skin, mucosae or nails
T/F
All types of LP are more common in women?
False
palmoplantar more common in men
LP in general and most subtypes more common in women
T/F
40% of cases of oral LP affect the gums?
False
10% - usually causes desquamative gingivitis - must check genital esp women (vulvovaginal-gingival LP)
T/F
>90% of women with vulvovaginal LP have clinical oral LP
False
70%
T/F
70% of cases of erosive vulval LP involve the vagina
True
T/F
Children do not get vulval LP
True
T/F
Nail lichen planus is more common in children
False
20 nail dystrophy is more commonly seen in children but other than this LP of the nails is rare in children
T/F
Nails are involved in 30% of LP patients
False
10% esp those aged >40
T/F
2 thirds of cases of classical LP resolve in one year
True
85% in 1.5 years
remainder can drag on
T/F
50% of resolved LP cases relapse
False
only 1 in 5 (20%)
T/F
Hypertrophic LP lasts for 3 years
False
Ave is 6 years
T/F
Oral LP is usually lifelong
False
Ave 5 years but erosive type often lifelong
T/F
Nail LP lasts about one year
False
Often many years
T/F
90% of pts with oral LP and metal fillings have positive patch tests to metals
False
30-40% positive
T/F
90% of pts with oral LP and metal fillings improve whne the fillings are removed
True
(85-95%)
even if patch test negative
T/F
Lichen striatus affects girls 5x more than boys
False
girls 2-3x more than boys
T/F
25% of patients with LP have lichen nitidus type lesions
True
T/F
25% of lichen nitidus pts have nail involvement
False
5-10%
T/F
Lichen nitidus lasts up to 8 years
True
but usually resolves in a year
T/F
Ashy dermatosis usually clears in one year
False70-80% of children clear in 2-3 yearsadult onset form persists for many years
T/F
Chronic erosive/atrophic oral LP has a 5% risk of SCC over 10 yrs
True
need close follow up
T/F
Oral lesions of lichen planus pemphigoides may resemble LP or pemphigoid
True
T/F
ILCS are never used for erosive oral LP
false
important Rx option for erosive disease
What chemicals can trigger lichenoid contact dermatitis or stomatitis?
Mercury (amalgam) Gold Copper Nickel Cinnamates Musk ambrette Aminoglycoside antibiotics Chemicals for colour photograph developing Methacrylic acid esters used in the car industry
What are the associations of lichen planus?
What are the associations of other lichen planus group conditions?
Hep C most associated esp w/ oral disease
- Also worth doing LFTs and HepB and HIV
Oral LP (esp erosive) carries small increased risk of oral SCC - stop smoking, sun protect, see dentist, always check mucosal surfaces for active LP and cancers
Vulvovaginal or penile LP caries risk of SCC
Hypertrophic LP and ulcerating plantar LP can also give rise to SCCs
No other cancer risk but prudent to ensure screening up to date for age/sex and screen for red flags in Hx and exam.
No definite cancerous triggers for LP
No proven autoimmune disease risk
Always consider drug rcn as DD and lichenoid contact rcn esp for oral LP
- drug and contact, dental Hx
Other conditions;
Lichen striatus - no associations
Lichen nitidus
Ashy dermatosis
Keratosis lichenoides chronica (Nekam’s) - lymphoproliferative Dx, glomerulonephritis
SALE - sun only
ALDY - may be triggered by vaccines
How does LP pigmentosus differ from Ashy dermatosis (Erythem dyschromium perstans)?
Affects older age group (30s and 40s) Photo and flexural distribution Irregular or confluent lesions commonly May have classic LP lesions (20%) Early lesions don’t have erythematous border of EDP
What are the types of oral lichen planus?
Reticular (most common = classical type) Atrophic Erosive (ulcerative) (inc vulvovaginal-gingival) Plaque like (most common in smokers) Papular Pigmented Bullous Desquamative gingivitis (inc vulvovaginal-gingival)Also can be lichenoid contact stomatitis
What are the types of genital LP?
Mainly Vulval/limited syndrome types: Pigmented LP Lichenplanopilaris Vulvovaginal-gingival LP Types more likely to be part of LP elsewhere: Classical LP Hypertrophic LP Penis LP: Mainly annular LP Can cause balantis or phimosis
What is Summertime Actinic Lechenoid Eruption (SALE)?
Lichen nitidus like lesions occurring in sun exposed areas of dark skin types after prolonged sun exposure in summertime. Histo same as lichen nitidusSome say is the same as actinic LP but actinic LP;- Is red-brown hyperpigmented macules on face or other exposed areas after sun exposure in dark skin types- Has histo of LP not LN
Treatment ladder for Lichen planus
Topicals - localised disease or as adjuvant; - Diprosone/Dip OV/Clobetasol - Tacrolimus - Calcipotriol Intralesional; - ILCS 5-20mg/ml triamcinolone esp hypertrophic LP Systemics - 1st line; - Pred 25-50mg/kg 6wks, wean over 2-3 months - Acitretin - 30mg for 2mnths then wean (isotretinoin 2nd choice - 10mg 2mnths then wean ) - Metronidazole 500mg BD for 1-2 months - Sulphasalazine Start at 500mg BD, inc by 500mg every 3 days until 2.5-3g total daily; maintain for 3-6 weeks Systemics - 2nd line; - HCQ Systemics - 3rd line; - CsA - quick onset - Dapsone - quick onset - MMF - good evidence - MTX - AZA - Cyclophosphamide Phototherapy - can use 1st or 2nd line - nbUVB - broadband UVB - UVA1 - PUVA - bath or oral Also NdYAG laser CO2 laser surgery for small resistant lesions Other reported systemics; - Itraconazole - Griseofulvin - Bactrim - Doxy/tetracycline - Interferon - Thalidomide - Enoxaparin - TNFα inhibitors For subtypes; Erosive LP – efalizumab, alfacept Actinic LP – TCS, acitretin or CsA Ulcerative plantar LP – topical or systemic CsA Vulvovaginal - Clobetasol, TCNI, pred, MTX, MMF, CsA Penis - TCS, TCNI, circumcision LPP - HCQ, short course pred, CsA, MMF, thalidomide Nails - ILCS nailfold, pred, etanercept Oral - TCS by orabase or INHspray, TCNI, CsA mouthrinse, top rapamycin, top retinoid, ILCS erosive oral Dx often need pred @ higher dose than skin dx or MTX, CsA, Acitretin, Isotretinoin, Etrtinate, HCQ, Dapsone, Griseofulvin Excimer laser for resistant erosive oral LP ECP for resistant erosive oral LP
