Lichen Planus & Lichenoid Reactions Flashcards
At what age does Lichen Planus usually occur?
Between 20-50 years.
How are the lesions in Lichen Planus described?
Polygonal flat topped violaceous papules.
They often cluster and bear a superficial fine white lacy reticulate pattern
This is known as Wickham’s Striae
What areas of the body are most likely to be affected by lichen planus?
- Wrists
- Lower back
- Shins
- Ankles
- Mucous membranes
- Nails
- Scalp
Lichen Planus can affect the Vulva.
How does this usually initially start to present?
Dyspareunia or pruritus
(They can also affect the underlying structure/architecture)
How does Vulvar Lichen Planus differ from Lichen Sclerosus?
It doesn’t have the white pallor or purpura of Lichen Sclerosus
When Lichen Planus affects the epithelium of the scalp, what is it known as?
Lichen Plano Pilaris (LPP)
Does LP display the Koebner Phenomenon?
Yes
What is the most common complaint when lichen planus erupts?
Itchiness
What is the other main complaint with Lichen Planus when the active lesions start to settle?
Post Inflammatory hyperpigmentation
What should you also consider if you notice that someone has Lichen Planus?
Consider examining genitals
(Vulvar Lichen Planus)
If someone has alopecia due to lichen planus, what do you notice?
There will be peripilar scaling and erythema under the dermatoscopy.
What is this?
Oral Lichen Planus
(Note Wickham’s Striae)
What are the most common drugs to cause a lichenoid eruption?
- Anticonvulstants
- NSAIDs
- Diuretics
- Penicillamine
Although most causes of Lichen Planus and Lichenoid Eruptions are idiopathic, what condition has been associated with it?
Hepatitis B & C
What features point towards a lichenoid drug reaction vs lichen planus?
- Absence of Wickham’s Striae
- Extensive rash across the trunk, limbs.
- Nail and mucous membrane involvement is uncommon.
If a lichenoid drug reaction occurs,
How quickly does it occur after starting the drug?
Are the quick or slow to resolve?
- 10 days to 2 months of commencing a drug therapy
- They are slow to resolve.
Oral lichenoid eruptions have been related to [BLANK]?
Amalgam fillings
80% of cases of idiopathic lichen planus will resolve in [BLANK]?
9-15 months
If someone has oral lichen planus, what are they more prone to getting?
SCC form the oral areas of lichen planus
(Advise on reducing alcohol and smoking)
Name some other types of lichen planus?
- Acitinic Lichen Planus
- Annular Lichen Planus
- Atrophic Lichen Planus
- Ashy Dermatosis
- Hypertrophic Lichen Planus
- Bullous Lichen Planus
- Lichen Planus Pemphigoides
- Linear LP
What is this?
Where is it usually found on the body?
Hypertrophic Lichen Planus
- Usually on the lower legs and shins.
- Treatment: Potent topical steroids under occlusion for a few months followed by regular calcineurin inhibitors.
- Differential: Lichen Simplex Chronicus
What is this?
Who usually gets it?
What is its differential?
Acitinic Lichen Planus
Minaly Type 5 skin from the Middle East
Differential Diagnosis: Melasma
What is this?
Who usually gets it?
How is it treated?
Ashy Dermatosis
- Usually Skin types 3-5.
- Difficult to treat - Consider Potent steroids if biopsy shows inflammation.
What is this an example of?
Linear Lichen Planus
It occurs spontaneously over Blashko’s lines.
What is this?
Annular Lichen Planus
Rare
Usually occurs with classical Lichen Planus
More commonly seen in men in genitalia or intertriginous areas.
What is the management strategy in lichen planus?
- Check for hepatitis B &C if extensive disease
- Check scalp, nails, mucous membranes and genitalia
-
Topical
- Potent & Super Potent Steroids - good for most
- Topical calcineurin inhibitors can also be tried.
- Intralesional Steroids - used for nail, scalp & localised treatment
- Systemic steroids - for widespread disease
-
Phototherapy - narrowband UVB as TLO-1
- NOTE: PIH can be exacerbated by narrowband UVB
- Other oral therapies
- Cyclosporine, Azathioprine, Immunosuppresives can be used in recalcitrant cases.
- Lichen planopilaris may respond to Hydroxychloroquine and Acitretin.
- Tranexamic acid for PIH - treat for 6 months duration.
How do you treat oral lichen planus?
Topical steroid in Orabase
(eg 0.1% triamcinolone in an adherent base)
OR
Steroid gargles (5mg soluble Prednisolone tablets) 4 times daily
OR IN RESISTANT CASES
Ciclopsorine mouthwash (100mg/ml rinse).
AND
Benzydamine Hydrochloride oral rinse for pain relief.
