Lichen planus: Difference between revisions

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List of terms related to Lichen planus

	Lichen planus;
ICD-10	L43
ICD-9	697.0
OMIM	151620
DiseasesDB	7452
MeSH	D008010

VisualWikitext

Revision as of 20:17, 28 July 2015

For patient information, click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]

Synonyms and keywords: Ruber planus; Wickham striae

Overview

Lichen planus is an inflammatory disease that affects the skin and the oral mucosa.

Classification

Lichen Planopilaris is the specific name given to lichen planus on the scalp that may cause permanent, scarring alopecia. If left untreated the scarring will cause permanent hair loss. The Cicatricial Alopecia Research Foundation is a non-profit organization that provides support and resources for people with lichen planopilaris.

Cause

Common Causes

The cause of lichen planus is not known; however, there are cases of lichen planus-type rashes (known as lichenoid reactions) occurring as allergic reactions to medications for high blood pressure, heart disease and arthritis. These lichenoid reactions are referred to as lichenoid mucositis (of the mucosa) or dermatitis (of the skin). Lichen planus has been reported as a complication of chronic hepatitis C virus infection and can be a sign of chronic graft-versus-host disease of the skin. It has been suggested that true lichen planus may respond to stress, where lesions may present on the mucosa or skin during times of stress in those with the disease.

Causes in Alphabetical Order

Natural History, Complications, and Prognosis

Lichen planus is usually not harmful and may get better with treatment. It usually clears up within 18 months. However it may last for weeks to months, and may come and go for years. If lichen planus is caused by a medication, the rash should go away once the medicine is stopped.

A possible complication that is associated with lichen planus is that mouth ulcers that are there for a long time may develop into oral cancer.

Diagnosis

Symptoms

The microscopic appearance of lichen planus is pathognomonic for the condition

Hyperparakeratosis with thickening of the granular cell layer
Development of a "saw-tooth" appearance of the rete pegs
Degeneration of the basal cell layer
Infiltration of inflammatory cells into the subepithelial layer of connective tissue

Other symptoms such as:

Physical Examination

The typical rash of lichen planus is well-described by the "5 P's": well-defined pruritic, planar, purple, polygonal papules. The commonly affected sites are near the wrist and the ankle. The rash tends to heal with prominent blue-black or brownish discoloration that persists for a long time. Besides the typical lesions, many morphological varieties of the rash may occur. The presence of cutaneous lesions is not constant and may wax and wane over time. Oral lesions tend to last far longer than cutaneous lichen planus lesions.

The following images show good examples of how lichen planus manifests on the body.

Lichen planus close up
Lichen planus on the arm
Lichen planus on the oral mucosa
Lichen planus on the hands

Skin

Lichen Planus Actinicus

Face

Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]

Trunk

Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]

Extremity

Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]
Lichen planus actinicus. Adapted from Dermatology Atlas.^[1]

Lichen planus annular

Trunk

Lichen planus annular. Adapted from Dermatology Atlas.^[1]
Lichen planus annular. Adapted from Dermatology Atlas.^[1]

Lichen Planus Follicularis

Neck

Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]

Extremity

Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]

Scalp

Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]
Lichen planus follicularis. Adapted from Dermatology Atlas.^[1]

Lichen Planus Linearis

Trunk

Lichen planus linearis. Adapted from Dermatology Atlas.^[1]
Lichen planus linearis. Adapted from Dermatology Atlas.^[1]

Extremity

Lichen planus linearis. Adapted from Dermatology Atlas.^[1]
Lichen planus linearis. Adapted from Dermatology Atlas.^[1]
Lichen planus linearis. Adapted from Dermatology Atlas.^[1]
Lichen planus linearis. Adapted from Dermatology Atlas.^[1]
Lichen planus linearis. Adapted from Dermatology Atlas.^[1]
Lichen planus linearis. Adapted from Dermatology Atlas.^[1]
Lichen planus linearis. Adapted from Dermatology Atlas.^[1]
Lichen planus linearis. Adapted from Dermatology Atlas.^[1]
Lichen planus linearis. Adapted from Dermatology Atlas.^[1]

Lichen Planus Verrucosus

Lichen planus verrucosus . Adapted from Dermatology Atlas.^[1]
Lichen planus verrucosus . Adapted from Dermatology Atlas.^[1]

Lichen Planus Vesicular

Trunk

Lichen planus vesicular . Adapted from Dermatology Atlas.^[1]
Lichen planus vesicular . Adapted from Dermatology Atlas.^[1]
Lichen planus vesicular . Adapted from Dermatology Atlas.^[1]
Lichen planus vesicular . Adapted from Dermatology Atlas.^[1]
Lichen planus vesicular . Adapted from Dermatology Atlas.^[1]

Extremity

Lichen planus vesicular. Adapted from Dermatology Atlas.^[1]
Lichen planus vesicular . Adapted from Dermatology Atlas.^[1]
Lichen planus vesicular . Adapted from Dermatology Atlas.^[1]
Lichen planus vesicular. Adapted from Dermatology Atlas.^[1]
Lichen planus vesicular . Adapted from Dermatology Atlas.^[1]
Lichen planus vesicular . Adapted from Dermatology Atlas.^[1]
Lichen planus vesicular . Adapted from Dermatology Atlas.^[1]
Lichen planus vesicular . Adapted from Dermatology Atlas.^[1]
Lichen planus vesicular . Adapted from Dermatology Atlas.^[1]

Mucosal Lichen Planus

Oral cavity

Mucosal lichen planus. Adapted from Dermatology Atlas.^[1]
Mucosal lichen planus . Adapted from Dermatology Atlas.^[1]
Mucosal lichen planus . Adapted from Dermatology Atlas.^[1]

Head

Oral lichen planus may present in one of three forms.

The reticular form is the most common presentation and manifests as white lacy streaks on the mucosa (known as Wickham's striae) or as smaller papules (small raised area). The lesions tend to be bilateral and are asymptomatic. The lacy streaks may also be seen on other parts of the mouth, including the gingiva (gums), the tongue, palate and lips.
The bullous form presents as fluid-filled vesicles which project from the surface.
The erosive form presents with erythematous (red) areas that are ulcerated and uncomfortable. The erosion of the thin epithelium may occur in multiple areas of the mouth, or in one area, such as the gums, where they resemble desquamative gingivitis. Wickham's striae may also be seen near these ulcerated areas. This form may undergo malignant transformation.

Throat

Rarely, lichen planus shows esophageal involvement, where it can present with erosive esophagitis and stricturing. It has also been hypothesized that it is a precursor to squamous cell carcinoma of the esophagus.

Genitals

Lichen planus may also affect the genital mucosa - vulvovaginal-gingival lichen planus. It can resemble other skin conditions such as atopic dermatitis and psoriasis.

Clinical experience suggests that Lichen planus of the skin alone is easier to treat as compared to one which is associated with oral and genital lesions.

Lichen planus. Adapted from Dermatology Atlas.^[1]
Lichen planus. Adapted from Dermatology Atlas.^[1]
Lichen planus. Adapted from Dermatology Atlas.^[1]
Lichen planus. Adapted from Dermatology Atlas.^[1]
Lichen planus. Adapted from Dermatology Atlas.^[1]

Differentiating lichen planus from other Diseases

The clinical presentation of lichen planus may also resemble other conditions, including:

A biopsy is useful in identifying histological features that help differentiate lichen planus from these conditions.

Epidemiology and Demographics

Age

Lichen planus in children is rare, and it occurs most often in middle-aged adults.

Gender

Lichen planus affects women more than men (at a ratio of 3:2).

Risk Factors

Some of the risk factors for lichen planus are as follows:

Exposure to medications, dyes, and other chemical substances (including gold, antibiotics, arsenic, iodides, chloroquine, quinacrine, quinide, phenothiazines, and diuretics)
Disorders such as hepatitis C

Treatment

Currently there is no cure for lichen planus but there are certain types of medicines used to reduce the effects of the inflammation. Lichen planus may go into a dormant state after treatment. There are also reports that lichen planus can flare up years after it is considered cured.

Pharmacotherapy

Acute Pharmacotherapies

Chronic Pharmacotherapies

Oral retinoids
Immunosuppressant medications

References

↑ ^1.000 ^1.001 ^1.002 ^1.003 ^1.004 ^1.005 ^1.006 ^1.007 ^1.008 ^1.009 ^1.010 ^1.011 ^1.012 ^1.013 ^1.014 ^1.015 ^1.016 ^1.017 ^1.018 ^1.019 ^1.020 ^1.021 ^1.022 ^1.023 ^1.024 ^1.025 ^1.026 ^1.027 ^1.028 ^1.029 ^1.030 ^1.031 ^1.032 ^1.033 ^1.034 ^1.035 ^1.036 ^1.037 ^1.038 ^1.039 ^1.040 ^1.041 ^1.042 ^1.043 ^1.044 ^1.045 ^1.046 ^1.047 ^1.048 ^1.049 ^1.050 ^1.051 ^1.052 ^1.053 ^1.054 ^1.055 ^1.056 ^1.057 ^1.058 ^1.059 ^1.060 ^1.061 ^1.062 ^1.063 ^1.064 ^1.065 ^1.066 ^1.067 ^1.068 ^1.069 ^1.070 ^1.071 ^1.072 ^1.073 ^1.074 ^1.075 ^1.076 ^1.077 ^1.078 ^1.079 ^1.080 ^1.081 ^1.082 ^1.083 ^1.084 ^1.085 ^1.086 ^1.087 ^1.088 ^1.089 ^1.090 ^1.091 ^1.092 ^1.093 ^1.094 ^1.095 ^1.096 ^1.097 ^1.098 ^1.099 ^1.100 ^1.101 ^1.102 ^1.103 ^1.104 ^1.105 ^1.106 ^1.107 ^1.108 ^1.109 ^1.110 ^1.111 ^1.112 ^1.113 ^1.114 ^1.115 ^1.116 ^1.117 ^1.118 ^1.119 ^1.120 ^1.121 ^1.122 ^1.123 ^1.124 ^1.125 ^1.126 ^1.127 ^1.128 ^1.129 ^1.130 ^1.131 ^1.132 ^1.133 ^1.134 ^1.135 ^1.136 ^1.137 "Dermatology Atlas".

Template:WikiDoc Sources

[Dermatology_Atlas-1] 1.000 ^1.001 ^1.002 ^1.003 ^1.004 ^1.005 ^1.006 ^1.007 ^1.008 ^1.009 ^1.010 ^1.011 ^1.012 ^1.013 ^1.014 ^1.015 ^1.016 ^1.017 ^1.018 ^1.019 ^1.020 ^1.021 ^1.022 ^1.023 ^1.024 ^1.025 ^1.026 ^1.027 ^1.028 ^1.029 ^1.030 ^1.031 ^1.032 ^1.033 ^1.034 ^1.035 ^1.036 ^1.037 ^1.038 ^1.039 ^1.040 ^1.041 ^1.042 ^1.043 ^1.044 ^1.045 ^1.046 ^1.047 ^1.048 ^1.049 ^1.050 ^1.051 ^1.052 ^1.053 ^1.054 ^1.055 ^1.056 ^1.057 ^1.058 ^1.059 ^1.060 ^1.061 ^1.062 ^1.063 ^1.064 ^1.065 ^1.066 ^1.067 ^1.068 ^1.069 ^1.070 ^1.071 ^1.072 ^1.073 ^1.074 ^1.075 ^1.076 ^1.077 ^1.078 ^1.079 ^1.080 ^1.081 ^1.082 ^1.083 ^1.084 ^1.085 ^1.086 ^1.087 ^1.088 ^1.089 ^1.090 ^1.091 ^1.092 ^1.093 ^1.094 ^1.095 ^1.096 ^1.097 ^1.098 ^1.099 ^1.100 ^1.101 ^1.102 ^1.103 ^1.104 ^1.105 ^1.106 ^1.107 ^1.108 ^1.109 ^1.110 ^1.111 ^1.112 ^1.113 ^1.114 ^1.115 ^1.116 ^1.117 ^1.118 ^1.119 ^1.120 ^1.121 ^1.122 ^1.123 ^1.124 ^1.125 ^1.126 ^1.127 ^1.128 ^1.129 ^1.130 ^1.131 ^1.132 ^1.133 ^1.134 ^1.135 ^1.136 ^1.137 "Dermatology Atlas".

[1]

@@ Line 716: / Line 716: @@
 =====Lichen Planus Vesicular=====
-======Trunk=====
+======Trunk======
 <gallery>
 Image:Lichen planus vesicular01.jpg|Lichen planus vesicular . <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
@@ Line 757: / Line 757: @@
 </gallery>
 =====Mucosal Lichen Planus=====
 ======Oral cavity======

v t e Diseases of the skin and subcutaneous tissue (integumentary system) (L, 680-709)
Infections	Template:Navbox subgroup
Bullous disorders	acantholysis (Pemphigus, Transient acantholytic dermatosis) · Pemphigoid (Bullous, Cicatricial, Gestational) · Dermatitis herpetiformis
Inflammatory	Template:Navbox subgroup
Radiation-related disorders	Sunburn · actinic rays (Actinic keratosis, Actinic cheilitis) · Polymorphous light eruption (Acne aestivalis) · Radiodermatitis · Erythema ab igne
Pigmentation disorder	hypopigmentation (Albinism, Vitiligo) · hyperpigmentation (Melasma, Freckle, Café au lait spot, Lentigo/Liver spot, Acanthosis nigricans, Acral acanthotic anomaly)
Other skin	keratosis/hyperkeratosis (Seborrheic keratosis, Callus) · other epidermal thickening (Ichthyosis acquisita, Palmoplantar keratoderma) skin ulcer (Pyoderma gangrenosum, Bedsore) Cutaneous Markers of Internal Malignancy (Florid cutaneous papillomatosis, acanthosis nigricans, sign of Leser-Trelat) atrophic (Lichen sclerosus, Acrodermatitis chronica atrophicans) necrobiosis (Granuloma annulare, Necrobiosis lipoidica) · other granuloma (Granuloma faciale, Pyogenic granuloma) cutaneous vasculitis (Livedoid vasculitis, Erythema elevatum diutinum)
Connective tissues	collagen disease: Keloid localized connective tissue disorders: Lupus erythematosus (Discoid lupus erythematosus, Subacute cutaneous lupus erythematosus) · Scleroderma/Morphea · Linear scleroderma · Calcinosis cutis · Sclerodactyly · Ainhum
see also congenital, neoplasia


Lichen planus
ICD-10	L43
ICD-9	697.0
OMIM	151620
DiseasesDB	7452
MeSH	D008010

Lichen planus: Difference between revisions

Revision as of 20:17, 28 July 2015

Overview

Classification

Cause

Common Causes

Causes in Alphabetical Order

Natural History, Complications, and Prognosis

Diagnosis

Symptoms

Physical Examination

Skin

Trunk

Extremity

Oral cavity

Face

Lichen Planus Actinicus

Face

Trunk

Extremity

Lichen planus annular

Trunk

Lichen Planus Follicularis

Neck

Extremity

Scalp

Lichen Planus Linearis

Trunk

Extremity

Lichen Planus Verrucosus

Lichen Planus Vesicular

Trunk

Extremity

Mucosal Lichen Planus

Oral cavity

Head

Throat

Genitals

Differentiating lichen planus from other Diseases

Epidemiology and Demographics

Age

Gender

Risk Factors

Treatment

Pharmacotherapy

Acute Pharmacotherapies

Chronic Pharmacotherapies

References

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