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Lichen Planus

Lichen Planus

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Published by Bahaa Mostafa Kamel

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Published by: Bahaa Mostafa Kamel on Oct 25, 2010
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Lichen planus



Lichen planus is a relatively common skin disease characterized by itchy, flat, violaceous skin papules .It comes in episodes lasting months to years. The onset may be gradual or quick, but its cause is unknown. It appears to be a reaction in response to more than one provoking factor

The mucous membrane of the mouth, genital region, hair and nails are affected in some individuals. Papules may appear in areas of trauma koebner¶s phenomenon.


Lichen planus (LP) is thought to be caused by a T cell±mediated autoimmune reaction against basal epithelial keratinocytes in people with genetic predisposition.

Triggering factors:  Infection : probably virus, but virus particles have not been isolated.  Allergy to septic focus.  Emotional factors appear to be sometimes of importance.  Photosensetization,especialy in the photosensetive type. 


Hepatitis C infection. Certain types of flu vaccines . Allergy causing agents (allergens). Nonsteroidal anti-inflammatory drugs. Certain medications for heart disease, high blood pressure or arthritis 

Allergic reactions to amalgam fillings may contribute to oral lesions]


This disease occurs most often in men and women between 20 to 60 years. Lichen planus affects women more than men 3:2 It is uncommon in the children and elderly. All racial groups seem to be susceptible to lichen planus.


The disease is characterized by itchy papular lesions that are located at: the wrist region ,flexor aspect of the forearm, ankles, legs , neck , genital and sacral regions.


Mucous membrane  lesions occur in 25% of cases


scalp,the palms, soles and nails can be involved 

Signs and symptoms of lichen planus vary depending on what parts of the body are affected. The disorder rarely worsens after the first few months, but the symptoms may persist for months or several years .


The lesion is a papule which is characterized by being flat topped,polygonal in shape,violacious in color ,has glistening surface,and shows central umblication and fine arborisations which are called µWickhams striae.there may be fine adherent scales on its surface.

The lesions may be few,numerous, disceret or coalising together giving rise to plaques.  The lesions may take a special congiguration : linear,annular,circinate or zosteriform pattern.  

The rash tends to heal with prominent blue-black or brownish discoloration that persists for a long time

Acute Lichen planus <6 monthes .acute onset ± preceded by upper respiratory tract infection. ± trunk and abdomen ±good prognosis ± respond to antibiotics (erythrocine)  Chronic Lichen planus> 6 monthes. 


The classical type. Circinate type. Annular type Linear type. Zosteriform type.. Atrophic type. Hypertrophic type. Vesiclobullous type.

Hypertrophic lichen planus 

This condition appears as thick, reddish-brown lesions that are covered with scales. These lesions tend to be on the shins, but they can occur anywhere on the body. This is an especially itchy and persistent (chronic) variant of lichen planus .

Hypertophic lichen planua 



Lichen planus of the mucous membrane. Tropical or photosensitive type . Genital lichen planus. Licken planus of the scalp Lichen plano-pilaris . Lichen planus of the nails, Lichen planus of palms and soles Inverse lichen planus.

Mucous membrane of the mouth( 25%)

1.Reticular form : more common,patches of lacy white lines or white dots appear most often on the inside of cheeks. The gums, lips and tongue also may be affected . 2.Erosive form: sores or ulcers that appear in the mouth. These tend to cause pain or a burning sensation , malignant change is a possibility.

Scalp lesion: lichen planopilaris  

Lichen planus affecting the scalp is relatively rare. The name given for this condition is lichen planopilaris. The lesions may result in : Temporary or permanent hair loss Scarring or discoloration of the scalp after healing.


Ridges running the length of the nail  Thinning or splitting of the nail  Temporary or permanent nail loss 


Men .The purplish skin lesions and itching most often affect the tip of the penis (glans .( Women .Lichen planus can cause purplish skin lesions and itching on the external genitalia (vulva) or painful, burning sores on the mucous membrane lining the vagina. .

Tests and diagnosis 

Biopsy. A punch biopsy test may be necessary to confirm the diagnosis or to rule out another cause. .t . Hepatitis C test.


Hyperkeratosis Hypergranulosis : which is sometimes irrigular and this is responsible for wikham¶s striae . Irregular acanthosis: Development of a "saw-tooth" appearance of the rete pegs. Liquifaction Degeneration of the basal cell layer foci with Civatte or colloid body formation. These result from degenerating epithelial cells . Infiltration of lymphocytic inflammatory cells into the subepithelial layer of connective tissue


Psoriasis Lichenoid drug eruption Chronic eczem Leucoplekia Lichen amyloidosis Plaques of Verruca vulgaris


Lichen planus, usually runs a chronic course with remission and excerbation . The average duration of the condition is 3-6 years, being longer in hypertrophic lesions and mucous membrane involvement . The prognosis of the acute variety is better than chronic type and response to treatment is better . 


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


Drugs . stop taking drug . Septic focus should be irradicated Stress assurance Hepatitis C . referre to a specialist in liver disease (hepatologist) for further diagnostic evaluation and disease management


Medicines used to treat lichen planus include: Topical and Oral steroids. Topical and Oral retinoids Hydroxychloroquine (PHOTOSENSETIVE TYPE( Antihistamines Antibiotic. Immunosupressive drugs




Corticosteroids reduce inflammation associated with lichen planus. Topical Intralesional Oral .


Retinoids are synthetic versions of vitamin A that can be applied topically or taken orally for treatment . 

Because both topical and oral retinoids can cause birth defects, the drugs shouldn't be used by women who are pregnant or planning to become pregnant in the near future


Antihistamine Antihistamines act against a protein called histamine that is involved in inflammatory activity,they relieve itching associated with lichen planus .


Light therapy, or phototherapy, may help clear up lichen planus affecting the skin .In loalized resistant or
hypertrophic cases


UVB The most common phototherapy for lichen planus uses ultraviolet B (UVB) light, which penetrates only the upper layer of skin (epidermis). UVA ultraviolet A (UVA) light, which penetrates deep into the skin. This therapy is usually used in combination with oral or topical psoralen. 

Short-term side effects of this therapy may include nausea, headache and itching. To avoid sunburns, avoid sun exposure for a couple of days after taking psoralen

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