LICHEN PLANUS

DR USMAN TARIQ
1. WHAT IS LICHEN PLANUS?

2. PATHOPHYSIOLOGY OF LICHEN PLANUS.

3. TYPES OF LP.

4. CLINICAL FEATURES OF LP.

5. HISTOPATHOLOGY OF LP.

6. DIAGNOSIS OF LP.

7. TREATMENT OF LP AND PROGNOSIS.

WHAT IS LICHEN PLANUS??
LICHEN PLANUS IS A RELATIVELY COMMON CHRONIC

DERMATOLOGIC DISEASE THAT OFTEN AFFECTS THE ORAL MUCOSA.

IT IS AN IMMUNOLOGICALLY MEDIATED MUCOCUTANEOUS

DISORDER.

ORAL SURFACES 40%

CUTANEOUS SURFACES 35%

MUCOSAL SURFACES ONLY 25%

PATHOPHYSIOLOGY OF LICHEN PLANUS

SKIN HAS THREE

LAYERS

1.EPIDERMI
S
THIN OUTERMOST LAYER
MULTIPLE LAYERS OF DEVELOPING
KERATINOCYTES

2.DERMI
S
CONTAINS NERVES AND BLOOD VESSELS

3.HYPODERMIS
MADE OF FAT AND CONNECTIVE TISSUE
ANCHORS SKIN TO UNDERLYING MUSCLES
 PATHOPHYSIOLOGY OF LICHEN PLANUS

STRATUM
CORNEUM
KERATINISATION LEADS TO FORMATION OF NEW
LAYER
STRATUM DEAD
KERATINOCYTES

KERATINOCYTES BEGIN KERATINISATION

STRATUM
LUCIDUM
BASICALLY THEY FLATTEN OUT AND
HERE GRANULOSUM
KERATINOCYTES IN STRATUM BASALE MATURE AND LOSE DIE
THEIR ABILITY TO
DIVIDE
THEY MIGRATE INTO NEXT LAYER
STRATUM
SPINOSUM
KERATINOCYTES START THEIR LIFE AT LOWEST LAYER OF EPIDERMIS
CALLED
STRATUM BASALE OR BASAL
LAYER
SINGLE LAYER OF STEM CELLS THAT CONTINUALLY DIVIDE AND PRODUCE NEW
KERATINOCYTES
STRATUM BASALE ALSO CONTAINS OTHER GROUP OF CELLS CALLED MELANOCYTES WHICH PRODUCE MELANIN

THESE NEW KERATINOCYTES THAN MIGRATE UPWARDS TO FORM THE OTHER LAYERS OF EPIDERMIS
PATHOPHYSIOLOGY OF LICHEN
PLANUS

HEMIDESMOSOMES ADHERE
KERATINOCYTES TO BASAL LAMINA

DERMO EPIDERMAL
JUNCTION BASEMENT
MEMBRANE
CONNECTING STRATUM BASALE TO UNDERLYING DERMIS IS
CALLED
 PATHOPHYSIOLOGY OF LICHEN
PLANUS
LEADING TO APOPTOSIS

OO
OO

TYPICALLY WHEN A CELL BECOMES INFECTED BY VIRUSES

OR MUTATED BY CANCERS ANTIGENS FROM INSIDE THE
IF THIS HAPPENS CYTOTOXIC T CELLS WILL BIND TO MHC1 MOLECULES RELEASING PERFORINS AND
CELLS WILL BE PRESENTED ON MHC1 MOLECULES
GRANZYMES

IN LICHEN PLANUS HEALTHY KERATINOCYTES START PRESENTING ANTIGENS ON MHC1 MOLECULES AND ITS UNCLEAR WHY THEY DO
SO
CYTOTOXIC T CELLS KILL
THEM
RELEASE
CYTOKINES
RECRUIT MORE CYTOTOXIC T
CELLS
DAMAGE TO KERATINOCYTES AND BASAL
LAMINA
MELANOCYTES BECOME DAMAGED AND RELEASE MELANIN AND HENCE HYPER
PIGMENTATION
CAN BE TRIGGERED BY CERTAIN MEDICATIONS AND IF THE CAUSE IS
IDENTIFIED ITS CALLED LICHENOID REACTION RATHER THAN LICHEN
PLANUS.
TYPES OF LICHEN PLANUS
1.RETICULAR LP
MIDDLE AGED ADULTS
ASYMPTOMATIC
POSTERIOR BUCCAL MUCOSA BILATERALLY
POST INFLAMMATORY MELANOSIS
WICKHAMS STRIAE
2.EROSIVE LP
USUALLY SYMPTOMATIC
ATROPHIC ERYTHEMATOUS AREAS WITH CENTRAL ULCERATION OF VARYING DEGREES
PERIPHERY OF ATROPHIC REGIONS IS USUALLY BORDERED BY FINE , WHITE RADIATING
STRIAE
TOUCHING THE AREA PRODUCES BLEEDING
3.PLAQUE LP
WHITE RAISED OR FLATTENED AREAS ON ORAL MUCOUS MEMBRANES
HISTOPATHOLOGY
ORTHOKERATOSIS AND PARAKERATOSIS OF EPITHELIUM
SAW TOOTH SHAPED RETE RIDGES
DESTRUCTION OF BASAL LAYER OF EPITHELIUM
DEGENERATING KERATINOCYTES

TREATMEN
T
CORTICOSTEROI
DS