Dr. dr.

Sri Vitayani Muchtar,

Sp.KK

LICHEN PLANUS
Lichen planus (Greek leichen, "tree moss";

Latin planus, "flat") is a unique, common

inflammatory disorder that affects the skin,
mucous membranes, nails, and hair

The exact incidence and prevalence of lichen

planus are unknown, but the overall

prevalence is believed to be somewhat less
than 1 percent of the general population

EPIDEMIOLOGY

ETIOLOGY AND
PATHOGENESIS
It is evident that immunologic mechanisms
almost certainly mediate the development of
lichen planus
No consistent alterations in immunoglobulins

(Igs) have been shown in lichen planus, and

humoral immunity most likely is a secondary
response in the immunopathogenesis.

ETIOLOGY AND
PATHOGENESIS
The epithelial lymphocyte interaction can be

divided into three major stages: antigen

recognition, lymphocyte activation, and
keratinocyte apoptosis.

CLINICAL FINDINGS
The classic cutaneous lesion of lichen planus is a

faintly erythematous to violaceous, flat-topped,

polygonal papule, sometimes showing a small
central umbilication
Papules are grouped and tend to coalesce. A

thin, transparent, and adherent scale may be

discerned atop the lesion. Fine, whitish puncta or
reticulated networks referred to as Wickham
striae are present over the surface of many welldeveloped papules

MORPHOLOGY OF
LESIONS
Hypertrophic Lichen Planus.
Atrophic Lichen Planus.
Vesiculobullous Lichen Planus.
Erosive and Ulcerative Lichen Planus.
Follicular Lichen Planus.
Lichen Planus Pigmentosus.

Pathology
The two major pathologic findings in lichen

planus are basal epidermal keratinocyte

damage and lichenoid-interface lymphocytic
reaction
The epidermal changes include

hyperkeratosis, wedgeshaped areas of

hypergranulosis, and elongation of rete ridges
that resemble a sawtooth pattern

Granuloma annulare
Relatively common disorder
Exact prevalence is unknown
Favors children and young adults.

ETIOLOGY AND
PATHOGENESIS
The cause is unknown and the pathogenesis
is poorly understood.
Predisposing Events
SUN EXPOSURE
DRUGS
DIABETES MELLITUS AND THYROID DISEASE
MALIGNANCY

CLINICAL FINDINGS
Clinical variants of granuloma annulare

include the localized, generalized,

subcutaneous, perforating, and patch types.
Linear granuloma annulare, a follicular
pustular form, and papular umbilicated lesions
in children have also been described

Cutaneous Lesions
LOCALIZED TYPE
GENERALIZED TYPE
SUBCUTANEOUS TYPE
PERFORATING TYPE
PATCH TYPE

Pathology
Pathologic features consist of granulomatous

inflammation in apalisaded or interstitial

pattern associated with varying degrees of
connective tissue degeneration and mucin
deposition.

Treatment
Await spontaneous resolution
Apply topical corticosteroid with or without

occlusion
Administer intralesional triamcinolone 2.5
mg/mL

Lichen Sclerosus et
Atropicus
Infrequent chronic inflammatory dermatosis

with anogenital and extragenital

manifestations.
Preferentially affects women in the fifth or
sixth decade of life and children younger than
the age of 10 years.
Gender ratio 5:1 female-male,

Antibodies to extracellular matrix protein and

Tcells with receptor rearrangement point to an

autoimmune pathogenesis.
Anogenital manifestations cause severe

discomfort (pruritus, dyspareunia, dysuria,

and painful defecation) and present with
polygonal papules and porcelain white
plaques, erosions, and various degrees of
sclerosis.

Vulvar lichen sclerosus is associated with an

increased risk of squamous cell carcinoma;

the role of human papillomavirus infection or
prior radiotherapy remains to be elucidated.

Extragenital lichen sclerosus with confluent whitish papules and

plaques on the skin over the thoracic and lumbar spine.

Histopathology
Classical LS shows an atrophic epidermis and

a lichenoid infiltrate at the dermal-epidermal

junction.
Papillary edema is usually seen in early LS but

is gradually replaced by fibrosis with

homogenization of acid mucopolysaccharides
as the lesion matures

TREATMENT
Potent topical corticosteroids and skin care

are the most successful therapeutics;

Calcineurin antagonists have also recently

demonstrated benefit.

PROGNOSIS AND CLINICAL

COURSE
The prognosis of LS is good for most

anogenital cases, especially for those in

prepubertal children that may resolve
spontaneously or may be healed after
treatment with ultrapotent topical steroids

THANK YOU