Lichen Planus

Background

  • Lichen Planus is a chronic mucocutaneous dermatosis of unknown aetiology
  • Usually in patients >45; incidence ~27/100,000
  • Can be precipitated by trauma (Koebner’s phenomenon) (areas of trauma affected); viral infection and there is likely to be a genetic component (tends to occur in families)
  • Associated with Primary Biliary Sclerosis
  • A lichenoid skin eruption may also be caused by drugs e.g. Gold, hydroxychloroquine and captopril

Presentation

  • In the mouth- can cause chronic areas of white striae, plaques and erosions which may be painful (particularly with irritant foods e.g. spicy)
  • In the skin, violaceous polygonal papules; intensely itchy; classically over the flexor surfaces of the wrist, forearms and shins
  • Nail involvement may cause pitting, ridging and nail loss
  • Scalp involvement may cause alopecia

Types of Lichen Planus (many others)

  • Hypertrophic – thickened lesions which typically affect the shins/ankles (can cause scarring)
  • Annular – ring-shaped- typically affecting the armpits/creases
  • Pigmentosa – causes pigmentation of the skin (more common in dark skinned individuals)
  • Actinic – sun-exposed areas

Management

  • Topical corticosteroid if required
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