Violaceous Papules & Nodules

Lichen Planus

-Inflammatory disorder of unknown etiology

-Skin, nail, hair and mucous membranes may be affected

-Skin lesions may be pink, but overtime become purple with well defined borders

Lichen Etiology & Epidemiology

-Unknown etiology

-Rare in kids <5

-Can occur abruptly; can also recur

-May occur secondary to meds

Signs & Symptoms of Lichen Planus

-Itching is variable, most often intermittent

-Most often found in Ankles and wrists & presents with pink to purple well defined papules

-Mucous membranes: shows a white lacy reticulated pattern (Whickam's Striae)

Treatment for Lichen Planus

-Sedating antihistamines for pruritus

-Group I or II topical steroids or steroid injections/oral

Kaposi Sarcoma

-Multisystem vascular neoplasia characterized by mucocutaneous violaceous lesions and edema

-Involve every organ

-Pts with this often are IC (HIV)

-Lesions asymptomatic, but are cosmetically concerning

PE Findings for Kaposi Sarcoma

-Often starts as ecchymotic like macules that evolve to papules and nodules that are volaceous, red, pink, and become purple-brownish

-Lesions are hard and palpable

-Often arranged parallel to skin tension lines

-Lymphedema also occurs

-Mucous lesion are often first manifestations

-Indicates CD4 counts <200

managment of Kaposi Sarcome

-Goal is to control symptoms not cure
-Radiotherapy
-Chemo
-Cryosurgery
-Laser
-Excisional surgery

Hypertrophic Scars

-Exuberant fibrous repair tissues after a cutaneous injury

-Remains confined to site of injury; Elevated; Tend to regrees (Become flattened)

Keloids

-Exuberant fibrous repair tissues after a cutaneous injury

-Extends beyond original injury site

-May be nodular, tumor like, firm to hard

-May continue to expand in size for decades

Treatment of Hypertrophic Scars & Keloids

-Prevention: Avoid cosmetic procedures

-Intralesional glucocorticoids: 10-40 mg/ml, every month to reduce pruritus and also flatten it

-Surgical: excision often results in larger scars; excision with immediate postsurgical radiotherapy is beneficial

-Silicone Gel sheets