Lichen Planus Notes

Lichen Planus

Key Features

• Idiopathic inflammatory disease affecting:
  • Skin
  • Hair
  • Nails
  • Mucous membranes

Pathogenesis

• T cell mediated autoimmune damage to basal keratinocytes
• HCV (2-14-fold increase in patients)

Clinical Features

• Primary lesion: polygonal-shaped, violaceous, flat-topped papule
• Surface: shiny or transparent
• Wickham’s striae (network of fine white lines)
• Pruritus
• Koebner phenomenon

Distribution

• Flexor surfaces of the wrists and forearms
• Dorsal surfaces of the hands
• Anterior aspect of the lower legs
• Neck
• Presacral area
• Oral mucosa
• Glans penis
• Nails, hairs

Differential Diagnosis

• LE
• Pityriasis rosea
• Psoriasis

Treatment

• Topical corticosteroids
• Intralesional CS
• Systemic CS
• Psoralen plus UVA (PUVA)
• Cyclosporine
• Antihistamines