lichen planus

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Lichen Planus

 

Definition

Lichen planus is a skin condition of unknown origin that produces small, shiny, flat-topped, itchy pink or purple raised spots on the wrists, forearms or lower legs, especially in middle-aged patients.

Description

Lichen planus affects between 1-2% of the population, most of whom are middle-aged women. The condition is less common in the very young and the very old. The lesions are found on the skin, genitals, and in the mouth. Most cases resolve spontaneously within two years. Lichen planus is found throughout the world and is equally distributed among races.

Causes and symptoms

No one knows what causes lichen planus, although some experts suspect that it is an abnormal immune reaction following a viral infection, probably aggravated by stress. The condition is similar to symptoms caused by exposure to arsenic, bismuth, gold, or developers used in color photography. Occasionally, lichen planus in the mouth appears to be an allergic reaction to medications, filling material, dental hygiene products, chewing gum or candy.
Symptoms can appear suddenly, or they may gradually develop, usually on the arms or legs. The lesions on the skin may be preceded by a dryness and metallic taste or burning in the mouth.
Once the lesions appear, they change over time into flat, glistening, purple lesions marked with white lines or spots. Mild to severe itching is common. White, lacy lesions are usually painless, but eroded lesions often burn and can be painful. As the lesions clear up, they usually leave a brown discoloration behind, especially in dark skinned people.
Lichen planus in the mouth occurs in six different forms with a variety of symptoms, appearing as lacy-white streaks, white plaques, or eroded ulcers. Often the gums are affected, so that the surface of the gum peels off, leaving the gums red and raw.

Diagnosis

A doctor can probably diagnose the condition simply from looking at the characteristic lesions, but a skin biopsy may be needed to confirm the diagnosis.

Treatment

Treatment is aimed at easing symptoms. Itching can be treated with steroid creams and oral antihistamines. Severe lesions can be treated with corticosteroids by mouth, or combinations of photochemotherapy (PUVA) and griseofulvin.
Patients with lesions in the mouth may find that regular professional cleaning of the teeth and conscientious dental care improve the condition. Using milder toothpastes instead of tartar control products also seems to lessen the number of ulcers and makes them less sensitive.

Prognosis

While lichen planus can be annoying, it is usually fairly benign and clears up on its own. It may take months to reach its peak, but it usually clears up within 18 months.

Key terms

PUVA — A type of phototherapy that combines the oral or topical photosensitizing chemical psoralen, plus long-wave ultraviolet light-A (UVA).

Resources

Other

Lichen Planus Self-Help. Baylor College of Dentistry. http://www.tambcd.edu/lichen.

lichen

 [li´ken]
1. any of certain plants formed by the mutualistic combination of an alga and a fungus.
2. any of various papular skin diseases in which the lesions are typically small, firm papules set very close together.
lichen amyloido´sus a condition characterized by localized cutaneous amyloidosis.
lichen fibromucinoido´sus (lichen myxedemato´sus) a condition resembling myxedema but unassociated with hypothyroidism, marked by mucinosis and a widespread eruption of asymptomatic, soft, pale red or yellowish, discrete papules.
lichen ni´tidus a usually asymptomatic chronic inflammatory eruption consisting of numerous glistening, flat-topped, discrete, smooth, commonly skin-colored micropapules, located most often on the penis, lower abdomen, inner thighs, flexor aspects of the wrists and forearms, breasts, and buttocks. Widespread involvement may produce confluence of the lesions, with formation of scaly plaques.
lichen pila´ris lichen spinulosus.
lichen planopila´ris a variant of lichen planus characterized by formation of cone-shaped horny papules around the hair follicles, in addition to the typical lesions of ordinary lichen planus.
lichen pla´nus an inflammatory skin disease with wide, flat, purplish, shiny papules in circumscribed patches; it may involve the hair follicles, nails, and buccal mucosa; called also lichen ruber planus.
lichen ru´ber monilifor´mis a generalized or localized eruption with either round, dome-shaped, waxy, dark or bright red papules, or waxy, yellow, milia-like papules, often forming a moniliform (string-of-beads) pattern, sometimes arranged in keloidal bands. Some authorities consider the condition to be a variant of lichen simplex chronicus.
lichen ru´ber pla´nus lichen planus.
lichen sclero´sus (lichen sclero´sus et atro´phicus) a chronic atrophic skin disease marked by white papules with an erythematous halo and keratotic plugging. It sometimes affects the vulva (kraurosis vulvae) or penis (balanitis xerotica obliterans).
lichen scrofuloso´rum (lichen scrofulo´sus) a form of tuberculid manifested as an eruption of clusters of lichenoid papules on the trunk of children with tuberculous disease.
lichen sim´plex chro´nicus dermatosis of psychogenic origin, marked by a pruritic discrete, or more often, confluent lichenoid papular eruption, usually confined to a localized area. Mechanical trauma, such as scratching or rubbing the area, is a factor in its development. The lesions may arise from normal skin or they may occur as a complication of other forms of dermatitis. Called also circumscribed or localized neurodermatitis and lichen chronicum simplex.

Treatment consists of administration of corticosteroids applied locally as a cream or given by intralesional injection to relieve the pruritus. The area should be protected by light dressings and the patient encouraged to avoid mental stress, emotional upsets, and irritation of the affected area. The application of very hot or very cold compresses may afford temporary relief of the itching. The condition tends to become chronic with unexplained remissions and reappearance of lesions in a different part of the body.
lichen spinulo´sus a condition in which there is a horn or spine in the center of each hair follicle; called also lichen pilaris.
lichen stria´tus a self-limited condition characterized by a linear lichenoid eruption, usually in children.
lichen urtica´tus papular urticaria.

li·chen pla·'nus

eruption of flat-topped, shiny, violaceous papules on flexor surfaces, male genitalia, and buccal mucosa of unknown cause; may form linear groups; microscopically characterized by a bandlike subepidermal lymphocytic infiltrate. Spontaneous resolution is common after months to years.

lichen planus

a nonmalignant, chronic, pruritic skin disease of unknown cause that is characterized by small flat purplish polygonal papules or plaques with fine gray lines on the surface. Common sites are flexor surfaces of wrists, forearms, ankles, abdomen, sacrum, and genitalia. On mucous membranes the lesions appear gray and lacy. Nails may have longitudinal ridges. Episodes of disease activity vary but may last for months and may recur. Treatment with topical corticosteroids is common.
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Lichen planus

lichen planus

A pruritic dermopathy of flexor surfaces (especially wrist), orogenital mucosa, hands, feet, lower back, and the pretibial area, which is characterised by papular thickening of upper dermis, and a shiny violaceous surface.
 
DiffDx
Lichenoid drug reaction, lichenoid keratosis, granuloma annulare, systemic lupus eythematosus, psoriasis.

Management
Corticosteroids.

lichen planus

Dermatology A pruritic dermatopathy of flexor surfaces–especially wrist, orogenital mucosa, characterized by papular thickening of upper dermis, a shiny violaceous surface Management Corticosteroids

li·chen pla·nus

, lichen ruber planus (lī'ken plā'nŭs, rū'bĕr)
Eruption of flat-topped, shiny, violaceous papules on flexor surfaces, male genitalia, and buccal mucosa of unknown cause; may form linear groups. Spontaneous resolution is common after months to years.
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LICHEN PLANUS
Enlarge picture
LICHEN PLANUS

lichen planus

An inflammatory rash marked by the presence of itchy, red to violet, polygon-shaped papules, which typically appear on the scalp, in the oral cavity, or on the limbs. The papules may merge into plaques crisscrossed by Wickham striae. Typically, the rash persists for 1 to 2 years and then spontaneously improves although about one in five patients will suffer a recurrence. Synonym: lichen ruber planus See: illustration

Etiology

The cause of the rash is unknown, but it is occasionally associated with the use of chemicals (such as photoprocessing compounds, gold) or medications (such as beta blockers, diuretics, nonsteroidal anti-inflammatory drugs).

Treatment

Corticosteroids, applied topically, taken orally, or injected into the lesions, are often effective.

illustration
See also: lichen

lichen planus

An uncommon skin disease featuring small, intensely itchy, slightly raised, reddish-purple patches that enlarge and run together to form flat-topped plaques up to 2 cm in diameter. They are usually found on the fronts of the wrists and forearms, the sides of the calves and ankles and the lower back. The cause is unknown. Lichen planus usually clears up within 2 years. Itching can be relieved by hydrocortisone ointment.

Wilson,

Sir William J.E., English dermatologist, 1809-1884.
Wilson lichen - eruption of flat-topped, shiny, violaceous papules on flexor surfaces, male genitalia, and buccal mucosa of unknown cause. Synonym(s): lichen planus

lichen planus

; LP eruption of flat-topped, shiny, violaceous, pruritic papules with overlying fine white scale (Wickham's striae) classically of flexor surfaces and buccal mucosa that gradually become symptomless and fade to brown over ensuing months; unknown cause but often presents at times of stress, or in association with local trauma (see Koebner phenomenon) in susceptible individuals; plantar lesions may form parakeratotic plaques; some patients show insulin resistance and prediabetic response to glucose tolerance test

li·chen pla·nus

, lichen ruber planus (lī'ken plā'nŭs, rū'bĕr)
Eruption of flat-topped violaceous papules on flexor surfaces and buccal mucosa of unknown cause.

lichen planus (lī´kən plā´nəs),

n a dermatologic disease affecting the skin and oral mucosa; of unknown etiology but often associated with nervousness, fatigue, emotional depression, and allergy and considered to be a manifestation of quinacrine (Atabrine) therapy. Oral lesions often appear as white or blue-white striae forming an interweaving lacelike network of lines of epithelial thickening. Associated with the striated network; bullous or erosive lesions may be found. Histologically, varying degrees of hyperkeratosis and epithelial acanthosis may be found, with formation of sawtooth-shaped rete pegs of epithelium projecting into connective tissue. Subjacent to the epithelium is a bandlike infiltrate of round cells with perivascular accumulation of leukocytes. Treatment is symptomatic.
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Lichen planus.
lichen planus, oral,
n See lichen planus.
References in periodicals archive ?
Based on data available, the present study is the first study on the use of a natural product (propolis) with the aim of decreasing IL-17 serum levels in patients with ulcerative oral lichen planus, given the etiopathogenesis of the disease, i.
Over the past decade, research has indicated a link between lichen planus and the hepatitis C, although its nature remains unclear.
Pock L, Jelinkova L, Drlik L, et al: Lichen planus pigmentosus-inversus.
We have previously conducted two randomized, double-blind, placebo-controlled trials (RCT) of curcuminoids in patients with the autoimmune condition oral lichen planus (OLP) at the University of California, San Francisco (UCSF).
Alteration of the Expression of CD4 Isoforms in Oral Epithelia and Saliva from Patients with Oral Lichen Planus.
A LICHEN planus is a chronic inflammatory skin condition.
Q: My 85-year-old mother has erosive lichen planus on her tongue that causes pain and burning.
The diagnosis of anogenital lichen sclerosus can usually be made clinically; however, several inflammatory dermatoses can occur in the anogenital area: lichen planus, cicatricial pemphigoid, lichen simplex, morphea, and eczema.
Moreover, to test the specificity of our monoclonal antibody, skin biopsy specimens from patients with Mediterranean spotted fever (15 cases), acute eczematous dermatitis (2 cases), psoriasis (2 cases), and lichen planus (1 case) served as negative controls.
Skin disease: White patches in the mouth can indicate the skin condition lichen planus, which causes sore patches on the body.
A number of dermatologic skin lesions such as lichen planus, psoriasis, eczema, lichen sclerosis et atrophicus, and seborrhea are associated with PA.