Lichen planus I

Lichen planus I

OVERVIEW:

A unique inflammatory disorder of the skin and mucous membranes. The disease is characterized by small flat, angular, violaceous, shiny, pruritic papules on the skin and white papules in the mouth. Onset abrupt or gradual. May be intermittent for years.

System(s) affected: Skin/Exocrine
Genetics: N/A
Incidence/Prevalence in USA: 450/100,000
Predominant age: 30-60 years, rare in children and the elderly
Predominant sex: Female > Male

SIGNS AND SYMPTOMS:

• Skin
• Pruritus - often severe
• Papules - 1-10 mm, shiny, flat
• Color - violaceous, with white lace-like pattern (Wickham's striae) on papules. Wickham's striae best seen after topical application of mineral oil and if present, are almost pathognomonic for lichen planus.
• Shape - polygonal or oval shaped
• Arrangement - may be grouped, linear, annular, or scattered individual lesions.
• Koebner's phenomenon is often seen
• Distribution - ventral surface of wrists and forearms, glans penis, dorsa feet, groin, sacrum, shins and scalp. Hypertrophic (verrucous) lesions may occur on lower legs. An annular pattern may appear on trunk and mucous membranes. Linear arrangements of papules have been described.
• Mucous membranes
• Mucous membrane involvement is seen in 40-60% of patients with skin lesions. 20% of patients have mucous membrane lesions only.
• Milky-white papules with white lace-like pattern
• Usually seen on buccal mucosa, but may appear on tongue, gingiva, palate, and lips
• May be bullous or erosive
• Painful, especially if ulcers present
• Oral lesions may be precancerous (squamous cell carcinoma)
• Hair and nails
• Scalp - atrophic scalp skin and destruction of hair follicles. May result in permanent patchy scarring alopecia.
• Nails - (10%) may cause proximal to distal linear grooves and partial or complete destruction of nail bed with pterygium formation. Large toes most commonly affected.

CAUSES:

Etiology unknown. Possibly a disease of keratinization or an autoimmune disease. Emotional stress may antedate an attack.

RISK FACTORS:

Exposure to drugs or chemicals, graft versus host disease, or lupus erythematosus (LE-LP overlap syndrome)

DIAGNOSIS

DIFFERENTIAL DIAGNOSIS:

• Chemical exposure (chemicals used in color developing)
• Drug eruption (chloroquine, quinacrine, gold salts, methyldopa, penicillamine, arsenic, bismuth, ACE inhibitors)
• Lichen nitidus
• Leukoplakia
• Psoriasis
• Candidiasis
• Squamous cell carcinoma; basal cell carcinoma
• Aphthous ulcers
• Herpetic stomatitis
• Secondary syphilis
• Scabies
• Pseudopelade

LABORATORY:

N/A

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS:

Inflammation with hyperkeratosis, increased granular layer, irregular acanthosis, basement-membrane thinning with sawtoothing, hyaline bodies below the epidermis, band-like lymphocytic infiltrate of the upper dermis

SPECIAL TESTS:

N/A
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SEE ALSO (Enter the keywords below into our search box or click on the link):

Bronchiolitis
Common cold
Epiglottitis
Tracheitis, bacterial

Medical Diagnosis » L » Lichen planus I