Lichen Planus Disease

BASICS

DESCRIPTION

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

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

IMAGING

N/A

DIAGNOSTIC PROCEDURES

Skin biopsy

TREATMENT

APPROPRIATE HEALTH CARE

Outpatient

GENERAL MEASURES

Goal is to relieve itching with topical and systemic antipruritics
Psoralens and ultraviolet A (PUVA) photochemotherapy may be helpful for generalized or resistant cases
Behavior modification for stress reduction may prevent recurrence

SURGICAL MEASURES

N/A

ACTIVITY

Fully active

DIET

No special diet

PATIENT EDUCATION

Help with stress reduction if appropriate

FOLLOW UP

PREVENTION/AVOIDANCE

Reduce stress

POSSIBLE COMPLICATIONS

Alopecia
Nail destruction
Squamous cell carcinoma of the mouth

EXPECTED COURSE AND PROGNOSIS

Spontaneous resolution in weeks is possible, but disease may persist for years - especially in the mouth and on shins
There is a tendency toward relapse, especially with emotional stress
Recurrence 12-20% especially in those with generalized involvement

MISCELLANEOUS

ASSOCIATED CONDITIONS

Hepatitis C
Lichen nitidus
Bullous pemphigoid
Alopecia
Myasthenia gravis
Lupus erythematosus
Biliary cirrhosis
Vitiligo
Ulcerative colitis
Graft-versus-host reaction
Morphea and lichen sclerosus et atrophicus

AGE-RELATED FACTORS

Pediatric: N/A
Geriatric: N/A
Others: N/A

PREGNANCY

Avoid corticosteroids, retinoids

OTHER NOTES

Remember the 5 p's of lichen planus - purple, planar, polygonal, pruritic papules

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

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