Lichen Planus

• Common inflammatory disease of the skin, mucous membranes, and hair follicles

• The four ‘P’s– Pruritic – Polygonal – Planar– Papules

Etiology

• Exactly not known

• Infections: HCV, HSV, HPV, H. pylori

• Stress, Alcohol, Tobacco, Dental amalgams

• Autoimmune: A/W Vitiligo, AA, DM

• Drug induced

Clinical features

• Flat-topped polygonal, violaceous, pruritic papules

• Flexors, Trunk

• Wickham’s striae

• Koebner’s phenomenon

Classification

• Morphology

• Configuration

• Distribution

Morphology

• Classical

• Hypertrophic

• Atrophic

Configuration

• Linear

• Annular

• Reticulate (Net-like)

Distribution (Site)

• Trunk and flexors (Classical LP)

• Shins (Hypertrophic LP)

• Scalp (Lichen planopilaris)

• Oral cavity (OLP)

• Nails (Pterygium)

Drug induced LP

• Gold salts

• Beta blockers

• Antimalarials (OLP)

• Thiazide diuretics

• Furosemide

• Spironolactone

• Penicillamine

Clinical features

• Extensor involvement

• Bilaterally symmetrical

• Photosensitivity

• Photoaggravation

Treatment

• Corticosteroids

– Topical: Clobetasol, halobetasol (0.05% cream/ointment)

– Intralesional: Triamcinolone acetonide (10-40 mg/ml every 3 weeks)

– Systemic: Prednisolone, Methylprednisolone, Deflazacort (0.5-1 mg/kg)

• Immunosupressives: MTX, Cys, etc.

• Antihistamines: Sedative/Non-sedative

• Withdrawal of drug in case of DILP

• Removal of dentures for OLP