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Lichen planus

Lichen planus is an inflammatory disease that usually affects the skin, the mouth, or sometimes both. more...

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Cause

The cause of lichen planus is not known, however there are cases of lichen planus-type rashes (known as lichenoid reactions) occurring as allergic reactions to medications for high blood pressure, heart disease and arthritis. These lichenoid reactions are referred to as lichenoid mucositis (of the mucosa) or dermatitis (of the skin). Lichen planus has been reported as a complication of chronic hepatitis C virus infection. It has been suggested that true lichen planus may respond to stress, where lesions may present on the mucosa or skin during times of stress in those with the disease. Lichen planus affects women more than men 3:2, and occurs most often in middle-aged adults. Lichen planus in children is rare.

Clinical features

The typical rash of lichen planus takes the form of well-defined, purplish, polygonal, extremely itchy bumps on the skin. The commonly affected sites are near the wrist and the ankle. The rash tends to heal with prominent blue-black or brownish discoloration that persists for a long time. Besides the typical lesions, many morphological varieties of the rash may occur.

The presence of lesions is not constant and may wax and wane over time.

Inside the mouth, the disease may present in the (1) reticular form or in the (2) erosive form. (1) The reticular form is the more common presentation and manifests as white lacy streaks on the mucosa (known as Wickham's striae) or as smaller papules (small raised area). The lesions tend to be bilateral and are asymptomatic. The lacy streaks may also be seen on other parts of the mouth, including the gingiva (gums), the tongue, palate and lips. (2) The erosive form presents with erythematous (red) areas that are ulcerated and uncomfortable. The erosion of the thin covering of cells (the epithelium) may occur in multiple areas of the mouth, or in one area, such as the gums. Wickham's striae may also be seen near these ulcerated areas.

Lichen planus may also affect the genital mucosa. It can resemble other skin conditions such as atopic dermatitis and psoriasis.

Differential Diagnosis

The clinical presentation of lichen planus may also resemble other conditions, including:

  • Lichenoid drug reaction
  • Lupus Erythematosus
  • Chronic Ulcerative Stomatitis
  • Pemphigus Vulgaris
  • Benign Mucous Membrane Pemphigoid

A biopsy is useful in identifying histological features that help differentiate lichen planus from these conditions.

Cure

Currently there is no cure for lichen planus but there are certain types of medicines used to reduce the effects of the inflammation. Lichen planus may go into a dormant state after treatment. There are also reports that lichen planus can flare up years after it is considered cured.

Read more at Wikipedia.org


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Lichen planus is an inflammatory disease - LP - Washington Whispers - Brief Article
From Journal of Drugs in Dermatology, 1/1/03

LICHEN PLANUS (LP) IS AN INFLAMMATORY DISEASE. Topical calcipotriol, which mainly stimulates differentiation and inhibits proliferation of keratinocytes, also has immunosuppressive and anti-inflammatory functions. This study investigates the therapeutic effects of topical calcipotriol in LP.

18 histopathologically-proved LP patients were included in the study. Calcipotriol ointment was applied twice daily to all affected skin areas except genitalia. Clinical evaluation of all patients was performed monthly and response to treatment was assessed on clinical grounds as partial, complete, or no response.

16 patients completed the study. Of the study population, 56.25% (9/16) responded to topical calcipotriol treatment which was used for a maximum of 3 months. Complete clearing of the lesions with post-inflammatory hyperpigmentation and partial improvement were obtained in 31.25% (5/16) and 25% (4/16) of the patients, respectively. No improvement was observed in 43.75% (7/16) of the patients.

Given the lack of a control group, it is difficult to assess the true efficacy of calcipotriol in this study as compared to the self-resolution of LP. Controlled and comparative studies are needed to assess the efficacy of calcipotriol to other topical treatments.

Bayramgurler D, Apaydin R, Bilen N. Limited benefit of topical calcipotriol in lichen planus treatment: a preliminary study. J Dermatolog Treat 2002 Sep; 13(3):129-32.

COPYRIGHT 2003 Journal of Drugs in Dermatology
COPYRIGHT 2003 Gale Group

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