Lichen Planus

  • An inflammatory dermatosis

  • Pruritus

  • commonly associated with mucosal involvement

  • rarely nail dystrophy, scarring alopecia

  • ? T-cell driven immune mechanism

Pathology

  • mixed lymphohistiocytic infiltrate at dermo-epidermal junction

  • liquefactive degeneration of basal layer

  • acanthosis

  • hyperkeratosis of epidermis

Clinical features

  • small, purple, flat-topped polygonal papules

  • intense pruritis

  • common on flexors of wrists and lower legs

  • fine lacy striae on plaques (Wickhams)

  • Mucosal involvement

    • 50% cases

    • lacy white streaks

    • white plaques

    • ulceration

    • pain rather than itch

Prognosis

  • often clears by two years

  • can recur

  • muscosal disease and hypertrophic and atrophic variants more persistent

  • ulcerative mucosal disease is pre-malignant

Treatment

  • potent topical steroids

  • occasionally oral prednisolone

  • PUVA

  • retinoids

  • azathioprine

 

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