planus is an inflammatory pruritic papulosquamus disease which is
uncommon in children. In temperate climates the disease has been
recorded in infants but it is rare in childhood and most cases seen
are in older age groups.`
of lichen planus may be due to immunological factors.There are different data suggesting genetic predisposition.
planus involves the skin and mucous membrane. The primary lesion is
violaceous polygonal, flat topped papules which show grayish lines
on the surface when examined under a magnifying lens. This is known
asWickman‘s stria which is one of the diagnostic criteria for
planus has different clinical varieties:
type. Lesions of the scalp presents with dry scaly areas, which heal
by atrophy and cicatricial alopecia. Lichen planus of the palms and
soles may show pigmented, depressed areas besides the primary
lesion. Nails may be also involved causing nail dystrophy.
may have different shapes or patterns, usually symmetrical in the
form of annular, linear or confluent large plaques involving mainly
affects the lower limbs.
type involves mainly
the scalp leading to cicatricial alopecia.
planus tropicus is another type of lichen planus involving the sun
Fig. 275. lichen planus
Fig. 277. lichen planus
Fig. 278. Hypertrophic lichen planus
Fig.276. Hypertrophic lichen planus
Fig. 279. Hypertrophic lichen
planus With nail involvement
Fig. 280. lichen planus of
skin & nails
Fig. 281 Lichen tropicus
Fig. 282. Cicatricial Alopecia
the tropicus. The lesions are characterized by well-defined nummular
patches which have a deeply hyperpigmented center surrounded by a
striking hypopigmented zone precipitated by excessive exposure to
Fig.282b. Lichen actinicus
planus of the mucous membranes:
mucous membranes of the oral cavity, bladder, glans penis and rectum
may be involved where lesions of the mucous membranes are whitish.
Tongue lesions are more on the tip, where the lesions are whitish
and the center appear more depressed than the periphery of the
lesions. Candida albicans may be associated with lichen planus of
the oral cavity.
pruritus may accompany the skin lesions, while that of the mucous
membranes; the lesions are small, whitish and non-itchy.
planus associated with other diseases.
planus is found to be concomitant with some autoimmune diseases,
liver cirrhosis, and other liver abnormalities. So it seems
important to screen all patients with lichen planus to investigate
such cases thoroughly mainly liver-function tests.
drugs can induce
lichen planus- like reaction. These include beta-blockers as
naproxen, quinine, gold, PAS, streptomycin, isoniazid, methyldopa,
metropromazine and lithium carbonate.
features of lichen planus are:
the stratum granulosum.
of the basal layer of saw tooth appearance.
infiltrate mainly lymphocytes below the epidermis.
to relieve the severe pruritus which is usually one of the important
distressing features of lichen planus.
steroids are not
may resurface hypertrophic lesions if other methods were tried, as
occlusion with potent steroids topically in older age groups.
may cause improvement of some cases of lichen planus.
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