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Deepika vegiraju at 18:15, 29 April 2021

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== '''Alternate names''' ==
Actinic LP; Lichen planus actinus; Lichen planus subtropicus; Lichen planus tropicus; Lichenoid melanodermatitis; Summertime actinic lichenoid eruption

== '''Definition''' ==
Lichen planus (LP) is an [[inflammatory]] disorder of the skin and mucous membranes with no known cause. It appears as [[Pruritic disorder|pruritic]], violaceous [[papule]]s and [[plaques]] most commonly found on the wrists, lower back, and ankles.

[[File:Lichen Planus Fig7.tiff|thumb]]
[[File:Atrophic lichen planus.jpg|thumb]]
[[File:Lichen planus on leg.JPG|thumb]]
[[File:Lichen planus new photo to help for diagnosis.jpg|thumb]]

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== '''Epidemiology''' ==
* The prevalence of cutaneous LP is approximately 0.2% to 1% of adults worldwide.
* Oral LP is more common and reported in 1% to 4% of the population.
* Overall, women are more frequently affected than men at a ratio of 1.5:1, and most cases develop between the ages of 30 and 60.
* It is rare in children as they represent less than 5% of all LP patients.

== '''Cause''' ==
* Lichen planus is an [[idiopathic]] disease.<ref>Arnold DL, Krishnamurthy K. Lichen Planus. [Updated 2020 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526126/</ref>[https://www.ncbi.nlm.nih.gov/books/NBK526126//].

* Its pathogenesis is not fully understood, but it appears to represent a T-cell-mediated [[autoimmune disease]].
* The prevailing theory is that exposure to an exogenous agent such as a virus, drug, or contact allergen causes alteration of epidermal self-antigens and activation of cytotoxic CD8+ [[T cells]].
* The '''altered self-antigens cross-react with normal self-antigens found on basal keratinocytes resulting in T-cell targeting and apoptosis'''.
* A variety of agents have been associated with the development of LP, but a particular note has been made of the link with viruses, especially the hepatitis C virus (HCV).
* Oral lichen planus is correlated with contact allergies to a variety of metals found in dental restorations including mercury, copper, and gold.
* A large number of drugs have been associated with LP, but recurrence of lesions following drug rechallenge is rare.
* More commonly associated drugs include [[antimalarials]], ACEIs, [[Thiazide diuretic|thiazide diuretics]], [[NSAIDS|NSAIDs]], [[quinidine]], [[beta-blockers]], [[tumor necrosis factor]] (TNF)-alpha inhibitors, and gold.

== '''Signs and symptoms''' ==
* Lichen planus can display a variety of lesion types, but the most common presentation is an area of polygon-shaped, itchy, violaceous, flat-topped papules a few millimeters wide.
* This classic presentation is known as The Six Ps of LP: purple, polygonal, planar, pruritic papules, and plaques.

== '''Types''' ==
Various subtypes of LP exist that display patterns different from the classic presentation.
* '''Hypertrophic LP''' is often found on the shins and ankles and is characterized by red, red-brown, or yellow-grey papules and plaques that coalesce with a thickened or verrucous surface.
* '''Ulcerative LP '''is found on the soles of the feet or between the toes with painful, erosive lesions that make walking difficult.
* '''Bullous LP''' appears most often on the legs as small to large tense blisters filled with clear or pale-yellow fluid.

== '''Diagnosis''' ==
* While in the clinic, [[dermoscopy]] allows visualization of Wickham striae in most cases.<ref>Arnold DL, Krishnamurthy K. Lichen Planus. [Updated 2020 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526126/</ref>[https://www.ncbi.nlm.nih.gov/books/NBK526126//].
* A network of white lines with red globules along the periphery is the classic finding.
* Oral LP lesions located near dental restorations should prompt patch testing to determine if an allergy to one of the associated metals exists.
* [[Biopsy]] with the microscopic analysis is the most useful tool to confirm the presence of LP.
* Lesions have many characteristics as noted previously that typically allow a definitive diagnosis.

== '''Treatment''' ==
* '''Cutaneous LP''' typically clears spontaneously within 1 to 2 years, so treatment is aimed at reducing [[pruritus]] and time to resolution. For limited LP, first-line treatment is superpotent [[Topical steroid therapy|topical steroids]] (clobetasol 0.05%) twice daily for 2 to 4 weeks.
* For diffuse LP, first-line treatment is daily oral [[corticosteroids]] ([[prednisone]] 30 to 60 mg) tapered over 2 to 6 weeks. If no change is seen, second-line therapy should be considered. Second-line therapy may include [[metronidazole]] (500 mg twice daily for 3 to 8 weeks), [[sulfasalazine]] (500 mg twice daily increased in 500 mg increments every 3 days until 2.5 grams daily is reached, for 3 to 6 weeks), [[isotretinoin]] (10 mg twice daily for 2 months), [[acitretin]] (30 mg daily for 8 weeks), [[PUVA]], UVB, topical calcineurin inhibitors, or methotrexate (15 mg per week for adults, 0.25 mg/kg per week for children).
* Third line treatment may include trimethoprim-sulfamethoxazole, [[griseofulvin]], [[terbinafine]], antimalarials, [[tetracyclines]], [[ciclosporin]],
* [[mycophenolate mofetil]], [[azathioprine]], [[etanercept]], [[adalimumab]], or low-molecular-weight [[heparin]]

'''Oral LP''' may spontaneously resolve within 5 years, but many cases are chronic and never resolve.
* Treatment-induced remission is typically followed by relapse.
* Thus, asymptomatic oral LP should not be treated as the side-effect burden of treatment is high.
* The goal for treatment of symptomatic oral LP is to heal erosive lesions to reduce pain and allow normal food intake.
* Patients should be instructed to avoid spicy or acidic foods as well as alcohol and tobacco as these exacerbate symptoms.
* First-line treatment is very high potency [[Topical steroid therapy|topical steroids]] three times daily until remission.
* Second-line treatment is oral [[corticosteroids]] or application of topical [[calcineurin]] inhibitors.
* Third-line treatment may include [[cyclosporine]], [[azathioprine]], [[mycophenolate mofetil]], or [[methotrexate]].

Consideration of '''drug-induced LP''' must always be explored prior to starting therapy.
* Withdrawal of the suspected drug leading to the gradual disappearance of lesions confirms the diagnosis, although it may take some time for lesions to fully resolve.<ref>Arnold DL, Krishnamurthy K. Lichen Planus. [Updated 2020 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526126/</ref>[https://www.ncbi.nlm.nih.gov/books/NBK526126//].

== '''Prognosis''' ==
* Cutaneous LP often clears spontaneously within 1 to 2 years, but residual hyperpigmentation is very common.
* Oral LP may clear spontaneously within 5 years, but typically it is a chronic disease with a remitting and relapsing course.
* Hair loss from LPP is permanent. Drug-induced LP lesions clear slowly after the causative medication is withdrawn.

== '''References''' ==
<references />

{{Diseases of the skin and appendages by morphology}}
{{Papulosquamous disorders}}
{{oral pathology}}

{{DEFAULTSORT:Lichen Planus}}
[[Category:Lichenoid eruptions]]
[[Category:Conditions of the mucous membranes]]
[[Category:Hepatitis C virus-associated diseases]]
[[Category:Autoimmune diseases]]
[[Category:Oral mucosal pathology]]
{{rarediseases}}
{{stub}}

Lichen planus - Revision history

Prab: CSV import

Deepika vegiraju at 18:15, 29 April 2021