Lichen Planus

Question 1

Features of Lichen Planus

LP

Answer 1

white striae
bilateral
symmetrical
burning/etching/painful for ulcerative types

Question 2

Types of LP

lichen planus

Answer 2

1. reticular
2. erosive/atrophic
3. ulcerative
4. lichenoid reaction (not exactly a type)

Question 3

What are the histological features of LP?

Answer 3

chronic inflammatory cell infiltrate.
saw toothh rete ridges.
basal cell damage.
patchhy acanthosis.
parakeratosis
civatte bodies (dead keratinocytes)

Question 4

What can cause a lichenoid reaction?

Answer 4

Drugs

Amalgam

Question 5

What drugs can cause a lichenoid reaction?

Answer 5

ACE inhibitors
Beta-adrenergic blockers
Diuretics (bendroflumethiazide, frusemide)
NSAIDs
DMARDs (gold, penicillanine, sulphasalazine)

Question 6

Management of LP and LR?

lichen planus and lichenoid reactions

Answer 6

Remove any causes (drug/amalgam)

Biopsy

Blood tests
* haematinics, FBC
* ANA, Ro, dsDNA - if lupus suspected

Topical OTC
* CHX MW
* benzdamine MW

Avoid SLS-containing TP

Persistent symptomatic:
* beclomethasone 0.5mg/puff 2puffs, 2-3 daily
* bethamethasone 1mg/10ml/2mins 2x daily
* clobetasol steroid cream
* tacrolimus ointment or mouthwash
* hydroxychloroquine
* azathioprinne
* mycophenolate

Question 7

Case Example