Lichen planus etc Dan Flashcards Preview

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Flashcards in Lichen planus etc Dan Deck (39):
1

T/F
Skin LP is more common than mucosal LP

False
skin 1% of population
mucosa  1-4%
oral LP is thought to be up to 8x more common than skin disease

2

T/F
Lichen planus affects 10% of first degree relatives of a patient

True

3

T/F
LP mainly affects middle eastern peoples?

False
No racial predisposition
But childhood LP has higher prevalence in arab populations

4

T/F
75% of pts with mucosal LP get skin lesions

False
75% of those with skin LP get mucosal lesions1
5% of those with oral LP get skin lesions

5

T/F
Oral LP is often present in isolation

True

6

T/F
Annular lesions occur in 10% of cases of LP

True

7

T/F
Exanthematous LP disseminates rapidly but lasts for years

False
Acute/exanthematous LP onset in weeks and usuallly resolves in 3-9 months or up to 1 year

8

T/F
LP involves the penis in 10% of cases and often ulcerates

False
25% of men with LP elsewhere
almost never ulcerates
is usually annular LP

9

T/F
Linear LP has later onset than classical LP
Linear LP is usually zosteriform

False
any age but Ave earlier than classic - 20s-30s
(classic 30s-60s)
False
Is Blaschkoid rather than zosteriform

10

T/F
50% of pts with follicular LP (LPP) have LP lesions elsewhere

True
skin, mucosae or nails

11

T/F
All types of LP are more common in women?

False
palmoplantar more common in men
LP in general and most subtypes more common in women

12

T/F
40% of cases of oral LP affect the gums?

False
10% - usually causes desquamative gingivitis - must check genital esp women (vulvovaginal-gingival LP)

13

T/F
>90% of women with vulvovaginal LP have clinical oral LP

False
70%

14

T/F
70% of cases of erosive vulval LP involve the vagina

True

15

T/F
Children do not get vulval LP

True

16

T/F
Nail lichen planus is more common in children

False
20 nail dystrophy is more commonly seen in children but other than this LP of the nails is rare in children

17

T/F
Nails are involved in 30% of LP patients

False
10% esp those aged >40

18

T/F
2 thirds of cases of classical LP resolve in one year

True
85% in 1.5 years
remainder can drag on

19

T/F
50% of resolved LP cases relapse

False
only 1 in 5 (20%)

20

T/F
Hypertrophic LP lasts for 3 years

False
Ave is 6 years

21

T/F
Oral LP is usually lifelong

False
Ave 5 years but erosive type often lifelong

22

T/F
Nail LP lasts about one year

False
Often many years

23

T/F
90% of pts with oral LP and metal fillings have positive patch tests to metals

False
30-40% positive

24

T/F
90% of pts with oral LP and metal fillings improve whne the fillings are removed

True
(85-95%)
even if patch test negative

25

T/F
Lichen striatus affects girls 5x more than boys

False
girls 2-3x more than boys

26

T/F
25% of patients with LP have lichen nitidus type lesions

True

27

T/F
25% of lichen nitidus pts have nail involvement

False
5-10%

28

T/F
Lichen nitidus lasts up to 8 years

True
but usually resolves in a year

29

T/F
Ashy dermatosis usually clears in one year

False70-80% of children clear in 2-3 yearsadult onset form persists for many years

30

T/F
Chronic erosive/atrophic oral LP has a 5% risk of SCC over 10 yrs

True
need close follow up

31

T/F
Oral lesions of lichen planus pemphigoides may resemble LP or pemphigoid

True

32

T/F
ILCS are never used for erosive oral LP

false
important Rx option for erosive disease

33

What chemicals can trigger lichenoid contact dermatitis or stomatitis?

Mercury (amalgam)
Gold
Copper
Nickel
Cinnamates
Musk ambrette
Aminoglycoside antibiotics
Chemicals for colour photograph developing
Methacrylic acid esters used in the car industry

34

What are the associations of lichen planus?
What are the associations of other lichen planus group conditions?

Hep C most associated esp w/ oral disease
- Also worth doing LFTs and HepB and HIV
Oral LP (esp erosive) carries small increased risk of oral SCC - stop smoking, sun protect, see dentist, always check mucosal surfaces for active LP and cancers
Vulvovaginal or penile LP caries risk of SCC
Hypertrophic LP and ulcerating plantar LP can also give rise to SCCs
No other cancer risk but prudent to ensure screening up to date for age/sex and screen for red flags in Hx and exam.
No definite cancerous triggers for LP
No proven autoimmune disease risk
Always consider drug rcn as DD and lichenoid contact rcn esp for oral LP
- drug and contact, dental Hx
Other conditions;
Lichen striatus - no associations
Lichen nitidus
Ashy dermatosis
Keratosis lichenoides chronica (Nekam's) - lymphoproliferative Dx, glomerulonephritis
SALE - sun only
ALDY - may be triggered by vaccines

35

How does LP pigmentosus differ from Ashy dermatosis (Erythem dyschromium perstans)?

Affects older age group (30s and 40s)
Photo and flexural distribution
Irregular or confluent lesions commonly
May have classic LP lesions (20%)
Early lesions don’t have erythematous border of EDP

36

What are the types of oral lichen planus?

Reticular (most common = classical type)
Atrophic
Erosive (ulcerative) (inc vulvovaginal-gingival)
Plaque like (most common in smokers)
Papular
Pigmented
Bullous
Desquamative gingivitis (inc vulvovaginal-gingival)Also can be lichenoid contact stomatitis

37

What are the types of genital LP?

Mainly Vulval/limited syndrome types:
Pigmented LP
Lichenplanopilaris
Vulvovaginal-gingival LP
Types more likely to be part of LP elsewhere:
Classical LP
Hypertrophic LP
Penis LP:
Mainly annular LP
Can cause balantis or phimosis

38

What is Summertime Actinic Lechenoid Eruption (SALE)?

Lichen nitidus like lesions occurring in sun exposed areas of dark skin types after prolonged sun exposure in summertime. Histo same as lichen nitidusSome say is the same as actinic LP but actinic LP;- Is red-brown hyperpigmented macules on face or other exposed areas after sun exposure in dark skin types- Has histo of LP not LN

39

Treatment ladder for Lichen planus

Topicals - localised disease or as adjuvant;
- Diprosone/Dip OV/Clobetasol
- Tacrolimus
- Calcipotriol
Intralesional;
- ILCS 5-20mg/ml triamcinolone esp hypertrophic LP
Systemics - 1st line;
- Pred 25-50mg/kg 6wks, wean over 2-3 months
- Acitretin - 30mg for 2mnths then wean (isotretinoin 2nd choice - 10mg 2mnths then wean )
- Metronidazole 500mg BD for 1-2 months
- Sulphasalazine Start at 500mg BD, inc by 500mg every 3 days until 2.5-3g total daily; maintain for 3-6 weeks
Systemics - 2nd line;
- HCQ
Systemics - 3rd line;
- CsA - quick onset
- Dapsone - quick onset
- MMF - good evidence
- MTX
- AZA
- Cyclophosphamide
Phototherapy - can use 1st or 2nd line
- nbUVB
- broadband UVB
- UVA1
- PUVA - bath or oral
Also
NdYAG laser
CO2 laser
surgery for small resistant lesions
Other reported systemics;
- Itraconazole
- Griseofulvin
- Bactrim
- Doxy/tetracycline
- Interferon
- Thalidomide
- Enoxaparin
- TNFα inhibitors
For subtypes;
Erosive LP – efalizumab, alfacept
Actinic LP – TCS, acitretin or CsA
Ulcerative plantar LP – topical or systemic CsA
Vulvovaginal - Clobetasol, TCNI, pred, MTX, MMF, CsA
Penis - TCS, TCNI, circumcision
LPP - HCQ, short course pred, CsA, MMF, thalidomide
Nails - ILCS nailfold, pred, etanercept
Oral - TCS by orabase or INHspray, TCNI, CsA mouthrinse, top rapamycin, top retinoid, ILCS
erosive oral Dx often need pred @ higher dose than skin dx or MTX, CsA, Acitretin, Isotretinoin, Etrtinate, HCQ, Dapsone, Griseofulvin
Excimer laser for resistant erosive oral LP
ECP for resistant erosive oral LP