Lichen Planus & Lichenoid Reactions Flashcards

(27 cards)

1
Q

At what age does Lichen Planus usually occur?

A

Between 20-50 years.

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2
Q

How are the lesions in Lichen Planus described?

A

Polygonal flat topped violaceous papules.

They often cluster and bear a superficial fine white lacy reticulate pattern

This is known as Wickham’s Striae

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3
Q

What areas of the body are most likely to be affected by lichen planus?

A
  • Wrists
  • Lower back
  • Shins
  • Ankles
  • Mucous membranes
  • Nails
  • Scalp
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4
Q

Lichen Planus can affect the Vulva.

How does this usually initially start to present?

A

Dyspareunia or pruritus

(They can also affect the underlying structure/architecture)

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5
Q

How does Vulvar Lichen Planus differ from Lichen Sclerosus?

A

It doesn’t have the white pallor or purpura of Lichen Sclerosus

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6
Q

When Lichen Planus affects the epithelium of the scalp, what is it known as?

A

Lichen Plano Pilaris (LPP)

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7
Q

Does LP display the Koebner Phenomenon?

A

Yes

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8
Q

What is the most common complaint when lichen planus erupts?

A

Itchiness

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9
Q

What is the other main complaint with Lichen Planus when the active lesions start to settle?

A

Post Inflammatory hyperpigmentation

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10
Q

What should you also consider if you notice that someone has Lichen Planus?

A

Consider examining genitals

(Vulvar Lichen Planus)

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11
Q

If someone has alopecia due to lichen planus, what do you notice?

A

There will be peripilar scaling and erythema under the dermatoscopy.

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12
Q

What is this?

A

Oral Lichen Planus

(Note Wickham’s Striae)

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13
Q

What are the most common drugs to cause a lichenoid eruption?

A
  • Anticonvulstants
  • NSAIDs
  • Diuretics
  • Penicillamine
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14
Q

Although most causes of Lichen Planus and Lichenoid Eruptions are idiopathic, what condition has been associated with it?

A

Hepatitis B & C

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15
Q

What features point towards a lichenoid drug reaction vs lichen planus?

A
  • Absence of Wickham’s Striae
  • Extensive rash across the trunk, limbs.
  • Nail and mucous membrane involvement is uncommon.
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16
Q

If a lichenoid drug reaction occurs,

How quickly does it occur after starting the drug?

Are the quick or slow to resolve?

A
  • 10 days to 2 months of commencing a drug therapy
  • They are slow to resolve.
17
Q

Oral lichenoid eruptions have been related to [BLANK]?

A

Amalgam fillings

18
Q

80% of cases of idiopathic lichen planus will resolve in [BLANK]?

19
Q

If someone has oral lichen planus, what are they more prone to getting?

A

SCC form the oral areas of lichen planus

(Advise on reducing alcohol and smoking)

20
Q

Name some other types of lichen planus?

A
  • Acitinic Lichen Planus
  • Annular Lichen Planus
  • Atrophic Lichen Planus
  • Ashy Dermatosis
  • Hypertrophic Lichen Planus
  • Bullous Lichen Planus
  • Lichen Planus Pemphigoides
  • Linear LP
21
Q

What is this?

Where is it usually found on the body?

A

Hypertrophic Lichen Planus

  • Usually on the lower legs and shins.
  • Treatment: Potent topical steroids under occlusion for a few months followed by regular calcineurin inhibitors.
  • Differential: Lichen Simplex Chronicus
22
Q

What is this?

Who usually gets it?

What is its differential?

A

Acitinic Lichen Planus

Minaly Type 5 skin from the Middle East

Differential Diagnosis: Melasma

23
Q

What is this?

Who usually gets it?

How is it treated?

A

Ashy Dermatosis

  • Usually Skin types 3-5.
  • Difficult to treat - Consider Potent steroids if biopsy shows inflammation.
24
Q

What is this an example of?

A

Linear Lichen Planus

It occurs spontaneously over Blashko’s lines.

25
**What is this?**
**Annular Lichen Planus** **Rare** Usually occurs with classical Lichen Planus More commonly seen in **men** in **genitalia** or **intertriginous areas**.
26
What is the management strategy in lichen planus?
1. **Check for hepatitis B &C** if extensive disease 2. Check **scalp**, **nails**, **mucous membranes** and **genitalia** 3. **Topical** * **Potent** & **Super Potent Steroids** - good for most * **Topical calcineurin** **inhibitors** can also be tried. 4. **Intralesional Steroids** - used for nail, scalp & localised treatment 5. **Systemic steroids** - for widespread disease 6. **Phototherapy** - **narrowband UVB as TLO-1** * NOTE: **PIH** can be **exacerbated** by narrowband **UVB** 7. Other **oral** **therapies** * **Cyclosporine**, **Azathioprine**, **Immunosuppresives** can be used in recalcitrant cases. * **Lichen planopilaris** may respond to **Hydroxychloroquine** and **Acitretin**. * **Tranexamic** acid for **PIH** - treat for **6 months duration.**
27
How do you treat oral lichen planus?
**Topical steroid** in **Orabase** (eg **0.1% triamcinolone** in an **adherent base)** OR **Steroid gargles** (5mg soluble Prednisolone tablets) 4 times daily OR IN RESISTANT CASES **Ciclopsorine** mouthwash (100mg/ml rinse). **AND** **Benzydamine Hydrochloride** oral rinse for pain relief.