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Lichen planus (LP) is a unique inflammatory cutaneous and mucous membrane reaction pattern of unknown etiology. The mean age of onset is 40.3 years in males compared with 46.4 years in females. The main eruption clears within 1 year in 68% of patients, but 49% recur. Although the disease may occur at any age, it is rare in children younger than 5 years of age. Approximately 10% of patients have a positive family history. This supports the hypothesis that genetic factors are of etiologic importance in lichen planus. Liver disease is a risk factor for LP although not a specific marker of it. LP may be associated with hepatitis C.
There are several clinical forms, and the number of lesions varies from a few chronic papules to acute generalized disease . Eruptions from drugs (e.g., gold, chloroquine, methyl-dopa, penicillamine), chemical exposure (film processing), bacterial infections (secondary syphilis), and post-bone marrow transplants (graft-vs.-host reaction) that have a similar appearance.
The morphology and distribution of the lesions are characteristic. The clinical features of lichen planus can be remembered by learning the five P's of lichen planus: pruritic, planar (flat-topped), polyangular, purple papules. The primary lesion is a 2- to 10-mm flat-topped papule with an irregular angulated border (polygonal papules). Close inspection of the surface shows a lacy, reticular pattern.
Newly evolving lesions are pink-white, but over time they assume a distinctive violaceous, or purple, hue with a peculiar waxy luster. Lesions that persist for months may become thicker and dark red.
Papules are most commonly located on the flexor surfaces of the wrists and forearms, the legs immediately above the ankles, and the lumbar region. Itching is variable; 20% of patients with lichen planus.
This second most common cutaneous pattern may occur on any body region, but it is typically found on the pretibial areas of the legs and ankles. After a long time, papules lose their characteristic features.
Lichen planus may occur abruptly as a generalized, intensely pruritic eruption. Initially, the papules are pinpoint, numerous, and isolated. The papules may remain discrete or become confluent.
Lichen planus of the palms and soles generally occurs as an isolated phenomenon, but may appear simultaneously with disease in other areas. The lesions differ from classic lesions of lichen planus.
Follicular lichen planus is also known as lichen planopilaris. Lesions localized to the hair follicles may occur alone or with papular lichen planus. Follicular lichen planus, manifested.
Oral lichen planus can occur without cutaneous disease. Onset before middle age is rare; the mean age of onset is in the sixth decade. Women outnumber men by more than 2:1. Mucous membrane involvement is observed in more than 50% of patients with cutaneous lichen planus.
Lichen planus usually involves skin and oral cavity lesions, but erosive vaginal disease may be the first sign. Lichen planus may be the most common cause of desquamative vaginitis.
Nail changes frequently accompany generalized lichen planus, but may occur as the only manifestation of disease. Approximately 25% of patients with nail LP have LP in other sites.
Group I or II topical steroids (in a cream or ointment base applied three times daily) are used.
Triamcinolone acetonide (Kenalog, 5 to 10 mg/ml) may reduce the hypertrophic lesions located.
Generalized, severely pruritic lichen planus responds to oral corticosteroids. For adults, a 2- to
Acitretin 30 mg/day is effective for
Patients with severe, chronic lichen planus were successfully treated with oral cyclosporin (6 mg/kg/day). A response was
Antihistamines such as hydroxyzine, 10 to 25 mg every 4 hours, may provide very satisfactory relief from itching.
A bilateral comparison study demonstrated that PUVA is an effective therapy for generalized, symptomatic lichen planus and suggested that
Oral griseofulvin (250 mg twice daily for 3 to 6 months) has been reported to clear more than 80% of
Topical application of corticosteroids (fluocinonide 0.025%, fluocinolone acetonide, triamcinolone acetonide [Kenalog]) in an adhesive base (orabase) is safe and effective.
Intralesional steroids in a single submucosal injection, 0.5 to 1.0 ml of methyl prednisolone acetate (Depo-Medrol 40 mg/ml).
Prednisone rapidly and effectively controls the disease, but recurrences may occur.
Dapsone (50 to 150 mg/day) is the treatment of choice.
Hydroxychloroquine sulfate (Plaquenil), 200 to 400 mg daily, is useful for oral LP.
Azathioprine is very effective for controlling oral lichen planus and may be considered.
In one study patients swished and expectorated 5 ml of solution (containing 100 mg of CS per ml) three.