Lichen Planus(Lichen Ruber)

Professor W K Jacyk

Lichen Planus

• Flat topped papules, red-violet• Location : most often volar aspect of the

wrists and anterior aspect of the legs• Localised or generalised • Koebner phenomenon- typical lesions develop

along the lines of scratching

Lichen Planus

• Affects skin, oral, genital mucosa, nails• Skin lesions are pruritic• Nail changes are variable-from delicate to

complete destruction

• Fairly common• Blacks more often than whites• Clinical variability• Classic • Hypertrophic, verrucous• Follicular• Bullous • Course: self limiting but may last several months

Aetiology

• Triggers • Certain medications • Viral hepatitis B, C• Other liver diseases • Immunological reaction (cell mediated )to

some epidermal antigen, so far not identified• Characteristic histology

Treatment

• Milder cases-topical corticosteroids -topical calcineurin inhibitors -PUVA• Severe – sytemic corticosteroids -cyclophosphamide -cyclosporin

Lichenoid drug eruptions

• Common• Many medications cause this type of skin lesions• Antimalarials- chloroquine• Antituberculous –isoniazid• Antihypertensives- thiazides, methyldopa, SACE• Gold • D-penicllamine• Lithium

Pityriasis Rosea• Common • Young adults • Seasonal?• Characteristic course• Herald (mother patch) 7-10 days later secondary

eruption, waist to neck, usually profuse• Lasts few weeks • Spontaneous resolution• Pruritic • Aetiology –HHV 7

Management

• Explain- self limiting, non-infectious, not a sign of internal disease, usually only once in life

• Treat only when very pruritic• Topical corticosteroid preparations• Sunlight or artificial UVB• Short course of oral corticosteroids• Sedative antihistaminics

Risk of misdiagnosis

• Tinea- herald patch• Syphillis • psoriasis

Seborrhoeic dermatitis-Adult form

• “Seborrhoeic” a historical name • Disease is unrelated to the sebaceous glands • Lesions mainly face, scalp, presternal area(in

man), folds(axillae, groins, submammary)• Most common in adult males• Role of Pityrosporum yeasts • Common in infection with HIV and HTLV-1

Treatment

• Courses of imidazoles- ketoconazole, itraconazole

• Courses of antibiotics • Topical steroids