Lichen planus lp is an inflammatory skin condition with characteristic clinical and histopathological findings. Boyd and neldner, 1991 exact pathogenesis of lichen planus is still unclear. Lichen planus affects primarily middleaged adults, and the prevalence is greater among women. Lichen planus lp is a chronic inflammatory and immune mediated disease that affects the skin, nails, hair, and mucous membranes. Lichen planus is a frequent mucocutaneous disease that affects mostly women between the fifth and sixth decades of life. The oral mucosa and skin may present clinical and microscopic alterations similar to those observed in lp, called lichenoid reactions lrs, which are triggered by systemic or topical etiological agents. In all clinically diagnosed cases of lph, histopathology was confirmatory. Lichen planus is a chronic, inflammatory, autoimmune disease that affects the skin, oral mucosa, genital mucosa, scalp, and nails.
Hypertrophic lichen planus of the vulva is a rare entity. Lichen planus hypertrophicus of the vulva a rare entity. The common clinical types of vulval lichen planus include papulosquamous, erosive and pigmented types. Lichen planusa clinicohistopathological indian j dermatol.
In the last two decades it has been the subject of lively discussion, inasmuch as some cases of this description do. A study of clinical and histopathological correlation of lichen planus. Oral lichen planus a study of associated factors with special reference to thyroid disease jairo robledosierra department of oral medicine and pathology, institute of odontology, sahlgrenska academy at university of gothenburg oral lichen planus olp is one of the most common and debilitating oral mucosal lesions in the adult population. Lichen planus pigmentosus features both striking incontinence of pigment with an accumulation of dermal melanophages as well as increased melanin in the basal layer 1, 16, 21. Hypertrophic lichen planus hlp classically involves shin and ankles and is characterized by hyperkeratotic plaques and nodules. Apr 04, 2018 lichen planus is a common skin rash that is not contagious. Universal diagnostic criteria for oral lichen planus patil, et al. Lichen planuslike keratosis lplk is a common benign skin tumor. The mean age of males was a decade lower than that of females in lp and lichen planus pigmentosus figure 1, figure 2. It must be distinguished from bullous lichen planus, in which, as a consequence of severe basal cell hydropic degeneration, blisters arise within lichenoid papules or plaques. It can resemble other benign and malignant tumors such as basal cell carcinoma, seborrheic keratosis, and actinic keratosis. Treatment generally requires topical or intralesional.
Lp can involve the skin or mucous membranes including the oral, vulvovaginal, esophageal, laryngeal, and conjunctival mucosa. Lichenoid esophagitis is an umbrella term to cover a pattern of injury. Lichen planus is a chronic inflammatory skin condition affecting the skin and mucosal surfaces. Lichen planus lp is a chronic inflammatory disorder that most often affects middleaged adults. Pdf hypertrophic lichen planus a case report researchgate. Lichen planus is characterized by lichenoid, polygonal papules with fine white lines. In the present study, 100 cases of oral lichen planus were clinically and histopathologically analyzed. Scanning power view of lichen planus shows a lichenoid reaction pattern figure 1 characterised by the combination of degeneration of the basal layer of the epidermis and a band like lymphocytic infiltrate obscuring the dermoepidermal junction. This line has considerable relevance if we consider the above example. A universal diagnostic criteria for oral lichen planus. Lichen planus lp is a chronic mucocutaneous disorder of the stratified squamous epithelium that affects oral and genital mucous membranes, skin, nails, and scalp. Lichen planus hypertrophicusit manifests as large, itchy, voilaceous,hyperkeratotic papules and plaques on the anterior surface of legs. Hon aprof amanda oakley, dermatologist, hamilton, new zealand, 1997. Histopathology in such lesions shows marked hyperkeratosis, acanthosis.
Diagnosis and treatment of lichen planus american family. Linear lp, lp hypertrophicus, and annular lp are known to be common variants. Oct 28, 2018 lichen planus like keratosis lplk is a common benign skin tumor. A collective outbreak, expanding down the entire limb of the body as seen in some children. Lichen planus new breakthrough treatment that works.
Lichen planus hypertrophicus it manifests as large, itchy, voilaceous,hyperkeratotic papules and plaques on the anterior surface of legs. Mild cases can be treated with fluorinated topical steroids. The medical term lichen refers to small bumps on the skin and the term planus means flat, together they refer to the characteristic flat topped papules of lichen planus lp. Where the trigger is known, a lesion is known as a lichenoid. Hyperkeratotic palmoplantar lichen planus in a child. Lichen planus lp is a selflimited disease that usually resolves within 812 months.
Clinicopathological study to evaluate oral lichen planus. It is thought to be the result of an autoimmune process with an unknown initial trigger. Lichen planus is a fairly common, itchy, noninfectious rash that usually occurs in adults. In lichen planus, it is suggested that the white structures on dermoscopy corresponded. Lichen planus is a disease of the skin andor mucous membrane that resembles lichens. Zosteriform lichen planus needs to be differentiated from. Apr 30, 2016 hypertrophic lichen planus hlp classically involves shin and ankles and is characterized by hyperkeratotic plaques and nodules. Several hypotheses have been made regarding its aetiology, including genetic, infective, psychogenic and autoimmune factors sontheimer, 2009, sugerman et al. The erythematous scaly form is the most common clinical presentation. Vulvovaginal lichen planus is a type of chronic inflammatory dermatosis of the vulva, usually seen as a part of widespread lichen planus. Generally, the timing of development of the signs and symptoms are important in ensuring an accurate diagnosis. Diagnosis is usually clinical and supported by skin biopsy. The mark of lichen planus are best described as a pinkpurple in colour and flat topped, and is generally measure between 3mm and 5mm.
Where the trigger is known a lesion as a lichenoid lesion. It is derived from the greek word leichen0 means tree moss and latin word planus means flat. The biopsy itself was grand, only a little bit sore when they were doing the stitching. We report a case of an 87yearold woman with a 12year history of hlp on both lower legs presenting with malignant transformation of one lesion into a squamous cell carcinoma scc. Update on lichen planus and its clinical variants sciencedirect. Lichen planus lesions are described using the six ps. Oral lichen planus with malignant transformation to invasive. What are the signs and symptoms of hypertrophic lichen planus.
Hence, there was a clinicopathological discrepancy. Mar 21, 2018 learn indepth information on hypertrophic lichen planus, its causes, symptoms, diagnosis, complications, treatment, prevention, and prognosis. It looks like a keloid or hypertrophied scar, often found on the ankles. Histopathology of hlp and pn demonstrate epidermal hyperplasia, hypergranulosis, and compact hyperkeratosis. Lichen planuslike cutaneous lesions dr sampurna roy md. Lp most commonly presents as itchy, shiny, reddishpurple spots lesions on the skin cutaneous lp or as whitegray lesions in the mouth or on the lips oral lp. Clinical variants of lichen planus wiley online library.
Lichen planus pictures, symptoms, causes, treatment, types. Prurigo nodularis pn is a chronic neurodermatitis that presents with intensely pruritic nodules. Oral lichen planus with malignant transformation to. The literature suggests that certain presentations of the disease such as. However, the final diagnoses of true oral lichen planus after clinicopathological correlation in prospective and retrospective study groups appeared to be 38. A clinicopathological study of cutaneous lichen planus. The significance of eosinophils in hypertrophic lichen planus.
Since its original description by devergie in 1854, several cases of linear lichen planus have been described in the literature, but there have been notably few cases of the more rare zosteriform lichen planus. Squamous cell carcinoma arising in hypertrophic lichen planus. Lichen planus pemphigoides is a rare condition characterized by blisters arising on normal or erythematous skin in a patient with concurrent lichen planus. Less commonly, lp may also involve the genitals penile or vulvar lp, scalp lichen. Squamous cell carcinoma developing in a cutaneous lichen. Lichen planus is a recurrent, pruritic, inflammatory eruption characterized by small, discrete, polygonal, flattopped, violaceous papules that may coalesce into rough scaly plaques, often accompanied by oral andor genital lesions. Light microscopy of the a ected skin biopsy samples.
Lichen planus is a common skin rash that is not contagious. In classical lichen planus patients, a particular pattern of white structures with linear streaks arranged in a radial manner starburst pattern was observed. Lichen planus new breakthrough treatment that works, award. The lesions are multiple more than 10 lesions, bilateral, and often symmetrical with prominent associated pruritus. The age range of the patients was from 5 to 60 years in males and 7 to 76 years in females. Of 303 patients diagnosed with oral lichen planus, 58 19. Hypertrophic lichen planus lp is a variant of lp favoring the. Jan 15, 20 lichen planus pigmentosus features both striking incontinence of pigment with an accumulation of dermal melanophages as well as increased melanin in the basal layer 1, 16, 21. They are generally observed in middleaged and older adults, especially in those who have a lighterskin. Lichen planus, developed, clinical picture 1068 another case. Hypertrophic lichen planus hlp is a chronic tcellmediated inflammatory disease characterised by pruritic hypertrophic or verrucous plaques on the lower limbs. It has different variants based on the morphology of the lesions and the site of involvement. Twice malignant transformation of hypertrophic lichen planus.
Hypertrophic lichen planus lichen simplex chronicus. These pitfalls in histopathology of hlp make it difficult to diagnose histopathologically, unlike classical lp. There is irregular epidermal hyperplasia forming a characteristic sawtooth appearance with wedgeshaped hypergranulosis. Direct immunofluorescence in lichen planus and lichen. Lichen planus knowledge for medical students and physicians. Classic lp typically presents as pruritic, polygonal, violaceous flattopped papules and plaques. Jul 01, 2011 lichen planus is a chronic, inflammatory, autoimmune disease1 occurring in 0.
Differentiating hypertrophic lichen planus lp from welldifferentiated squamous cell carcinoma scc is a histological challenge given the numerous histopathologic similarities between scc and. The four main patterns of pigmentation delineated in this. A study of 124 indian patients with lichen planus pigmentosus. The primary lesion of lichen planus is a violaceous, flat topped, polygonal, pruritic, papule, and represents commonest among all the morphologies of lichen planus in all age groups. Jan 30, 2014 lichen planus subtypes based on the site of involvement. Media in category histopathology of lichen planus the following 3 files are in this category, out of 3 total. The most common lesions are purple papules with welldemarcated, irregular borders, which typically occur on the wrists, lower extremities, and genitoanal region. Lichen planus is a chronic inflammatory disease of unknown origin that is characterized by different types of lesions involving the skin and mucosa in middleaged individuals. Other diagnoses like lichen planus actinicus lpa, lichen planopilaris lpp and oral lp were also confirmed histopathologically.
Clinicopathological study to evaluate oral lichen planus for. More severe cases, especially those with scalp, nail, and mucous membrane involvement, may need more intensive therapy. Majority of the patients of lichen planus, lichen planus pigmentosus and lichen planopilaris were in the age group of 2040 years. Lichen planus lp is an idiopathic subacute or chronic inflammatory disease of the skin, mucous membranes and nails. Lichen planus follicularis lichen planopilaris practically be seen in the hair bearing areas such as pubic region and scalp. Infections especially hiv and viral hepatitis crohns disease.
Lichen planus lp is a rare, chronic, inflammatory autoimmune skin and mucous membrane disease. Common symptoms may include lacywhite lesions in the mouth, which may cause. The hardest part was keeping my tongue under control about a month later it came back that i have oral lichen planus which is an auto immune disorder. It is characterized by polygonal, flattopped, violaceous papules and plaques with overlying, reticulated, fine white scale wickhams striae, commonly affecting dorsal hands, flexural wrists and forearms, trunk, anterior lower legs and oral mucosa. Common symptoms may include lacywhite lesions in the mouth, which may cause a burning sensation. Please remove adblock adverts are the main source of revenue for dovemed. This chapters discusses the typical features of lp as well as the lp variants, it does not discuss follicular lp syn. Lichen planus may affect the skin cutaneous lichen planus, oral cavity oral lichen planus, genitalia penile or vulvar lichen planus, scalp lichen planopilaris, nails, or esophagus. Hypertrophic lichen planus versus prurigo nodularis. An introduction to dermatology 1905 section of a lichen planus papule 75x.
Sep 10, 20 lichen planus lichen planus lp is a disease of the skin andor mucous membranes that resembles lichens. Lichen planus atrophicus it presents as an annular area having atrophic,hyperigmented centre and active erythematous 12mm thick,raised ually seen on the face and dorsum of hands. Hypertrophic lichen planus versus welldifferentiated squamous. The surfaces of the lesions often exhibit a pattern of. Lichen planus is a benign disorder characterized by an itchy, noninfectious skin rash. Oral lichen planus is a relatively common manifestation, found in approximately 1% to 2% of individuals older than 15 years.
Lichen planus pigmentosus lpp is a fairly common benign pigmentary disorder in india. Lichen planus vulgaris common type was seen in 329 74% patients, lichen planus hypertrophicus in 56 %, lichen planus actinicus in 33 7. Lichen planus lp is a mucocutaneous disease with wellestablished clinical and microscopic features. Lichen planus subtypes based on the site of involvement.
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