Dr. dr. Sri Vitayani Muchtar, Sp.KK

LICHEN PLANUS

Lichen planus (Greek leichen, "tree moss"; Latin planus, "flat") is a unique, common inflammatory disorder that affects the skin, mucous membranes, nails, and hair

EPIDEMIOLOGY

The exact incidence and prevalence of lichen planus are unknown, but the overall prevalence is believed to be somewhat less than 1 percent of the general population

ETIOLOGY AND PATHOGENESIS

It is evident that immunologic mechanisms almost certainly mediate the development of lichen planus

No consistent alterations in immunoglobulins (Igs) have been shown in lichen planus, and humoral immunity most likely is a secondary response in the immunopathogenesis.

ETIOLOGY AND PATHOGENESIS

The epithelial lymphocyte interaction can be divided into three major stages: antigen recognition, lymphocyte activation, and keratinocyte apoptosis.

CLINICAL FINDINGS

The classic cutaneous lesion of lichen planus is a faintly erythematous to violaceous, flat-topped, polygonal papule, sometimes showing a small central umbilication

Papules are grouped and tend to coalesce. A thin, transparent, and adherent scale may be discerned atop the lesion. Fine, whitish puncta or reticulated networks referred to as Wickham striae are present over the surface of many well-developed papules

MORPHOLOGY OF LESIONSHypertrophic Lichen Planus.Atrophic Lichen Planus.Vesiculobullous Lichen Planus.Erosive and Ulcerative Lichen Planus.Follicular Lichen Planus.Lichen Planus Pigmentosus.

Pathology

The two major pathologic findings in lichen planus are basal epidermal keratinocyte damage and lichenoid-interface lymphocytic reaction

The epidermal changes include hyperkeratosis, wedgeshaped areas of hypergranulosis, and elongation of rete ridges that resemble a sawtooth pattern

Granuloma annulareRelatively common disorder Exact prevalence is unknownFavors children and young adults.

ETIOLOGY AND PATHOGENESIS

The cause is unknown and the pathogenesis is poorly understood.Predisposing EventsSUN EXPOSUREDRUGSDIABETES MELLITUS AND THYROID DISEASEMALIGNANCY

CLINICAL FINDINGS

Clinical variants of granuloma annulare include the localized, generalized, subcutaneous, perforating, and patch types.Linear granuloma annulare, a follicular pustular form, and papular umbilicated lesions in children have also been described

Cutaneous Lesions

LOCALIZED TYPEGENERALIZED TYPESUBCUTANEOUS TYPEPERFORATING TYPEPATCH TYPE

Pathology

Pathologic features consist of granulomatous inflammation in apalisaded or interstitial pattern associated with varying degrees of connective tissue degeneration and mucin deposition.

Treatment

Await spontaneous resolutionApply topical corticosteroid with or without occlusionAdminister intralesional triamcinolone 2.5 mg/mL

Lichen Sclerosus et Atropicus

Infrequent chronic inflammatory dermatosis with anogenital and extragenital manifestations.Preferentially affects women in the fifth or sixth decade of life and children younger than the age of 10 years.Gender ratio 5:1 female-male,

Antibodies to extracellular matrix protein and Tcells with receptor rearrangement point to an autoimmune pathogenesis.

Anogenital manifestations cause severe discomfort (pruritus, dyspareunia, dysuria, and painful defecation) and present with polygonal papules and porcelain white plaques, erosions, and various degrees of sclerosis.

Vulvar lichen sclerosus is associated with an increased risk of squamous cell carcinoma; the role of human papillomavirus infection or prior radiotherapy remains to be elucidated.

Extragenital lichen sclerosus with confluent whitish papules and plaques on the skin over the thoracic and lumbar spine.

Histopathology

Classical LS shows an atrophic epidermis and a lichenoid infiltrate at the dermal-epidermal junction.

Papillary edema is usually seen in early LS but is gradually replaced by fibrosis with homogenization of acid mucopolysaccharides as the lesion matures

TREATMENT

Potent topical corticosteroids and skin care are the most successful therapeutics;

Calcineurin antagonists have also recently demonstrated benefit.

PROGNOSIS AND CLINICAL COURSE

The prognosis of LS is good for most anogenital cases, especially for those in prepubertal children that may resolve spontaneously or may be healed after treatment with ultrapotent topical steroids

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