Histopathological findings in oral lichen planus and their correlation. We report herein a 32yearold female who developed depressed. Nonoral lichen planus lesions 83% of our patients had only oral lesions, while 17% had involvement of lp at sites other than the oral cav. Clinical variants of lichen planus wiley online library. Lichen planuslike cutaneous lesions dr sampurna roy md. Understand the various conditions that cause vulvar pruritus 2. In atrophic lp, specifically, affected people develop pale papules or plaques with an atrophic broken down tissue center. A fairly common problem in which the gingivae show chronic desquamation and is a term that denotes a particular clinical picture and not a diagnosis in itself. According to type of lichen planus out of 87 cases of lichen planus most common was classical lp with 4450.
The study group comprised of clinical diagnosed 87 cases of lichen planus. Lichen planus lp is an inflammatory, pruritic disease of the skin and mucous membranes and can be generalized or localized. Although these papules can be found anywhere on the body, they most commonly affect the trunk andor. Lichen sclerosus differential diagnoses medscape reference. Effects of low level laser therapy on erosiveatrophic. It has different variants based on the morphology of the lesions and the site of involvement. Lichen planus lp is a chronic inflammatory and immune mediated. To the best of our knowledge, no case of lichen planus of uterine cervix has been reported in the available literature. Here, we report the rare concomitant clinical presentation of psoriatic arthritis and annular atrophic lichen planus on the trunk of a 52. Pathology of lichen planopilaris top 8 facts dr sampurna.
Characteristic features include distinctive purplish, flattopped papules discrete or coalescent into plaques on the trunk and flexor surfaces. A case report of erosive lichen planus of the oral mucosa. Learn to like the lichens lichen sclerosus lichen simplex chronicus lichen planus hope k. Keywords atrophic vulvovaginitis contact dermatitis lichen planus lichen sclerosus lichen simplex chronicus vulvodynia please cite this article as. Although these papules can be found anywhere on the body, they most commonly affect the trunk andor legs on skin areas. Classic lp typically presents as pruritic, polygonal, violaceous flattopped papules and plaques. It is derived from the greek word leichen0 means tree moss and latin word planus means flat. This could be the oral, esophageal, vaginal mucosa as well as the skin. Thus, some experts combine the two entities and name it atrophic erosive lichen planus. Jan 30, 2014 the atrophic subtype is common presentation that has similarities to the erosive subtype with more prominent atrophic lesions on a background of erythema and radiating white striae at the margins. Behcets, oral lichen planus, psoriasis gynecologic dysplasia. Mar 29, 2018 oral lichen planus olp is a mucosal subtype of lichen planus. Although the disorder may occur in all age groups, women over the age 50 years.
Association of autoimmune diseases with lichen sclerosus in 532 male and female patients. Lichen planus is a chronic inflammatory disease that affects skin and mucosa. Jul 16, 2015 annular atrophic lichen planus lp is a rare form of lichen planus, which is a condition that affects the skin andor mouth. Common symptoms may include lacywhite lesions in the mouth, which may cause a burning sensation. Druginduced oral lichenoid reactions or oral lichenoid lesions were first cited in 1971 by almeyda and levantine. Successful treatment of psoriatic arthritis and comorbid. Lichen planus affects primarily middleaged adults, and the prevalence is greater among women. May 17, 2018 the association of lichen sclerosus and erosive lichen planus of the vulva with autoimmune disease.
Identify and treat lichen sclerosus, lichen simplex chronicus, and. Lichenoid keratosis is also known as benign lichenoid keratosis, solitary lichen planus, lichen planus like keratosis and involuting lichenoid plaque. Clinical features, histopathology and immunofluorescence. In annular atrophic lp, specifically, affected people develop skin lesions with features of both annular lp and atrophic lp ringshaped, slightly raised, purple lesions with central atrophy tissue breakdown. Atrophic lichen planus lp is a rare form of lichen planus, which is a condition that affects the skin andor mouth. It is one of the most common dermatological disease present in the oral cavity. The lesions of cutaneous lichen planus typically resolve within 12 years, whereas the reticular forms of oral lichen planus have a mean duration of 5 years and erosive lesions of oral lichen planus are longlasting and persist for up to 1520 years or longer. Pdf lichen planus lp is an inflammatory skin condition with characteristic. And when it does, its often associated with multiple lesions, often occurring not only in the mouth but also on the skin. Markers of oral lichen planus malignant transformation.
Psoriasis vulgaris and lichen planus are distinct t. It leads to the severe destruction of the epithelial basal layer. Pdf update on lichen planus and its clinical variants researchgate. The lesions had an erythematous papular border with an atrophic center width, 14 cm. Clinically, erosive lichen planus manifests as atrophic and erythematous areas frequently surrounded by radiating thin striae. The erosive atrophic form of oral lichen planus olp is associated with severe pain and burning sensation and is often unresponsive to treatment. There is irregular epidermal hyperplasia forming a characteristic sawtooth appearance with wedge. Authordetails abigail kingston bsc mrcog specialist registrar in obstetrics and gynaecology.
Jul 01, 2011 in addition to the usual sites of distribution, this form of lichen planus may occur on male genitalia and buccal mucosa. Vulvar pathology diagnosis amie kawasaki, md assistant fellowship program director. Lichen planus is an uncommon disorder of unknown cause that most commonly affects middleaged adults. Lichen planus of uterine cervix the first report of a. Oral lichen planus olp is a chronic inflammatory disease of unknown etiology with significant impact on patients quality of life. They are one of the causes of atypical solar lentigo.
Lichen planus lesions are described using the six ps. Lichen planus occurring at mucosal sites has been shown to be associated with squamous cell carcinoma in a proportion of cases. The literature suggests that certain presentations of the. Update on lichen planus and its clinical variants sciencedirect. T dental college gurgaon, haryana, india abstract oral lichen planus is a cellmediated immune condition. We present a case of a 77yearold female who suffered from oral lichen planus olp involving her gingiva and bilateral buccal mucosa for over 6 months. Apr 04, 2018 lichen planus is a common skin rash that is not contagious. Oral lichen planus mostly affects middleaged females. Term suggests flat fungal condition current evidence indicates immunologicaly mediated mucocutaneous disorder.
It may be found with other diseases of altered immunity, such as ulcerative colitis, lichen sclerosis, myasthenia gravis etc. Histopathologic findings generally reveal a lichenoid dermatitis in active lesions with a distinct loss of elastic fibers in the center of the lesions. The prevalence of lp is unknown, but is estimated to be 1% in the usa. Thus, some experts combine the two entities and name it atrophicerosive lichen planus. Annular atrophic lichen planus aalp is a rare variant of lichen planus. Based on these findings, the diagnosis of annular atrophic lichen planus. Lichen planus is an immune mediated inflammatory lesion involving skin and mucosal sites including oral mucosa, vulva and rarely vagina. Annular atrophic lichen planus genetic and rare diseases. Apply to skin qhs with gradual decrease to two to three times a week. Lichen sclerosus has both genital and extragenital presentations and also goes by the names lichen sclerosus et atrophicus dermatological literature, balanitis xerotica obliterans glans penis presentation, and krau. Lichen planus lehman 2009 international journal of. Cutaneous lichen planus is recurrent, pruritic8,9 and noncontagious.
Histopathology and immunohistochemistry of a representative lesion of the submammary region in december 2015. Oral lichen planus is a relatively common mucocutaneous disease with an estimated prevalence of 0. Lichen planus of uterine cervix the first report of a novel. Desquamative gingivitis an overview sciencedirect topics. Lichenoid keratosis generally develops in fairskinned patients aged 3080 years. Lichen planus is the most common oral mucosal condition that we see. Lichen planus is a mucocutaneous disease characterized by nonspecific inflammation.
Jul 16, 2015 atrophic lichen planus lp is a rare form of lichen planus, which is a condition that affects the skin andor mouth. Dermographic, clinical and histopathological prole of. On the vulva is also known as chronic atrophic vulvitis. Atrophic and erosive lichen planus are most commonly associated with increased risk of squamous cell. The oral manifestations of lichen planus have been described. Highpotency topical corticosteroids are firstline therapy for all forms of lichen planus, including cutaneous, genital, and mucosal erosive. Histopathology is often conclusive, but in vesiculobullous clp or. Therefore, new therapeutic approaches are required. Lichen planus lp is a chronic inflammatory disorder that most often affects middleaged adults. Acitretin soriatane is a retinoid that may be used for lichen sclerosus unresponsive to topical steroids and in some cases lichen planus. 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. Lichen planus is a disease that can affect the skin and any lining mucosa. We showed that oral hygiene measures and conventional periodontal treatment and strict maintenance were sufficient to control the gingival involvement of olp. Lp can involve the skin or mucous membranes including the oral, vulvovaginal, esophageal, laryngeal, and conjunctival mucosa.
The presence of a well formed granular layer and numerous cytoid bodies, and a lack of basement membrance thickening or epidermal atrophy favour lichen planus over lichen sclerosus. The most common agents are nonsteroidal antiinflammatory drugs and angiotensin converting enzyme inhibitors. In contrast to lichen planus and lichen planopilaris, linear lichen planopilaris of the face is more common in middleaged men. The magic of herbal curcumin therapy in recurrent oral. There have been multiple case reports of squamous cell carcinoma developing within lesions of hypertrophic cutaneous lichen planus and erosive oral lichen planus. There is irregular epidermal hyperplasia forming a characteristic sawtooth appearance with wedgeshaped hypergranulosis. May 17, 2014 lichen planus is a mucocutaneous disease characterized by nonspecific inflammation.
Overall, lichen planus affects approximately 2 percent of the population. Diagnosis and treatment of lichen planus american family. Since then, many drug substances have been associated with such lesions. Hyperkeratotic palmoplantar lichen planus in a child. Topical corticosteroids are considered as a medication of first choice but they can produce adverse effects. Lichen planus is a cellmediated immune response of unknown origin. Annular atrophic lichen planus is a rare form of lichen planus, clinically characterized by a circumscribed annular configuration. Asymptomatic nail changes that improved markedly after the intake of a full course of itraconazole, but recurred few months later. The magic of herbal curcumin therapy in recurrent oral lichen planus sumanth prasad, savita solanki, chinmaya br, shourya tandon and ashwini b s.
Linear lichen planopilaris of the face is a rare variant of lichen planopilaris. It is one of the most common dermatological conditions involving the oral cavity. May 08, 2020 lichen planus also will tend to form on areas of skin injurytrauma. Lichen planus also will tend to form on areas of skin injurytrauma. Dec 11, 2009 lichen planus is an immune mediated inflammatory lesion involving skin and mucosal sites including oral mucosa, vulva and rarely vagina. Its prevalence in the general population is around 1% to 2%, and there are a large number of cases in females.
Lichen planus lp is derived from the greek leichen meaning tree moss and the latin planus meaning flat lichens are primitive plants composed of symbiotic algae and fungi planus in latin for flat. Atrophic and erosive lichen planus are most commonly associated with increased. It is a chronic mucocutaneous autoimmune disease and factors like psychological stress, systemic conditions or drugs are the possible etiological conditions. Although these papules can be found anywhere on the body, they most commonly affect the trunk andor legs on skin areas previously affected by classic. Approximately 50% of vulvar cancer associated with lichen sclerosus. 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. On the glans penis it was referred to as balanitis xerotica obliterans, abbreviated bxo. Lichen planus is a common dermatologic disorder involving the glabrous skin, hairbearing skin and scalp, nails, and mucous membranes of the oral cavity, penis, and vulva. Lichen planus lp is a chronic inflammatory and immune mediated disease that affects the skin, nails, hair, and mucous membranes. 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 may affect the skin cutaneous lichen planus, oral cavity oral lichen planus, genitalia penile or vulvar lichen planus, scalp lichen planopilaris, nails, or esophagus. Lichen sclerosus is a relatively common chronic condition classically associated with the vulva. However, histopathological examination of lp and lpvariant lesions reveal similar. The literature suggests that certain presentations of the disease such as. Annular atrophic lichen planus lp is a rare form of lichen planus, which is a condition that affects the skin andor mouth. Onycholysis and mild subungual hyperkeratosis histopathology. Jun 16, 2009 lichen planus lp is an inflammatory dermatosis of the mucocutaneous surfaces that can present with a variety of clinical manifestations. To the best of our knowledge, no case of lichen planus of uterine cervix has been reported in. Atrophic lichen planus definition of atrophic lichen planus. The patient had been treated unsuccessfully with medium.
Oral lichen planus was first described clinically by erasmus wilson in 1869 and histologically by dubdreuilh in the year 1906. Lichen planus is a chronic, inflammatory, autoimmune disease that affects the skin, oral mucosa, genital mucosa, scalp, and nails. Lichen planus has been found to be associated with hepatitis c virus infection, chronic active hepatitis, and primary biliary cirrhosis. Oral lichen planus olp is the mucosal counterpart of cutaneous lp. Variants of lichen planus are reticular, atrophic, erosive and ulcerative. Lichen sclerosus ls is a chronic inflammatory dermatosis that results in white plaques with epidermal atrophy and scarring. In certain cases, the epithelium may separate if erosion is severe, resulting in a relatively rare form of the disease known as bullous lichen planus. This is known as the isomorphic response or koebner phenomena. Jun 06, 2014 histopathology, a diagnosis of lichen planus with well differentiated scc was made. Malignant transformation into oral squamous cell carcinoma oscc is considered as one of the most serious complications of the disease. Kreuter a, kryvosheyeva y, terras s, moritz r, mollenhoff k, altmeyer p, et al. Lichen planus is a noninfectious, inflammatory skin condition, which generally occurs in middleaged adults. The atrophic subtype is common presentation that has similarities to the erosive subtype with more prominent atrophic lesions on a background of erythema and radiating white striae at the margins. Annular atrophic lichen planus responds to hydroxychloroquine.
Varients of lichen planus are presented in figures 29. A study of clinical and histopathological correlation of lichen planus. The clinical presentation of aalp shows distinct atrophic plaques with elevated borders on the trunk and extremities. Lichen planus lp is an inflammatory skin condition with characteristic clinical and histopathological findings.
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