Lichen Planus | Medical Science Optional Notes for UPSC PDF Download

Lichen planus

Diagnosis

• Clinical Diagnosis: Primarily based on clinical observations.
• Biopsy: Biopsy serves to confirm the diagnosis.

Histopathology

• Hyperkeratosis and Acanthosis: Thickening of the skin and increased keratinization.
• Prominent Granular Cell Layer: Notable layer of granular cells.
• Sawtoothing of Rete Pegs: Irregular projections of the epidermis.
• Band-like Chronic Inflammatory Infiltrate: Presence of T cells and macrophages, causing destruction of the dermoepidermal junction.
• Civatte Bodies: Apoptotic basal cells that stain positive with periodic acid-Schiff (PAS).
• Artifactual Cleft Formation: Formation of clefts between the epidermis and papillary dermis.
• Occasional Subepidermal Bullae: Rare formation of fluid-filled pockets below the epidermis.
• No Atypia: Absence of abnormal cellular features.
• Direct Immunofluorescent Staining: May reveal deposits of immunoglobulins at the base of the epidermis.
  

Treatment

• The course of Lichen Planus (LP) varies, with most patients experiencing spontaneous remissions within 6 months to 2 years after onset.
• Treatment may not always be necessary. Local treatments for symptomatic cutaneous or mucosal disease include:
• Potent topical steroids
• Topical calcineurin inhibitors (e.g., tacrolimus ointment, pimecrolimus cream)
• Topical retinoids
• Intralesional steroid injections

Lichen planus-Repeat

Q1: Enumerate the cutaneous, mucosal, and follicular and nail manifestations of lichen planus. Describe the histopathologic features in typical lichen planus and their relevance to clinical presentation. (2013)

Q2: A 30-year-old female presents with itchy lesions over upper and lower limbs of one month duration. On examination, multiple discrete flat-topped skin-coloured and violaceous papules were present around ankles, wrist and forearms. (2017)
(i) Which other areas will you examine to arrive at a clinical diagnosis?
(ii) What are the tests will you perform to confirm the diagnosis?
(iii) How will you treat this lady