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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
Question for Lichen PlanusTry yourself: Which diagnostic method is used to confirm the diagnosis of lichen planus?View Solution
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
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FAQs on Lichen Planus - Medical Science Optional Notes for UPSC
| 1. What is lichen planus? |  |
Ans. Lichen planus is a chronic inflammatory skin condition that affects the skin, mucous membranes, hair, and nails. It is characterized by itchy, flat-topped, polygonal-shaped bumps that can be purple or white in color.
| 2. What are the common symptoms of lichen planus? | |
Ans. The common symptoms of lichen planus include itching, a network of fine white lines on the surface of the skin, shiny or scaly patches, presence of small, raised, pink-red lesions, and in severe cases, ulceration and blisters.
| 3. What causes lichen planus? | |
Ans. The exact cause of lichen planus is unknown, but it is believed to be an autoimmune disorder where the body's immune system attacks its own cells. Other possible causes include viral infections, certain medications, and genetic factors.
| 4. How is lichen planus diagnosed? | |
Ans. Lichen planus is usually diagnosed based on the appearance of the skin lesions and a thorough physical examination. In some cases, a skin biopsy may be performed to confirm the diagnosis. Blood tests may also be done to rule out other underlying conditions.
| 5. What are the treatment options for lichen planus? | |
Ans. The treatment for lichen planus aims to relieve symptoms and promote healing. Topical corticosteroids, such as creams or ointments, are often prescribed to reduce inflammation and itching. In severe cases, oral corticosteroids, immunosuppressant drugs, or phototherapy may be recommended. Additionally, maintaining good oral hygiene and avoiding triggers, such as stress or certain foods, can help manage the condition.
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