While lacy lesion in oral cavity with extension of proximal nail fold onto the nail plate?/bed? (LQ)
Acute or chronic inflammation of mucous membranes or skin characterized by violaceous, shiny, pruritic papules topped with Wickham’s striae (fine white lines); milky white papules in mouth
1). Sites: most common –around wrist and ankle
2). Scalp lesions associated with scarring alopecia [ Lichen plano pilaris]
3). Spontaneously resolves in weeks or lasts for years (mouth and shin lesions)
4). Mnemonic “5 P’s: Purple, Pruritic, Polygonal, Plain-topped, Papules,
5). Precipitating factor: severe emotional stress
6. Associated with hepatitis C
7. Violaceous color of plaque is due to tyndall effect.
Symptoms and Signs
1). Onset may be abrupt or gradual. The initial attack persists for weeks or months, and recurrences may occur for years. Children are affected infrequently.
2). The primary papules are 2 to 4 mm in diameter, with angular borders, a violaceous color, and a distinct sheen in cross-lighting. Rarely, bullae may develop. Moderate to severe, often refractory, itching may be present.
3). The lesions are usually distributed symmetrically, most commonly on the flexor surfaces of the wrists legs, trunk, glans penis and oral and vaginal mucosa.
4). Lesions are occasionally generalized, but the face is rarely involved. Lesions may become large, scaly, and verrucous (hypertrophic lichen planus), particularly on the lower legs. During the acute phase, new papules may appear at sites of minor skin injury, such as a superficial scratch (Koebner's phenomenon).
5). Hyperpigmentation (and sometimes atrophy) may develop as lesions subsides. Rarely, a patchy scarring alopecia of the scalp occurs.
6). The oral mucosa is involved in about 50% of patients, often before or in the absence of cutaneous lesions. The buccal mucosa, tongue margins, and gingival mucosa in edentulous areas show asymptomatic ill-defined, bluish white linear lesions that may initially be reticulated or lacy and may coalesce and increase in size.
7). An erosive form may occur in which the patient complains of shallow, often painful, recurrent oral ulcers, which if long-standing rarely become cancerous. Chronic exacerbations and remissions are common.
8). The prevalence of chronic liver diseases, including primary biliary cirrhosis, alcoholic cirrhosis, hepatitis B, and especially hepatitis C, is increased.
9). A recurrent, pruritic, inflammatory eruption characterized by small discrete polygonal flat-topped violaceous papules that may coalesce into rough scaly patches, often accompanied by oral lesions.
10). The cause is usually unknown. Some drugs (eg, arsenic, bismuth, gold) or exposure to certain chemicals used to develop color photographs may cause an eruption indistinguishable from lichen planus.
11). Long-term use of quinacrine or quinidine may produce hypertrophic lichen planus of the lower legs and other dermatologic and systemic disturbances. Other causes include liver disease and graft-vs.-host disease.
1). Topical corticosteroids with occlusion or intradermal steroid injections
2). Short courses of oral prednisone (rarely)
3). PUVA for generalized or resistant cases
4). Oral retinoids for erosive lichen planus in mouth