Papulosquamous diseases

BY: DR.HEBA JEHAD EL-HISSI

DERMATOLOGY, AESTHETIC MEDICINE AND LASER CONSULTANT
Lichen planus

 inflammatory disease of the skin,hair, nails,and mucous

membranes, seen most commonly in middle aged adults
 Due to T cell-mediated autoimmune reaction toward basal layer
keratinocytes
 may be idiopathic, drug-related or infection-related (HCV)
 Occurs in 10% of first degree relatives of affected patients.
 Often lasts 1–2 years (except oral and hypertrophic forms, which
typically have protracted courses)
 There is a slight predominance in women

 Women tend to develop the disease later in life than men.

 Two thirds of the patients developing the disease between 30-60
years.
 Oral involvement in up to 75% of patients with cutaneous lichen
planus
 Only 10%-20% of patients with oral lichen planus will develop
cutaneous disease.
Types of lichen planus
 Actinic LP
 Acute ( exanthematous ) LP
 Annular LP
 Atrophic LP
 Bullous LP
 LP pemphigoides
 Hypertrophic LP
 Inverse LP
 LP pigmentosus
 Lichen planopilaris
 Linear LP
 LP-LE overlap
 Nail LP
 ulcerative LP
 Vulvovaginal LP
 Drug induced LP
Pruritic, polygonal,planar,shiny papules and plaques
Koebner phenomenon
Nail LP
Lichen planopilaris
Oral lichen planus

 Reticular
 Atrophic
 Bullous
 Erosive
 Papular
 Pigmented
 Plaque like
Reticular type

 Most common and characteristic

 Usually asymptmatic
 Often bilateral and symmetric
 Most common site is buccal mucosa
 Slightly raised whitish linear lines in a lace like pattern or rings with
short radiating spines.
 Gingival involvemen is common
Papular lichen planus
Plaque like oral lichen planus:
higher incidence among tobacco smokers
Bullous lichen planus
Erosive lichen planus
Desquamative gingivitis
Don’t forget to ask about
 dysphagia ( possibility of esophageal involvement)
 Other mucosal ( genital ) lesions: 70% of patients with vulvovaginal
LP have clinical signs of oral Lp
(Vulvovaginal-gingival syndrome)
Diagnosis

 Clinical picture
 Biopsy:

Hyperkeratosis,
Wedge-shaped hypergranulosis,
“saw-toothed” acanthosis,
dyskeratotic epidermal basal cell damage that is associated with a
massive bandlike infiltration of mononuclear cells at the dermal-
epidermal junction ( Interface dermatitis)
Treatment

 LP is largely a self-limiting disease. Spontaneous remissions occur

in the majority of patients after 1 year.
 OLP, on the other hand, lasts for an average of 5 years.
 Topical drugs:
• Steroids are the first line therapy for localized disease
• Calcineurin inhibitors( tacrolimus, pimecrolimus)
 Systemic steroids for generalized disease
 Psoralen with ultraviolet A (PUVA), griseofulvin, dapsone,
cyclosporine, and hydroxychloroquine also have been reported
anecdotally to be effective for steroid-resistant LP.
Annual monitoring for oral lesions, premalignant condition
Thank you