Lichen Planus

by Carlo Raj, MD

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    00:03 Our topic here is lichen planus.

    00:06 Be very careful.

    00:08 I have described to you a condition called lichen simplex chronicus.

    00:16 Do not confuse one with the other.

    00:18 In lichen planus, thought to be an autoimmune phenomenon.

    00:23 Associated with hepatitis C in areas of high prevalence.

    00:27 Memorize that.

    00:29 With lichen planus, you automatically pay attention to letter P.

    00:36 And with that P, it will give you the clinical pearls of your particular morphology of lichen planus; purple pruritic polygonal that will coalesce and form plaques.

    00:50 The five Ps with lichen planus.

    00:55 Not to be confused with lichen simplex chronicus.

    01:01 Common in the wrists and hands.

    01:04 So, you would have this purple polygonal, and then you have your papules that are going to coalesce and form plaque, and can also occur in the oral.

    01:13 I’m going to stop there, because if this, like in planus, appears on the palate, then what it’s going to do, may I ask you something.

    01:22 What does a striae mean to you? What does a striae mean to you? For example, you’re a weightlifter, you’re playing football, weightlifting.

    01:30 And during the process of weightlifting, you’re gaining quite a bit of weight on purpose because you’re trying to be -- whatever, a linebacker, tackle, what have you.

    01:37 And during that process, you’re going to have stretching of the skin, striae.

    01:41 Or you have a patient that has increased cortisol.

    01:45 You take a look at the patient, he has moon facies, buffalo hump, truncal obesity and purple striae.

    01:52 So, anytime that you have stretching taking place to skin, you’re going to then develop striae.

    01:59 Why am I bringing this to your attention? It’s very important.

    02:02 When you have lichen planus on the palate, in the mouth, it might then cause stretching of the palate.

    02:09 And that particular striae is not purple, it will be a white striae.

    02:15 In pathology, we describe it as being a lattice, lattice formation, L-A-T-T-I-C-E.

    02:21 And we call this a Wickham striae.

    02:24 Keep that in mind.

    02:26 Apart from the skin with the wrist and such, also know that it may also occur in the oral region and on the palate.

    02:35 Lichen planus, automatically start playing around with the letter P.

    02:42 If you take a look at this morphology here, you’ll notice that we have not only a purplish papule on the perimeter or periphery, but then as you come closer, polygonal and it coalesced to form a? Plaque.

    03:00 Autoimmune in nature, PPPPP.

    03:04 Pathology: band-like inflammation, destruction of the keratinocytes, and at the dermoepidermal junction, okay? Lichen planus.

    03:18 Management: Limited disease treated with potent topical steroids.

    03:22 You have antihistamines may show to help with the pruritus, that's it.

    03:28 Extensive skin/mucosal disease may require oral steroids.

    03:32 And mucosal involvement is a sign of more of a recalcitrant and a longer lasting disease, which is not a good sign.

    03:39 Remember the one that I described in the mouth, Wickham's striae Consultation with a dermatologist or dentist is often recommended so that you know as to what to do with your patient cosmetically.

    About the Lecture

    The lecture Lichen Planus by Carlo Raj, MD is from the course Inflammatory Skin Diseases.

    Included Quiz Questions

    1. Hepatitis C
    2. Hepatitis B
    3. HIV
    4. Syphilis
    5. Cirrhosis
    1. Topical steroids
    2. Methotrexate
    3. Cyclosporin
    4. Oral antibiotics
    5. Topical antibiotics

    Author of lecture Lichen Planus

     Carlo Raj, MD

    Carlo Raj, MD

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