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Clinical:
| • | Koebner phenomenon; Wickham’s striae |
| • | nail finding: pterygium (looks like snow angels) destruction of nail matrix replaced with fibrosis |
| • | deep pigmentation may persist for several months after lesions have disappeared (often so intense that diagnosis of antecedent disease can be made from its distribution) |
Prognosis:
| • | spontaneous clearance after approx. 1 year |
| • | often recurrence but not multiple recurrence |
| • | oral and hypertrophic forms more chronic |
| • | Treatment: topical steroids, protopic, PUVA, oral prednisone, griseofulvin 500mg bid X 8 weeks |
clinical variants –
| • | hypertrophic LP: especially anterior lower legs, symmetric |
| • | keratosis lichenoides chronica: keratotic lichenoid papules; typically a streak linear or reticulate arrangement |
| • | lichen planus atrophicus: |
| • | annular LP: ddx - granuloma annulare |
| • | bullous LP: blisters that arise within lesions of LP |
| • | lichen planus pemphigoides: generalized blisters involving both lesional and non-lesional skin |
| • | LP/LE overlap: lesions resemble DLE clinically; often acral distribution |
CLINICAL VARIANTS vs. DISTINCT ENTITIES:
| • | polygonal patches of scarring alopecia (one or more residual tufts of normal appearing hair in these areas is characteristic) |
| • | follicular hyperkeratosis leads to keratotic, sometimes spiny papules |
| • | involvement of the front hair line and loss of eyebrows distinguishes these women from patients with pure androgenic alopecia |
| • | typical cutaneous and oral lesion of LP may be found in more than half the cases (or history of prior LP) |
| • | patchy cicatricial alopecia of the scalp and patches of follicular spinous papules involving the trunk, the upper parts of arms and legs and scalp |
| • | treatment very difficult |
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| • | AKA lichen planus actinicus, lichenoid melanodermatosis |
| • | a reputed variant of LP, common to the Middle East |
| • | occurs only on sun exposed parts of the body |
| • | several clinical patterns described: |
| • | most common = hyperpigmented papules, often annular configuration |
| • | or, well-defined nummular patches which have a deeply hyperpigmented center surrounded by a striking hypopigmented zone (esp. face; chloasma-like patches described) |
| • | or, skin-colored, closely aggregated, pinhead papules particularly on the face and dorsa of the hands |
histology:
| • | the lesions share a spectrum: LP --> --> eczematous |
| • | from – “almost indistinguishable from LP”, to – “overtly eczematous” |
| • | intermediate form (lichenoid melanodermatosis) = foci of spongiosis and parakeratosis accompany the lichenoid features |
| • | common to all these subtypes is striking pigmentary incontinence |
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| • | exact relationship to LP uncertain but there are close similarities and both conditions may coexist |
| • | vacuolization of the basal layer seems to be the primary histologic event |
clinical:
| • | macular, ashen-gray-blue hypermelanosis |
| • | trunk, face, upper extremities |
| • | often Latin or Indian descent |
| • | histology: active border shows vacuolar degeneration of the basal cells; pigmentary incontinence |
| • | treatment: bleaching creams, topical steroids |
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