LICHEN PLANUS (LP)
Lichen planus , the most typical and best characterized lichenoid dematosis, is an idiopathic inflammatory skin disease affecting the skin and mucosal membranes, often with a chronic course with relapses and periods of remission.
- Drugs-including antimicrobials, antihypertensives, antimalarials, antidepressants, anticonvulsants, diuretics, metals, non‐ steroidal anti‐inflammatory drugs (NSAIDS) and more recently imatinib , intravenous immunoglobulin
- Dental amalgam. Another putative antigen in oral LP is mercury in dental amalgam
- Betel nut. Social use of the betel nut is relatively common in India and South‐East Asia. The product that is chewed, betel quid, is a mixture of substances, including the areca nut and betel leaf, and is associated with oral LP
- Methacrylic acid esters used in the car industry , and more recently from dimethylfumarate, which can be found in sofas
- Hepatitis C infection
- Flu vaccine
- Certain pigments, chemicals and metals
- Pain relievers, such as ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve, others)
- Certain medications for heart disease, high blood pressure or arthritis
- Hepatitis B virus
- Human herpesvirus 6
- Varicella zoster virus
- Hepatitis B vaccines
- Radiotherapy, and confined to a radiation field
- Anxiety, depression and stress are common in patients with LP
Lichen planus is thought to be a T‐cell‐mediated autoimmune disease, possibly targeting the basal keratinocytes, which can be triggered by a variety of situations, including viruses, drugs and contact allergens.
- The classic clinical presentation of LP includes primary lesions consisting of firm, shiny, polygonal, 1–3 mm diameter papules with a red to violet colour.
- LP can affect any part of the body surface, but is most often seen on the volar aspect of the wrists the lumbar region and around the ankles.
- The ankles and shins are the commonest sites for hypertrophic lesions.
- When the palms and soles are affected, the lesions tend to be firm and rough with a yellowish hue
- Mucous membrane lesions are very common, occurring in 30–70% of cases, and may be present without evidence of skin lesions. They are, however, much less common in black people. The buccal mucosa and tongue are most often involved, but lesions may be found around the anus, on the genitalia, in the larynx.
- Pruritus is a fairly consistent feature in LP and ranges from occasional mild irritation to more or less continuous, severe itching, which interferes with sleep and makes life almost intolerable.
- Hypertrophic lesions usually itch severely.
- Nail involvement occurs in up to 10% of cases. Fingernails are more frequently affected than toenails.
History of the patient