lichen planus(lichen ruber)
DESCRIPTION
Lichen Planus(Lichen Ruber). Professor W K Jacyk. Lichen Planus. Flat topped papules, red-violet Location : most often volar aspect of the wrists and anterior aspect of the legs Localised or generalised Koebner phenomenon- typical lesions develop along the lines of scratching . - PowerPoint PPT PresentationTRANSCRIPT
Lichen Planus(Lichen Ruber)
Professor W K Jacyk
Lichen Planus
• Flat topped papules, red-violet• Location : most often volar aspect of the
wrists and anterior aspect of the legs• Localised or generalised • Koebner phenomenon- typical lesions develop
along the lines of scratching
Lichen Planus
• Affects skin, oral, genital mucosa, nails• Skin lesions are pruritic• Nail changes are variable-from delicate to
complete destruction
• Fairly common• Blacks more often than whites• Clinical variability• Classic • Hypertrophic, verrucous• Follicular• Bullous • Course: self limiting but may last several months
Aetiology
• Triggers • Certain medications • Viral hepatitis B, C• Other liver diseases • Immunological reaction (cell mediated )to
some epidermal antigen, so far not identified• Characteristic histology
Treatment
• Milder cases-topical corticosteroids -topical calcineurin inhibitors -PUVA• Severe – sytemic corticosteroids -cyclophosphamide -cyclosporin
Lichenoid drug eruptions
• Common• Many medications cause this type of skin lesions• Antimalarials- chloroquine• Antituberculous –isoniazid• Antihypertensives- thiazides, methyldopa, SACE• Gold • D-penicllamine• Lithium
Pityriasis Rosea• Common • Young adults • Seasonal?• Characteristic course• Herald (mother patch) 7-10 days later secondary
eruption, waist to neck, usually profuse• Lasts few weeks • Spontaneous resolution• Pruritic • Aetiology –HHV 7
Management
• Explain- self limiting, non-infectious, not a sign of internal disease, usually only once in life
• Treat only when very pruritic• Topical corticosteroid preparations• Sunlight or artificial UVB• Short course of oral corticosteroids• Sedative antihistaminics
Risk of misdiagnosis
• Tinea- herald patch• Syphillis • psoriasis
Seborrhoeic dermatitis-Adult form
• “Seborrhoeic” a historical name • Disease is unrelated to the sebaceous glands • Lesions mainly face, scalp, presternal area(in
man), folds(axillae, groins, submammary)• Most common in adult males• Role of Pityrosporum yeasts • Common in infection with HIV and HTLV-1
Treatment
• Courses of imidazoles- ketoconazole, itraconazole
• Courses of antibiotics • Topical steroids