liken planus & lichen sclerosus et atropichus, granuloma anulare
DESCRIPTION
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Dr. dr. Sri Vitayani Muchtar, Sp.KK
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LICHEN PLANUS
Lichen planus (Greek leichen, "tree moss"; Latin planus, "flat") is a unique, common inflammatory disorder that affects the skin, mucous membranes, nails, and hair
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EPIDEMIOLOGY
The exact incidence and prevalence of lichen planus are unknown, but the overall prevalence is believed to be somewhat less than 1 percent of the general population
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ETIOLOGY AND PATHOGENESIS
It is evident that immunologic mechanisms almost certainly mediate the development of lichen planus
No consistent alterations in immunoglobulins (Igs) have been shown in lichen planus, and humoral immunity most likely is a secondary response in the immunopathogenesis.
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ETIOLOGY AND PATHOGENESIS
The epithelial lymphocyte interaction can be divided into three major stages: antigen recognition, lymphocyte activation, and keratinocyte apoptosis.
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CLINICAL FINDINGS
The classic cutaneous lesion of lichen planus is a faintly erythematous to violaceous, flat-topped, polygonal papule, sometimes showing a small central umbilication
Papules are grouped and tend to coalesce. A thin, transparent, and adherent scale may be discerned atop the lesion. Fine, whitish puncta or reticulated networks referred to as Wickham striae are present over the surface of many well-developed papules
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MORPHOLOGY OF LESIONSHypertrophic Lichen Planus.Atrophic Lichen Planus.Vesiculobullous Lichen Planus.Erosive and Ulcerative Lichen Planus.Follicular Lichen Planus.Lichen Planus Pigmentosus.
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Pathology
The two major pathologic findings in lichen planus are basal epidermal keratinocyte damage and lichenoid-interface lymphocytic reaction
The epidermal changes include hyperkeratosis, wedgeshaped areas of hypergranulosis, and elongation of rete ridges that resemble a sawtooth pattern
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Granuloma annulareRelatively common disorder Exact prevalence is unknownFavors children and young adults.
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ETIOLOGY AND PATHOGENESIS
The cause is unknown and the pathogenesis is poorly understood.Predisposing EventsSUN EXPOSUREDRUGSDIABETES MELLITUS AND THYROID DISEASEMALIGNANCY
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CLINICAL FINDINGS
Clinical variants of granuloma annulare include the localized, generalized, subcutaneous, perforating, and patch types.Linear granuloma annulare, a follicular pustular form, and papular umbilicated lesions in children have also been described
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Cutaneous Lesions
LOCALIZED TYPEGENERALIZED TYPESUBCUTANEOUS TYPEPERFORATING TYPEPATCH TYPE
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Pathology
Pathologic features consist of granulomatous inflammation in apalisaded or interstitial pattern associated with varying degrees of connective tissue degeneration and mucin deposition.
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Treatment
Await spontaneous resolutionApply topical corticosteroid with or without occlusionAdminister intralesional triamcinolone 2.5 mg/mL
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Lichen Sclerosus et Atropicus
Infrequent chronic inflammatory dermatosis with anogenital and extragenital manifestations.Preferentially affects women in the fifth or sixth decade of life and children younger than the age of 10 years.Gender ratio 5:1 female-male,
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Antibodies to extracellular matrix protein and Tcells with receptor rearrangement point to an autoimmune pathogenesis.
Anogenital manifestations cause severe discomfort (pruritus, dyspareunia, dysuria, and painful defecation) and present with polygonal papules and porcelain white plaques, erosions, and various degrees of sclerosis.
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Vulvar lichen sclerosus is associated with an increased risk of squamous cell carcinoma; the role of human papillomavirus infection or prior radiotherapy remains to be elucidated.
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Extragenital lichen sclerosus with confluent whitish papules and plaques on the skin over the thoracic and lumbar spine.
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Histopathology
Classical LS shows an atrophic epidermis and a lichenoid infiltrate at the dermal-epidermal junction.
Papillary edema is usually seen in early LS but is gradually replaced by fibrosis with homogenization of acid mucopolysaccharides as the lesion matures
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TREATMENT
Potent topical corticosteroids and skin care are the most successful therapeutics;
Calcineurin antagonists have also recently demonstrated benefit.
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PROGNOSIS AND CLINICAL COURSE
The prognosis of LS is good for most anogenital cases, especially for those in prepubertal children that may resolve spontaneously or may be healed after treatment with ultrapotent topical steroids
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THANK YOU