Lichen ruber planus.
Lichen Ruber Planus also called lichen ruber or lichen planus (LP), is a noncontagious cutaneous disorder composed of pruritic, flat-topped papules seen on the inner surface of wrists and lower legs. It may be found with other diseases of altered immunity, such as ulcerative colitis, alopecia areata, vitiligo, dermatomyositis, morphea, lichen sclerosis, and myasthenia gravis. The mucous membranes, genitalia, nails and scalp may also be affected. Spontaneous resolution in 3 months – 2 year period. People with Hepatitis C are more susceptible to LP.
- Etiology: unknown; lesion may appear on traumatic site.
- Pathology:
- Liquefaction degeneration of basal layer of epidermis;
- Mixed cell infiltrate in papillary dermis; we can also see round deposits – colloid bodies;
- Prominent granular layer;
- Clinical features:
- Intense itching
- Red/violet flat-topped papules on flexor surfaces of wrists, forearm and legs
- Oral lesions – white, spongy raised lesions – may be asymptomatic, burning or even painful.
- In nails – complete destruction of nail bed
- Differential diagnosis: Psoriasis
- Treatment: may include
- Antihistamines – to reduce itching
- Phototherapy with UV light – to reduce symptoms
- Steroid ointments and creams – to reduce inflammation and redness
- Steroid tablets – for severe cases when ointments and creams are ineffective.
- Cyclosporine tablets – for extremely severe cases; reduces the activity of the immune system.