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Dermatology
Lichen Planus and Lichenoid Dermatoses
Built from Dermatology, 5th Edition
What’s inside
8 sections · 146 slides
Overview
- What this topic covers
- What does 'lichenoid' mean?
- A map of the lichenoid dermatoses
- Major lichenoid dermatoses and possible associated target antigens
- Major lichenoid dermatoses and possible associated target antigens (continued)
Lichen Planus
An idiopathic, T cell-driven disease of skin, hair, nails, and mucous membranes
- Lichen planus: key features
- History of the name
- How common is lichen planus?
- Where mucosal disease fits in
- The core idea: an autoimmune attack
- Possible outside triggers (target antigens)
- Hepatitis C virus and lichen planus
- Other viruses linked to lichen planus
- Vaccines, bacteria, and contact allergens
- Drugs that trigger a lichen planus-like rash
- Drugs implicated in lichenoid drug eruptions
- Drugs implicated in lichenoid drug eruptions (continued)
- Drugs implicated in lichenoid drug eruptions (continued)
- Drugs implicated in lichenoid drug eruptions (continued)
- Drugs implicated in lichenoid drug eruptions (continued)
- Drugs implicated in lichenoid drug eruptions (continued)
- Tumors and autoimmune associations
- Mouse model of the lichenoid tissue reaction
- What the mouse model showed
- Which T cells do the damage?
- Regulatory cells and innate immune signals
- The two phases of a lichen planus lesion: induction and evolution
- Getting T cells into the skin
- The interferon feedback loop in lichen planus
- Fixed drug eruption: a stable population of resident T cells
- Resident T cells and fixed drug eruption
- A role for sweat
- Chemokines and chemokine receptors involved in T cell migration into the skin
- The classic lichen planus papule
- Lichen planus: the flat-topped violaceous papule
- Postinflammatory hyperpigmentation after lichen planus
- Where lichen planus appears, and how it behaves
- The Koebner phenomenon in lichen planus
- Recognizing the pattern: more examples
- Lichen planus on the upper extremity and thigh
- Lichen planus of the hand and wrist
- Lichen planus of the thigh with postinflammatory hyperpigmentation
- Lichen planus: a family of variants
- Actinic lichen planus
- Acute (exanthematous) lichen planus
- Annular lichen planus
- Lichen planus of the glans penis
- Atrophic lichen planus
- Bullous lichen planus and lichen planus pemphigoides
- Unusual variants: atrophic, bullous, and pemphigoides
- Hypertrophic lichen planus
- Hypertrophic lichen planus of the shin, with obvious Wickham striae
- Inverse lichen planus
- Lichen planus pigmentosus
- A second example of intertriginous lichen planus pigmentosus
- Lichen planopilaris
- Two named variants of scalp lichen planus
- Linear lichen planus
- Lupus erythematosus and lichen planus overlap
- Nail lichen planus
- Oral lichen planus
- Erosive lichen planus of the lower lip (cheilitis)
- Oral lichen planus: extent and risk
- Ulcerative lichen planus
- Vulvovaginal lichen planus
- Variants of lichen planus
- Variants of lichen planus (continued)
- Variants of lichen planus (continued)
- Variants of lichen planus (continued)
- Lichenoid drug eruption: LP's drug-triggered twin
- Lichenoid drug eruption
- Lichenoid drug eruption on the shin from nivolumab
- Features for distinguishing lichenoid drug eruption from lichen planus
- Features for distinguishing lichenoid drug eruption from lichen planus (continued)
- TNF inhibitors: a paradox
- Lichenoid granulomatous dermatitis
- Lichenoid eruptions from cancer immunotherapy
- What lichen planus looks like under the microscope
- Lichen planus: characteristic histopathologic features
- Colloid bodies and pigment loss
- Immune cells seen on biopsy
- Before calling it 'idiopathic': rule out a cause
- Conditions that mimic lichen planus
- Treating lichen planus: general principles
- First-line and topical treatments
- Topical calcineurin inhibitors
- Newer topical and combination options
- Systemic corticosteroids
- Retinoids and antimicrobial-family drugs
- Immunosuppressive and biologic-era drugs
- Newest targeted therapies
- Therapeutic ladder for lichen planus
- Therapeutic ladder for lichen planus (continued)
- Therapeutic ladder for lichen planus (continued)
- Therapeutic ladder for lichen planus (continued)
- Phototherapy for resistant disease
Lichen Striatus
A self-limited, line-following rash of childhood
- Lichen striatus: key features
- History and how common it is
- What causes the line? (Lines of Blaschko)
- Lichen striatus follows the lines of Blaschko
- A single streak of lichen striatus on the lower extremity
- Clinical course of lichen striatus
- Lichen striatus: histopathologic features
- Lichen striatus under the microscope
- Telling lichen striatus apart, and treating it
Lichen Nitidus
A cluster of tiny, shiny papules, closely related to lichen planus but clinically distinct
- Lichen nitidus: key features
- History, how common, and a debated relationship to LP
- Lichen nitidus: numerous tiny, shiny papules
- Lichen nitidus: numerous small, flat-topped papules on the hands
- Where lichen nitidus appears, and its course
- Lichen nitidus with the Koebner phenomenon
- Lichen nitidus: the 'ball and claw' histopathologic pattern
- Lichen nitidus under the microscope
- Comparison of clinical and histologic features of lichen nitidus versus lichen planus
- Comparison of clinical and histologic features of lichen nitidus versus lichen planus (continued)
- Comparison of clinical and histologic features of lichen nitidus versus lichen planus (continued)
- Comparison of clinical and histologic features of lichen nitidus versus lichen planus (continued)
- Telling lichen nitidus apart, and treating it
Erythema Dyschromicum Perstans
Also called ashy dermatosis - slowly spreading gray-brown patches
- Erythema dyschromicum perstans: key features
- History and how common it is
- What might trigger EDP?
- Erythema dyschromicum perstans on the lower extremities
- Clinical course of EDP
- Telling EDP apart, and treating it
Keratosis Lichenoides Chronica
A rare, chronic, linear and net-like lichenoid eruption
- Keratosis lichenoides chronica: features and history
- Keratosis lichenoides chronica: limb and facial involvement
- Course, pathology, and treatment
Actinic Lichen Nitidus
Also called summertime actinic lichenoid eruption
- A sun-triggered lichenoid papular eruption
- Naming debate and how it is diagnosed today
Annular Lichenoid Dermatitis (of Youth)
A rare ring-shaped lichenoid eruption, first described in 2003
- A rare annular rash first seen in children
- Pathology and how it is told apart
- Clinical course and treatment
- Lichen planus: what to remember
- The lichenoid dermatoses: what to remember
- References
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- References (continued)
- Dermatology, 5th Edition (2-Volume Set)