LICHEN PLANUS (LP)

Lichen planus is an inflammatory disease that affects the skin and the oral mucosa. The cause of lichen planus is unknown, but it has been suggested may a response to stress.

Lichen planus affects women more than men (at a ratio of 3:2), and occurs most often in middle-aged adults. Lichen planus in children is rare.

Clinical presentation The typical rash of lichen planus is well-described by the "5 P's": well-defined pruritic, planar, purple, polygonal papules. Flexor surfaces especially wrists, flanks, medial thighs, shins of tibia, glans penis, nails, scalp & oral mucosa. Pruritus; rubbing than scratching. Koebner’s phenomenon (isomorphic response). After lesions subside, post lichen hyperpigmentation occurs.

Koebner's Phenomenon

Hypertrophic LP

Lichen planopilaris Lichen Planopilaris is the specific name given to lichen planus on the scalp that may cause permanent, scarring alopecia

LP of Scalp  Cicatricial (scaring) Alopecia

Oral LP Oral lichen planus is common, and commonly presented as reticular which is white lacy streaks on the mucosa (known as Wickham's striae) of palate and lips and the tongue.

LP of oral mucosa

Complications of LP Squamous cell carcinoma in oral ulcerative lesions. Cicatricial alopecia in scalp LP. Postinflammatory hyperpigmentation.

Treatment No cure but we can use: Medicines used to treat lichen planus include: Oral and topical steroid Oral retinoid immunosuppressant medications Hydroxychloroquin Tacrolimus Dopson

Chicken Pox Occurs primarily in children, although adults who are not immune can contract it. It is quite contagious and is spread by breathing in infected respiratory droplets or unprotected direct contact with the rash when it has ruptured. In person’s who have had chickenpox, the virus can cause shingles later in life.

Clinical presentation The best known symptom of chickenpox is the itchy, red rash that breaks out on the face, scalp, chest, back, and sometimes arms and legs. The rash usually appears about 2 weeks after exposure to the virus and begins as superficial spots. The spots quickly fill with a clear fluid(vesicles), rupture, and turn crusty. The scabs then fall off in a week or two.

The rash continues to break out for the first 1 to 5 days, so spots at various stages of development may be present at the same time. A secondary infection of the ruptured rash by bacteria may cause high fever and skin scarring.

Treatment Isolate the diseased until the rash crusts. Cool, wet compresses , calamine lotion , antihistamines help to relieve itching. Complications are treated according to symptoms; Secondary bacterial pneumonia is treated with antibiotics. Acyclovir is used for severe varicella infections involving the lungs or the brain and in persons with a depressed immune system.

Human Papillomavirus (HPV): WARTS Warts are caused by HPV HPV infects skin and mucosal epithelia Infection causes hyperplasia of the epithelium = a wart HPV infects the basal keratinocytes of cutaneous and mucosal epithelium 21

Epidemiology One of the top three skin problems in children Peak prevalence is during adolescence (13-16 years old) about 5-20% of teens are affected Males and females are equally affected

Role of HPV in Cutaneous Disease HPV can be transmitted by skin-to- skin contact or through contaminated surfaces or objects Patients can also spread virus from a wart to unaffected skin

The type of HPV influences the wart morphology

Clinical Features of Verruca Vulgaris Hyperkeratotic,dome-shaped papules or nodules Most common on fingers, dorsal hands, knees or elbows but may occur anywhere May koebnerize – spread with skin trauma

Clinical Features of Verrucae Planae: Flat Warts Skin-colored or pink Smooth-surfaced, slightly elevated, flat-topped papules Dorsal hands, arms, face (exposed surfaces)

Clinical Features of Palmoplantar Verruca Thick, endophytic (depressed into skin of sole) papules Mosaic warts: plantar warts coalescing into large plaques

First Line Approaches to Wart Treatment Cryotherapy – liquid nitrogen Salicylic acid – chemically irritating, destructive Other therapies that may be used include: Laser: pulse dye laser