1. Lichen Planus and Lichen nitidus By : Dr. Ahmad Al Aboud Supervised by: Dr.Amira Akbar

3. Background: Lichen planus (LP) is a pruritic, papular eruption characterized by its violaceous color, polygonal shape, and, sometimes, fine scale ( 4Ps ). It is most commonly found on the flexor surfaces of upper extremities, genitalia and mucous membranes. Lichen planus is most likely an immunologically mediated reaction.

4. Pathophysiology: Lichen planus is a cell-mediated immune response of unknown origin. IFN-alpha, ICAM-1, IL-1,4,6, GMCSF & TNF are involved in immune response Increased exp. Of K 6.16.17

5. Pathophysiology: LP may be found with other diseases of altered immunity: syphlis, HIV,HSV,ch. Bladder infections, ulcerative colitis, alopecia areata, vitiligo, dermatomyositis, morphea, lichen sclerosis and myasthenia gravis. An association is noted between LP and hepatitis C infection, chronic active hepatitis and primary biliary cirrhosis.

7. Frequency: In the US: Lichen planus is reported in approximately 1% of all new patients seen at the clinics. Some areas have reported a higher incidence in December and January.

8. Epidemiology: In the US: Lichen planus is reported in approximately 1% of all new patients seen at the clinics. Some areas have reported a higher incidence in December and January. Race: No racial predispositions have been noted. Sex: No significant differences are noted between male and female patients. Females are affected earlier than males Age: More than two thirds of patients are aged between 30 and 60 years; however, LP can occur at any age, Less common in v.younge and older ages

9. Mortality/Morbidity: Atrophy and scarring are seen in hypertrophic lesions and lesions on the scalp. Cutaneous LP does not carry a higher risk of skin cancer, but ulcerative lesions in the mouth, particularly in men, have a higher incidence of malignant transformation. Vulvar lesions in women may also be associated with squamous carcinoma.

22. Standard classical treatment for mild and moderate cases Mometasone furoate cream 0.1% cream OD 4-6 w all types Betamethasone Diprpionate cream 0.05% OD 2-4w under occlusion Chlorphenermine maleate PO 4mg NOCT 4-6W PRN Cutaneous Lichen planus Dr.Ahmad M. Al Aboud

23. Standard classical treatment for mild and moderate cases Tacrolemus cream 0.1% OD 4 W Ora Triamcinolone Acetonide inh. 23g OD alt 2-4W Oral 2sec sp. Oral Lichen planus Ahmad M. Al Aboud

24. treatment for Moderate to severe acute cases Prednisolone PO 20Mg OD 4-6 W Tap2-3W or Acitretin PO 30Mg OD 8w Lichen planus Ahmad M. Al Aboud

25. treatment for Moderate to severe acute cases Cyclosporine PO 5Mg OD 4-6W 2 w IMP. Or ECP 2 sessions / month 12 M Lichen planus Ahmad M. Al Aboud

27. Treatment : * Topical Corticosteroids * Topical Corticosteroids. Injections of Corticosteroids or Administration Under Occlusion * Injections of Corticosteroids or Administration Under Occlusion * Systemic Corticosteroids * Systemic Corticosteroids. RETINOIDS. * RETINOIDS. * Immunomodulators: cyclosporin. * Immunomodulators: cyclosporin. * Photochemotherapy. * Photochemotherapy. * Recent treatment modalities: * Recent treatment modalities: Griseofulvin Griseofulvin Dapsone Dapsone hydroxychloroquine hydroxychloroquine Thalidomide Thalidomide Levamisole hydrochloride Levamisole hydrochloride

32. Background: Lichen nitidus is a relatively rare, chronic skin eruption that is characterized clinically by asymptomatic, flat-topped, skin-colored micropapules. Lichen nitidus mainly affects children and young adults. Ratio of LN to LP is 1.7 :100

33. The frequency of lichen nitidus is unknown because of its uncommon occurrence. In a study of skin diseases in blacks over a 25- year period, the incidence of lichen nitidus was 0.034%.

34. Lichen nitidus is usually an asymptomatic eruption; however, patients occasionally complain of pruritus. Familial cases have been described.

37. Treatment : No therapeutic modality has been rigorously evaluated for the treatment of lichen nitidus because of the rarity and lack of symptomatology of this disease. Reported therapies, mostly from isolated case reports, include topical and systemic steroids, cetirizine, levamisole, etretinate, acitretin, itraconazole, cyclosporine, topical dinitrochlorobenzene, UV-A/UV-B phototherapy, and psoralen plus ultraviolet light of A wave length (PUVA).