Dermatology - Lichen Planus

Dermatology - Lichen Planus 
Lichen planus is a rare skin condition that affects fewer than one percent of the global population and is characterized by acute or chronic inflammation of the skin. The age at which symptoms first appear is typically between 30 and 60 years, and the occurrence of the condition is more frequent in women. The cause of this condition is usually unknown, however cell-mediated immunity can have a significant impact.


The onset can be either abrupt (occurring within a few days) or gradual (taking place over several weeks), and the lesions persist for a duration of months to years.
Lesions can either be without symptoms or cause itching, and lesions on the mucous membranes are particularly unpleasant, especially if they are ulcerated. Postinflammatory hyperpigmentation is a frequent occurrence. Lesions may appear on the lips and in a linear pattern following trauma, known as the Koebner or isomorphic phenomena.
Abnormalities
Manifesting as papules ranging from 1 to 10 mm in diameter, this condition is distinguished by its shiny, pruritic, polygonal appearance, with colors ranging from pink to purple. Lesions in the flexural aspects of extremities sometimes have a generalized pattern, appearing as clustered, annular, or diffused scattered isolated lesions. Oral lesions are uncomfortable, characterized by milky-white reticulated papules that have the potential to develop erosions and ulcers.
Wickham striae can frequently be observed with a hand lens. The different variations include hypertrophic, atrophic, follicular, reticular, vesicular, pigmented, nail, and genital manifestations.
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The diagnosis is determined through clinical examination and verified by doing a biopsy of the affected area. The differential diagnosis comprises lupus, psoriasis, pityriasis rosea, atopic dermatitis, basal cell carcinoma, squamous cell carcinoma in situ, lichen simplex chronicus, prurigo nodularis, stasis dermatitis, and Kaposi sarcoma.

Apply topical glucocorticoids with occlusion for skin lesions, provide intralesional triamcinolone (3 mg/mL) for lesions in the mouth and lips, and use cyclosporine and tacrolimus solutions as a mouthwash for very symptomatic oral lesions.
Systemic
For very resistant and widespread cases, a daily oral dose of 5 mg/kg of cyclosporine can effectively bring about a quick improvement in symptoms, with a minimal likelihood of the condition returning. Oral prednisone is beneficial for those experiencing symptomatic pruritus, painful erosions, dysphagia, or cosmetic deformity.
An abbreviated, gradually decreasing regimen is preferred: 70 mg initially, decreased by 5 mg per day. Retinoids, specifically Acitretin, at a dosage of 1 mg/kg per day, can be beneficial as a supplementary treatment in severe instances. However, additional topical treatment is necessary. Photochemotherapy can be beneficial for those who do not respond well to both topical and systemic treatments.