Lichen Planus

Published on 31/05/2015 by admin

Filed under Obstetrics & Gynecology

Last modified 31/05/2015

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Chapter 77 Lichen Planus

INTRODUCTION

Description: Lichen planus is a non-neoplastic epithelial disorder that affects glabrous skin, hair-bearing skin and scalp, nails, mucous membranes, or the oral cavity and the vulva.
Prevalence: Unknown, but relatively common.
Predominant Age: 30 to 60 years.
Genetics: No genetic pattern.

ETIOLOGY AND PATHOGENESIS

Causes: Unknown. Proposed—autoimmune disorder, possibly initiated by certain drugs such as beta blockers, angiotensin-converting enzyme (ACE) inhibitors.
Risk Factors: None known.

CLINICAL CHARACTERISTICS

Signs and Symptoms

• Red erosion and ulceration of the vulva and inner aspects of the labia minora (may precede oral lesions by years; 33% of patients)
• Loss of the labia minora with scarring, adhesions, and narrowing common (complete obliteration of the vagina possible); dyspareunia and postcoital bleeding common
• Oral lesions—reticulated gray, lacy pattern (Wickham’s striae) with gingivitis (vulvar involvement in 50% of patients with oral lesions)

DIAGNOSTIC APPROACH

Differential Diagnosis:

• Amebiasis
• Behçet’s syndrome
• Candidiasis
• Dermatophyte infection
• Lichen sclerosus
• Neurodermatitis
• Pemphigus and pemphigoid (cicatricial or bullous type)
• Plasma cell vulvitis
• Psoriasis
• Squamous cell hyperplasia
• Systemic lupus erythematosus
• Vulvar intraepithelial neoplasia (VIN III)

Associated Conditions: Hair loss and a history of papular lesions on the skin (ankle, dorsal surface of the hands, and flexor surfaces of the wrists and forearms).

Workup and Evaluation

Laboratory:

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