Chapter 33
Lichen Planus
Vibhu Mendiratta,
Sarita Sanke,
Vibhu Mendiratta
Lady Hardinge Medical College and associated hospitals, New Delhi, India
Search for more papers by this authorSarita Sanke
Lady Hardinge Medical College and associated hospitals, New Delhi, India
Search for more papers by this authorVibhu Mendiratta,
Sarita Sanke,
Vibhu Mendiratta
Lady Hardinge Medical College and associated hospitals, New Delhi, India
Search for more papers by this authorSarita Sanke
Lady Hardinge Medical College and associated hospitals, New Delhi, India
Search for more papers by this authorBook Editor(s):Peter Hoeger,
Veronica Kinsler,
Albert Yan,
John Harper,
Arnold Oranje,
Christine Bodemer,
Margarita Larralde,
David Luk, Vibhu Mendiratta,
Diana Purvis,
Peter Hoeger
Search for more papers by this authorVeronica Kinsler
Search for more papers by this authorAlbert Yan
Search for more papers by this authorJohn Harper
Search for more papers by this authorArnold Oranje
Search for more papers by this authorChristine Bodemer
Search for more papers by this authorMargarita Larralde
Search for more papers by this authorVibhu Mendiratta
Search for more papers by this authorDiana Purvis
Search for more papers by this authorFirst published: 20 November 2019
Summary
Lichen planus (LP) is a papulosquamous autoimmune T-cell-mediated disease that affects skin, mucous membranes, hair follicles and nails. It affects all age groups including children. Childhood LP cases can be sporadic or familial. Classic LP is characterized by faintly erythematous, violaceous, flat-topped, polygonal papules that are characteristically pruritic. White crisscrossing lines called Wickham's striae are seen on the surface. Several clinical variants are recognized according to the configuration of the lesions, their morphological appearance and the site involved. Vacuolar degeneration of the basement membrane with a band-like lymphocytic infiltrate at the dermoepidermal junction constitutes a histopathological hallmark. Classic, hypertrophic, annular and linear LP are the common childhood variants. LP is multifactorial in origin and is thought to be a T-cell-mediated injury to the basement membrane which results from infections, drugs and vaccinations. The lesions may last for up to 1–2 years, but the hypertrophic, mucosal, nail and follicular LP variants may last significantly longer. The nail and follicular variants can lead to the scarring processes of anonychia and cicatricial alopecia, respectively. Treatment is multidimensional and includes topical corticosteroids and calcineurin inhibitors, as well as systemic medications including nonsteroidal anti-inflammatory agents, systemic steroids, dapsone, methotrexate, ciclosporin (cyclosporine), azathioprine and phototherapy. This chapter outlines the clinical profile, aetiopathogenesis, course and treatment options in childhood LP.
References
- Wilson E. On leichen planus. J Cutan Med Dis Skin 1869; 3: 117–32.
- River JK, Jackson R, Orizaga M. Who was Wickham and what are his striae? Int J Dermatol 1986; 25: 611–13.
- Darier J. Precis de Dermatologie. Paris: Masson, 1909: 118.
- Katzenelson V, Lotem M, Sandbank M. Familial lichen planus. Dermatologica 1990; 180: 166–8.
- Samman PD. Lichen planus: An analysis of 200 cases. Trans St Johns Hosp Dermatol Soc 1961; 46: 36–8.
-
Bermajo-Fenoli A, Lopez-Jornet P. Familial oral lichen planus: presentation of six families. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 102: e12–15.
10.1016/j.tripleo.2006.03.016 Google Scholar
- Saurat JH, Lemarchand F, Hors J et al. HLA markers and lymphocytotoxins in lichen planus. Arch Dermatol 1977; 113: 1719–20.
- Lowe NJ, Cudworth AJ, Woodrow JC. HL-A antigens in lichen planus. Br J Dermatol 1976; 95: 169–71.
- Powell FC, Rogers RS, Dickson ER, Moore SB. An association between HLA DR 1 and lichen planus. Br J Dermatol 1986; 114: 473–8.
- White AG, Rostom AI. HLA antigens in Arabs with lichen planus. Clin Exp Dermatol 1994; 19: 236–7.
- Luis- Montoya P, Yamamoto- Furusho JK, Vega-Memije E et al. HLA-DRB 1*0101 is associated with the genetic susceptibility to develop lichen planus in the Mexican Mestizo population. Arch Dermatol Res 2007; 299: 405–7.
- Black MM. What is going on in lichen planus? Clin Exp Dermatol 1977; 2: 202–310.
- Sugerman PB, Satterwhite K, Bigby M. Autocytotoxic T-cell clones in lichen planus. Br J Dermatol 2000; 142: 49–56.
- Wenzel J, Scheler M, Proelss J et al. Type 1 interferon associated cytotoxic inflammation in lichen planus. J Cutan Pathol 2006; 33: 672–8.
- Ciaccio M, Rebora A. Lichen planus following HBV vaccination: A coincidence? Br J Dermatol 1990; 122: 424.
- Tasanen K, Renko M, Kandelberg P et al. Childhood lichen planus after simultaneous measles-mumps-rubella and diphtheria-tetanus-pertussis-polio vaccinations. Br J Dermatol 2008; 158: 646–8.
- Zignego AL, Ferri C, Pileri SA et al. Extrahepatic manifestations of hepatitis C infection: A general overview and guidelines and guidelines for a clinical approach. Dig Liver Dis 2007; 39: 2–17.
- Prabhu S, Pavithran K, Sobhanadevi G. Lichen planus and hepatitis C virus (HCV) - is there an association? A serological study of 65 cases. Indian J Dermatol Venereol Leprol 2002; 68: 273–4.
- Limas C, Limas CJ. Lichen planus in children: a possible complication of hepatitis B vaccines. Pediatr Dermatol 2002; 19: 204–9.
- Kanwar AJ, De D. Lichen planus in childhood: Report of 100 cases. Clin Exp Dermatol 2010; 35: 257–62.
- Nanda A, Al-Ajmi HS, Al-Sabah H et al. Childhood lichen planus: A report of 23 cases. Pediatr Dermatol 2001; 18: 1–4.
- Handa S, Sahoo B. Childhood lichen planus: A study of 87 cases. Int J Dermatol 2002; 41: 423–7.
- Sharma R, Maheshwari V. Childhood lichen planus: A report of 50 cases. Pediatr Dermatol 1999; 16: 345–8.
- Carrozzo M, Pellicano R. Lichen planus and hepatitis C virus infection: an updated critical review. Minerva Gastroenterol Dietol 2008; 54: 65–74.
- Rebora A, Rongioletti F. Lichen planus and chronic active hepatitis. J Am Acad Dermatol 1984; 10: 840–1.
- Ukonu AB, Augustine U. The prevalence of hepatitis C Virus (HCV) among lichen planus patients and its clinical pattern at the University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria. Glob J Health Sci 2012; 4: 113–19.
- Alaizari NA, Al-Maweri SA, Al-Shamiri HM et al. Hepatitis C virus infections in oral lichen planus: a systematic review and meta-analysis. Aust Dent J 2016; 61: 282–7.
- Laeijendecker R, Van Joost T, Tank B et al. Oral lichen planus in childhood. Pediatr Dermatol 2005; 22: 299–304.
- Ozta P, Onder M, Ilter N, Ozta MO. Childhood lichen planus with nail involvement: A case. Turk J Pediatr 2003; 45: 251–3.
- Kanwar AJ, Belhaj MS. Lichen planus among Arabs: A study from Libiya. J Dermatol 1984; 11: 93–6.
- Balaubramaniam P, Ogboli M, Moss C. Lichen planus in children: Review of 26 cases. Clin Exp Dermatol 2008; 33: 457–9.
-
Pusey WA. Lichen planus in an infant less than 6 months old. Arch Dermatol Syph 1929; 19: 671–2.
10.1001/archderm.1929.02380220140008 Google Scholar
- Samman PD. A note on the natural history of lichen planus. Br J Dermatol 1956; 68: 175–81.
- Altman J, Perry HO. The variations and course of lichen planus. Arch Dermatol 1961; 84: 179–91.
- Kumar V, Garg BR, Beruah MC, Vasireddi SS. Childhood lichen planus (LP). J D Dermatol 1993; 20: 175–7.
- Goettmann S, Zaraa I, Moulonguet I. Nail lichen planus: epidemiological, clinical, pathological, therapeutic and prognosis study of 67 cases. J Eur Acad Dermatol Venereol 2012; 26: 1304–9.
- Peluso AM, Tosti A, Piraccini BM, Cameli N. Lichen planus limited to the nails in childhood: case report and literature review. Pediatr Dermatol 1993; 10: 36–9.
- Saman PD. The nails in lichen planus. Br J Dermatol 1961; 73: 288–92.
- Grover C, Vohra S. Onychomadesis with lichen planus: an under-recognized manifestation. Indian J Dermatol 2015; 60: 420.
- Kanwar AJ, De Dipankar. Lichen planus in children. Ind J Dermatol Venereol Leprol 2010; 76: 366–72.
- Nakamura R, Broce AA, Palencia DP et al. Dermatoscopy of nail lichen planus. Int J Dermatol 2013; 52: 684–7.
- Tosti A, Piraccini BM, Cambiaghi S, Jorizzo M. Nail lichen planus in children: clinical features, response to treatment, and long-term follow-up. Arch Dermatol 2001; 137: 1027–32.
- Pandhi D, Singal A, Bhattacharya SN. Lichen planus in childhood: a series of patients. Pediatric Dermatol 2014; 31: 59–67.
- Prevost NM, English JC. Palliative treatment of fingernail lichen planus. J Drugs Dermatol 2007; 6: 202–4.
- Pinter A, Patzold S, Kaufmann R. Lichen planus of nails – successful treatment with alitreinoin. J Dtsch Dermatol Ges 2011; 9: 1033–4.
- Chieregato C, Zini A, Barba A, Magnanini M, Rosina P. Lichen planopilaris: report of 30 cases and review of literature. Int J Dermatol 2003; 42: 342–5.
- Christensen KN, Lehman JS, Tollefson MM. Pediatric lichen planopilaris: clinico-pathologic study of four new cases and a review of the literature. Pediatr Dermatol 2015; 32: 621–7.
- Nayar M, Schomberg K, Dawber RPR et al. A clinicopathological study of scarring alopecia. Br J Dermatol 1993; 128: 533–6.
- Abbasi NR, Orlow SJ. Lichen planopilaris noted during etanercept therapy in a child with severe psoriasis. Pediatr Dermatol 2009; 26: 118.
- Jayasekera PS, Walsh ML, Hurrell D, Parslew RA. Case report of lichen planopilaris occurring in a pediatric patient receiving a tumor necrosis factor α inhibitor and a review of the literature. Pediatr Dermatol 2016; 33: e143–6.
- Anuradha CH, Chandra Sekar P, Reddy GS et al. Oral mucosal lichen planus in children - Report of three cases. J Orofacial Sci 2011; 3: 20–3.
- Luis-Montoya P, Domínguez-Soto L, Vega-Memije E. Lichen planus in 24 children with review of the literature. Pediatr Dermatol 2005; 22: 295–8.
- Sanjaya PR, Hallikeri K, Angadi PV. Disseminated form of childhood lichen planus. Eastern J Med 2011; 16: 72–5.
- Sugarman PB, Savage NW. Oral lichen planus: Causes, diagnosis and management. Aust Dent J 2002; 47: 290–7.
- Chamani G, Rad M, Zarei MR et al. Efficacy of tacrolimus and clobetasol in the treatment of oral lichen planus: a systematic review and meta-analysis. Int J Dermatol 2015; 54: 996–1004.
- Igras E, Kennedy S, MacDermott EJ, Murphy CC. Isolated ocular lichen planus in a child. J AAPOS 2015; 19: 381–3.
- Collgros H, Vicente A, Gonsalez MA et al. Childhood actinic lichen planus: four cases report in Caucasian Spanish children and review of the literature. J Eur Acad Dermatol Venereol 2016; 30: 518–22.
- Dammak A, Masmoudi A, Boudaya S et al. Childhood actinic lichen planus (6 cases). Arch Pediatr 2008; 15: 111–14.
- Ramírez P, Feito M, Sendagorta E et al. Childhood actinic lichen planus. Australas J Dermatol 2012; 53: e10–3.
- Alvarez Alvarez C, Meijide Rico F, Rodríguez González L et al. Verrucous carcinoma of the penis arising from a lichen planus. A true preneoplastic lesion? Actas Urol Esp 2006; 30: 90–2.
- Sharma VK, Achar A, Ramam M, Singh MK. Multiple cutaneous horns overlying lichen planus hypertrophicus. Br J Dermatol 2001; 144: 424–5.
- Gayen T, Das A, Shome K, Bandyopadhyay D. Co-localization of lichen planus hypertrophicus and epidermal inclusion cyst: an incident unreported hitherto. Indian J Dermatol 2015; 60: 503–5.
- Pedraz J, Campos-Muñoz L, Conde-Taboada A et al. Familial eruptive generalized lichen planus in a pediatric patient. J Dermatol 2010; 37: 910–12.
- Ott H, Frank J, Poblete-Gutiérrez P. Eruptive lichen planus in a child. Pediatr Dermatol 2007; 24: 637–9.
- Kabbash C, Laude TA, Weinberg JM, Silverberg NB. Lichen planus in the lines of Blaschko. Pediatr Dermatol 2002; 19: 541–5.
- Adışen E, Onder M, Erdem O, Happle R. Superimposed linear lichen planus in a 4-year-old girl. Int J Dermatol 2014; 53: e541–2.
- Joshi RK, Antukorala, Abanmi A, Awadi TA. Lichen planus pemphigoides. Is it a separate entity? Br J Dermatol 1994; 130: 537–8.
- Kaposi M. Lichen ruber pemphigoides. Arch Derm Syphilol 1892; 24: 343–6.
- Kumar P, Savant SS, Das A et al. lichen planus pemphigoides presenting preferentially over preexisting scars: a rare instance of isotopic phenomenon. Indian J Dermatol 2015; 60: 596–9.
- Cohen DM, Ben-Amitai D, Feinmesser M, Zvulunov A. Childhood lichen planus pemphigoides: A case report and review of the literature. Pediatr Dermatol 2009; 26: 569–74.
- Davis AL, Bhogal BS, Whitehead P et al. Lichen planus pemphigoides: Its relationship to bullous pemphigoid. Br J Dermatol 1991; 125: 263–71.
- Sakuma-Oyama Y, Powell AM, Albert S et al. Lichen planus pemphigoides evolving into pemphigoid nodularis. Clin Exp Dermatol 2003; 28: 613–16.
- Hsu S, Ghohestani RF, Uitto J. Lichen planus pemphigoides with IgG autoantibodies to the 180 kd bullous pemphigoid antigen (type XVII collagen). J Am Acad Dermatol 2000; 42: 136–41.
- İlknur T, Akarsu S, Uzun S et al. Heterogeneous disease: a child case of lichen planus pemphigoides triggered by varicella. J Dermatol 2011; 38: 707–10.
- Flageul B, Hassan F, Pinquier L et al. [Lichen pemphigoid associated with developing hepatitis B in a child]. Ann Dermatol Venereol 1999; 126: 604–7.
- Goldscheider I, Herzinger T, Varga R et al. Childhood lichen planus pemphigoides: report of two cases treated successfully with systemic glucocorticoids and dapsone. Pediatr Dermatol 2014; 31: 751–3.
- Rosmaninho A, Sanches M, Oliveira A et al. Lichen planus pemphigoides induced by a weight reduction drug. Cutan Ocul Toxicol 2011; 30: 306–8.
- Chan LS, Vanderlugt CJ, Hashimoto T et al. Epitope spreading: Lessons from autoimmune skin diseases. J Invest Dermatol 1998; 110: 103–9.
- Duong B, Marks S, Sami N, Theos A. Lichen planus pemphigoides in a 2-year-old girl: response to treatment with methotrexate. Am Acad Dermatol 2012; 67: e154–6.
- Prost C, Tesserand F, Laroche L et al. Lichen planus pemphigoides: an immuno-electron microscopy study. Br J Dermatol 1985; 113: 31–6.
- Helm TN, Camisa C, Liu AY et al. Lichen planus associated with neoplasia: a cell-mediated immune response to tumor antigens? J Am Acad Dermatol 1994; 30: 219–24.
- Bhutani LK, Bedi TR, Pandhi RK, Nayak NC. Lichen planus pigmentosus. Dermatologica 1974; 149: 43–50.
- Kanwar AJ, Dogra S, Handa S et al. A study of 124 Indian patients with lichen planus pigmentosus. Clin Exp Dermatol 2003; 28: 481–5.
- Vineet R, Sumit S, K GV, Nita K. Lichen planus pigmentosus in linear and zosteriform pattern along the lines of Blaschko. Dermatol Online J 2015; 21.
- Verma P, Pandhi D. Topical tacrolimus and oral dapsone combination regimen in lichen planus pigmentosus. Skinmed 2015; 13: 351–4.
- Lee MD, Schwartz LR. Inverse lichen planus. Skinmed 2013; 11: 355–6.
- Gupta C, Sinha S, Sahoo B, Garg VK. Erythroderma secondary to lichen planus in a child. Indian J Dermatol Venereol Leprol 2016; 82: 89–91.
- Van der Horst JC, Cirkel PKS, Nieboer C. Mixed lichen planus-lupus erythematosus disease: a distinct entity? Clinical, histopathological and immunopathological studies in six patients. Clin Exp Dermatol 1983; 8: 631–40.
- Johnson ML, Farmer ER. Graft-versus-host reactions in dermatology. J Am Acad Dermatol 1998:; 38: 369–92.
- Rao R, Shenoi SD. Indirect immunofluorescence to demonstrate lichen planus specific antigen (LPSA) in lichen planus. Indian J Dermatol Venereol Leprol 2006; 72: 350–2.
