Lichen planus (LP) is a chronic inflammatory autoimmune condition affecting the skin and mucosa, primarily seen in adults aged 30-60, with a prevalence of about 1%. The condition manifests as purple, pruritic papules and can lead to complications like dysphagia and potential cancer risk, especially in high-risk populations. Diagnosis is clinical, and treatment options include topical and systemic therapies, with a variable course of remission and persistence.

1. Lichen Planus (LP)
Prof. Omer Kombali
Consultant of Dermatology & Andrology

2. Definition:
• Lichen planus (LP) is a chronic inflammatory condition affecting
the skin and mucosa.
• Self limiting condition.

3. Who gets
lichen
planus?
Affects approximately 1% of
the population worldwide.
Mostly adults aged between
30 - 60 years
No strong racial predilection.

4. What causes
lichen
planus? A T-cell mediated autoimmune
disorder in which inflammatory
cells attack an unknown protein
within the skin and mucosal
keratinocytes.
Unknown?

5. Contributing
factors:
• Genetic predisposition
• Physical and emotional stress
• Injury to the skin; lichen planus often appears
where the skin has been scratched or after surgery
(koebnerisation)
• Localised skin disease such as herpes zoster
• Systemic viral infection, such as hepatitis C.
• Contact allergy, such as to metal fillings in oral lichen
planus (rare) and colour photographic developers
• Drugs: gold, quinine, quinidine.
• Lichenoid inflammation is also notable in graft-
versus-host disease.
• Vitamin D deficiency may be associated with oral
lichen planus.

6. What is the primary lesion in lichen
planus?
• Skin:
Six Ps of LP:
purple, polygonal, planar,
pruritic papules, and
plaques.
shiny, and reddish-purple.

7. • Mucosa:
Reticulated, lacy, bluish
white, linear lesions
(Wickham striae) are a
hallmark of oral lichen planus,
especially on the buccal
mucosae.

8. What are
the clinical
features of
lichen
planus?
• Cutaneous LP
• Oral LP
• Vulval LP
• Penile LP
• Lichen planopilaris
• Nail LP
• LP pigmentosus
• LP Actinicus
• Lichenoid drug eruption
• Bulous LP & LP pemphigoides

28. Oral LP

36. • Lichen
planopilaris

37. • Lichen planopilaris

38. Penil LP

41. Vulvar LP

42. Bollous LP

43. Bollous LP

44. Bollous LP

45. Bollous LP

46. Actinic LP

47. Actinic LP

48. What are the
complications of
lichen planus?
May resemble squamous cell carcinoma
(hypertrophic LP)
Cancer is more common in smokers, those
with a history of cancer in mucosal sites,
and those who carry sexually acquired and
oncogenichuman papillomavirus.
Oesophageal lichen planus can cause
dysphagia, strictures, and possibly
squamous cell carcinoma.

49. How is lichen planus diagnosed?
CLINICALLY SKIN BIOPSY

50. What is the treatment for lichen planus?
Topical:
Corticosteroids
Calcineurin inhibitors
Tacrolimus & Pimecrolimus
Retinoids
IL steroid injection

51. What is the treatment for
lichen planus?
Systemic:
• Systemic steroids
• Acitretin (Neotigason)
• Hydroxychloroquine
• Methotrexate
• Azathioprine (Imuran)
• Mycophenolate mofetil
• Phototherapy

52. General measures
Avoid soaps and shower gels that
will exacerbate scaling.
Use emollients regularly.

53. What is the outcome for lichen planus?
LP have a chronic remitting and relapsing course.
Cutaneous lesions tend to clear within a couple of years in most people,
but post-inflammatory pigmentation may take years to subside.
Mucosal lichen planus is more likely to persist for a decade or longer.
Scarring alopecia.

54. Thank you