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Lichen Planus(Lichen Ruber)

Lichen Planus(Lichen Ruber). Professor W K Jacyk. Lichen Planus. Flat topped papules, red-violet Location : most often volar aspect of the wrists and anterior aspect of the legs Localised or generalised Koebner phenomenon- typical lesions develop along the lines of scratching .

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Lichen Planus(Lichen Ruber)

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  1. Lichen Planus(Lichen Ruber) Professor W K Jacyk

  2. Lichen Planus • Flat topped papules, red-violet • Location : most often volar aspect of the wrists and anterior aspect of the legs • Localised or generalised • Koebner phenomenon- typical lesions develop along the lines of scratching

  3. Lichen Planus • Affects skin, oral, genital mucosa, nails • Skin lesions are pruritic • Nail changes are variable-from delicate to complete destruction

  4. Fairly common • Blacks more often than whites • Clinical variability • Classic • Hypertrophic, verrucous • Follicular • Bullous • Course: self limiting but may last several months

  5. Aetiology • Triggers • Certain medications • Viral hepatitis B, C • Other liver diseases • Immunological reaction (cell mediated )to some epidermal antigen, so far not identified • Characteristic histology

  6. Treatment • Milder cases-topical corticosteroids -topical calcineurin inhibitors -PUVA • Severe – sytemic corticosteroids -cyclophosphamide -cyclosporin

  7. Lichenoid drug eruptions • Common • Many medications cause this type of skin lesions • Antimalarials- chloroquine • Antituberculous –isoniazid • Antihypertensives- thiazides, methyldopa, SACE • Gold • D-penicllamine • Lithium

  8. Pityriasis Rosea • Common • Young adults • Seasonal? • Characteristic course • Herald (mother patch) 7-10 days later secondary eruption, waist to neck, usually profuse • Lasts few weeks • Spontaneous resolution • Pruritic • Aetiology –HHV 7

  9. Management • Explain- self limiting, non-infectious, not a sign of internal disease, usually only once in life • Treat only when very pruritic • Topical corticosteroid preparations • Sunlight or artificial UVB • Short course of oral corticosteroids • Sedative antihistaminics

  10. Risk of misdiagnosis • Tinea- herald patch • Syphillis • psoriasis

  11. Seborrhoeic dermatitis-Adult form • “Seborrhoeic” a historical name • Disease is unrelated to the sebaceous glands • Lesions mainly face, scalp, presternal area(in man), folds(axillae, groins, submammary) • Most common in adult males • Role of Pityrosporum yeasts • Common in infection with HIV and HTLV-1

  12. Treatment • Courses of imidazoles- ketoconazole, itraconazole • Courses of antibiotics • Topical steroids

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