Lichen Planus (LP) is a chronic inflammatory skin disease that affects the skin, mucous membranes, hair, and nails, characterized by itchy, flat-topped, purple-colored papules with a white lacy pattern (Wickham’s striae).
- Mnemonic: "L.I.C.H.E.N. = Lesions Involve Chronic
Hyperkeratotic Epidermal Nodules"
CAUSES OF LICHEN PLANUS
- Exact Cause Unknown (Idiopathic).
- Autoimmune Reaction (T-cell Mediated).
- Viral Infections (Hepatitis B & C Association).
- Drug-Induced (Tetracyclines, NSAIDs, Antimalarials, Beta-blockers).
- Psychological Stress (May Worsen Condition).
- Mnemonic: "A.V.D.P.S." (Autoimmune, Viral, Drugs,
Psychological, Stress)
CLINICAL FEATURES OF LICHEN
PLANUS
- Intensely Itchy, Violaceous (Purple), Flat-Topped Papules.
- Common on Wrists, Forearms, Ankles, Lower Back.
- Fine White Lacy Streaks on Surface (Wickham’s Striae).
- Koebner’s Phenomenon (New Lesions at Trauma Sites).
- Self-Limiting but May Last Months to Years.
- Mnemonic: "P.I.W.K.S." (Purple, Itchy, Wickham’s Striae,
Koebner’s, Self-Limiting)
VARIANTS OF LICHEN PLANUS
1. Cutaneous (Classic) LP
- Most Common Type – Affects Skin.
- Violaceous Papules, Itchy, Flat-Topped Lesions.
2. Hypertrophic LP
- Thickened, Hyperpigmented, Lichenified Plaques (Mostly on Legs).
- Resembles Chronic Eczema.
3. Erosive/Ulcerative LP
- Painful Ulcers on Skin or Mucosa.
- May Lead to Squamous Cell Carcinoma (SCC).
4. Mucosal LP (Oral & Genital
LP)
- White, Lacy Streaks on Buccal Mucosa (Wickham’s Striae).
- May Cause Burning Sensation While Eating.
5. Nail LP
- Nail Thinning, Longitudinal Streaks, Pterygium Formation.
6. Scalp LP (Lichen Planopilaris)
- Hair Loss (Alopecia), Scalp Itching, Follicular Hyperkeratosis.
- Mnemonic: "C.H.E.M.N.S." (Cutaneous, Hypertrophic,
Erosive, Mucosal, Nail, Scalp LP)
DIFFERENTIAL DIAGNOSIS OF LP
- Psoriasis (Scaly Red Plaques – No Wickham’s Striae).
- Pityriasis Rosea (Herald Patch, Christmas Tree Pattern).
- Discoid Lupus (Scarring Lesions with Photosensitivity).
- Fixed Drug Eruption (Due to Medications – Reappears in Same Area).
- Mnemonic: "P.P.D.F." (Psoriasis, Pityriasis, Discoid
Lupus, Fixed Drug Eruption)
DIAGNOSIS OF LICHEN PLANUS
- Clinical Examination (Based on Skin & Mucosal Features).
- Dermoscopy (Reveals Wickham’s Striae).
- Skin Biopsy (Hyperkeratosis, Basal Cell Degeneration, Sawtooth Pattern).
- Mnemonic: "C.D.S." (Clinical, Dermoscopy, Skin Biopsy)
TREATMENT OF LICHEN PLANUS
1. GENERAL MEASURES
- Avoid Triggers (Drugs, Stress, Trauma).
- Moisturizers for Dry Skin.
- Mnemonic: "A.M." (Avoid Triggers, Moisturizers)
2. MEDICAL TREATMENT
- Topical Steroids (Clobetasol, Betamethasone – 1st Line Treatment).
- Antihistamines (Cetirizine, Hydroxyzine – Reduce Itching).
- Calcineurin Inhibitors (Tacrolimus – For Mucosal LP).
- Oral Steroids (Prednisolone – For Severe LP).
- Dapsone (Used in Ulcerative LP).
- Retinoids (Acitretin – For Hypertrophic LP).
- Mnemonic: "S.A.C.O.D.R." (Steroids, Antihistamines,
Calcineurin, Oral Steroids, Dapsone, Retinoids)
3. ADVANCED TREATMENTS (For
Resistant Cases)
- Phototherapy (Narrowband UVB, PUVA).
- Immunosuppressants (Methotrexate, Azathioprine).
- Mnemonic: "P.I." (Phototherapy, Immunosuppressants)
HOMOEOPATHIC MANAGEMENT OF LICHEN
PLANUS
- For Violaceous, Itchy, Thickened Lesions:
- Sulphur, Arsenicum Album, Graphites, Lycopodium.
- For Hypertrophic LP:
- Thuja, Kali Sulph, Sepia, Silicea.
- For Mucosal LP (Oral & Genital LP):
- Borax, Nitric Acid, Merc Sol, Mezereum.
- For Nail & Scalp LP (Hair Loss & Nail Changes):
- Fluoric Acid, Phosphorus, Natrum Mur.
- Mnemonic: "S.A.G.L." (Sulphur, Arsenicum, Graphites,
Lycopodium for Classic LP)
FINAL REVISION WITH MNEMONICS
- Definition = "L.I.C.H.E.N. = Lesions Involve Chronic Hyperkeratotic Epidermal Nodules"
- Causes = "A.V.D.P.S." (Autoimmune, Viral, Drugs, Psychological, Stress)
- Clinical Features = "P.I.W.K.S." (Purple, Itchy, Wickham’s Striae, Koebner’s, Self-Limiting)
- Variants = "C.H.E.M.N.S." (Cutaneous, Hypertrophic, Erosive, Mucosal, Nail, Scalp LP)
- Differential Diagnosis = "P.P.D.F." (Psoriasis, Pityriasis, Discoid Lupus, Fixed Drug Eruption)
- Diagnosis = "C.D.S." (Clinical, Dermoscopy, Skin Biopsy)
- Treatment = "A.M." (Avoid Triggers, Moisturizers) & "S.A.C.O.D.R." (Steroids, Antihistamines, Calcineurin, Oral Steroids, Dapsone, Retinoids)
- Advanced Treatment = "P.I." (Phototherapy, Immunosuppressants)
- Homeopathy = "S.A.G.L." (Sulphur, Arsenicum, Graphites, Lycopodium for Classic LP)
