Standard of Care

From Standard of Care

A chronic inflammatory mucocutaneous disease that affects the skin, tongue, and oral mucosa.

Women account for 60-75% of patients with oral LP and 50% with cutaneous LP.

Mean age at diagnosis. Between 50-60 years for oral disease and 40-45 years for cutaneous disease.

Less than 5% of cases involve children.

Manifests as papules, or rashes.

Skin involvement characterized by violaceous papules, which may have associated itching.

Cutaneous form generally heals within one year.

Long-standing skin involvement may cause hyperpigmentation, especially in dark skinned individuals.

Oral lesions characterized by white lace like pattern, but may be associated with plaques, papules, erosions, erythematous lesions.

Oral involvement is chronic and when associated with erosive lesions may be painful.

The skin and oral mucosa are the most frequent sites of involvement.

Other mucous membranes including genitalia, esophagus, and conjunctiva may be involved, as may skin appendages such as scalp, hair, and nails can be affected.

One or multiple areas of involvement can be present, concomitantly or sequentially.

Sometimes associated with certain medications and diseases, but is basically of unknown cause.

The mean age of onset around 50 years, and lichenoid drug eruption median age at onset is around 60 years.

Prevalence of cutaneous LP among men is 0.3% and prevalence of oral LP is 1.5%, while respective prevalence is among women is 0.1% and 2.3% from Swedish data (Hellgren L McCartan BE).

In a study of patients who presented with oral lesions prior or current cutaneous involvement, was present in 16% and genital disease in 19%, and in rare involvement of other sites (Eisen D).

Characterized by fine white reticulated pattern, known as Whickham striae.

Idiopathic LP associated with monomorphic, violaceous, shiny papules and plaques, with a fine reticulated pattern of white scale.

Mucous membranes, anterior lower legs and wrists are often affected.

Anogenital involvement clinically similar to cutaneous and oral forms of disease.

Erosive mucosal disease may lead to fibrosis with secondary complications including scarring of nails, scalp, vulva, vaginal stenosis, phimosis, and esophageal strictures.

Associated with lymphocytic infiltrate at the epidermal-dermal junction, damage to the basal layer, colloid bodies,and irregular rete ridges.

Associated with hepatitis C infection.

Commonly associated with Ace inhibitors, thiazides beta blockers, gold salts, antimalarial drugs, and penicillamine.

Lichenoid drug eruption has a latency period of weeks to years, and medications likely alter epidermal proteins acting as haptens inducing an immune response.

Lichenoid drug eruption is more polymorphic, and may be more eczematous and scaly than idiopathic variant.

Lichenoid drug eruptionmay have more atypical distribution of lesions than idiopathic LP.

Spontaneous resolution usually occurs within a few weeks of discontinuing associated medications, but it may last as long as 2 to 3 months.

In cases where lesions persist despite treatment, biopsy should be done to rule out displays your or squamous cell carcinoma that may be associated with LP.

1% incidence of squamous cell carcinoma among patients with LP.

Topical corticosteroids primary treatment for oral and cutaneous lesions, and oral corticosteroids reserved for extensive disease requiring symptomatic improvement.

Retinoid acitretin is first line nonsteroidal oral therapy.