Case 73 - Discussion

Uploaded: 2007-11-30, Updated: 2007-11-30


Lichen Planus

  • Clinical: most likely a cell-mediated immune response of unknown origin. An association is noted with hepatitis C virus infection, chronic active hepatitis, and primary biliary cirrhosis.

  • Location: most commonly found on the flexor surfaces of the upper extremities, on the genitalia, and on the mucous membranes.

  • Gross: A pruritic, papular eruption, violaceous color, shiny, polygonal shape. Varying in size from 1 mm to greater than 1 cm in diameter. They can be discrete or arranged in groups of lines or circles. Characteristic fine, white lines, called Wickham stria, are often found on the papules. Several clinical presentations: actinic, annular, atrophic, erosive, follicular, hypertrophic, linear, pigmented, and vesicular/bullous.

  • Histology

    • Epidermis: hyperkeratotic, irregular acanthosis and focal thickening in the granular layer;

    • Lower epidermis: degenerative keratinocytes, known as colloid or Civatte bodies;

    • Basement membrane zone: linear or shaggy deposits of fibrin and fibrinogen and liquefaction;

    • Upper dermis: a band-like infiltrate of lymphocytes and histiocytes with many Langerhans cells. The infiltrate is very close to the epidermis and often disrupts the dermal-epidermal junction

Superficial and Deep Inflammation of the Skin (8Ls+DRUGS)

  • Light reaction;

  • Lymphoma;

  • Leprosy;

  • Lues;

  • Lichen stratus;

  • Lupus erythematosus;

  • Lipidica (Necrobiosis);

  • Lepidoptera (and other arthropods)

  • Dermatophyte

  • Reticular erythmatous mucinosis;

  • Urticarial stages (BP);

  • Gyrate erythemas;

  • Scleroderma;

  • Drug reactions.