Contents

Chapter  1. Pathogenesis of lichen planus 1 Seasonal variation  16

Aparna palit, arun c inamadar Familial predilection  16
Etiological factors  1 Clinical presentations  16
Genetic predisposition  1 Primary lesion  16
Infections 2 Acute generalized (guttate or eruptive)
Vaccination 2 pattern 16
Drugs and chemicals  2 Acute and subacute pattern with
Mechanical trauma  2 confluence of lesions  16
Physical factors  3 Chronic localized pattern  16
Oxidative stress  3 Koebner phenomenon in
Psychological stress  3 lichen planus  21
Autoimmunity 3 Variants of lichen planus  21
Immunopathogenesis 3 Configurational variants  21
Lp-specific antigen recognition  3 Morphologic variants  25
Cytotoxic t cell activation  3 Distributional variants  32
Keratinocyte apoptosis  5 Lichen planus at special sites  32
Other mechanisms possibly operative Infrequent variants  36
in the pathogenesis of lp 6 Post-inflammatory effects  38
Immunopathogenesis of olp 6 Chapter  4. Lichen planus in children 44
Oral lichenoid reaction due to Amrinder j kanwar, dipankar de
amalgam 7 Epidemiology   44
Chapter  2. Autoimmune and other associations Pathogenesis 44
of lichen planus 10 Clinical features  45
Vidya kharkar Diagnosis 48
Hcv infection, primary biliary cirrhosis, Treatment 48
chronic active hepatitis and lichen Chapter  5. Lichen planus pigmentosus 50
planus 10 Pooja pahwa
Thymoma and lichen planus  11 Epidemiology   44
Autoimmune thyroid disease and Pathogenesis 44
lichen planus  11 Clinical features  45
Multiple autoimmune diseases and Diagnosis 48
lichen planus  11 Treatment 48
Vitiligo, psoriasis and lichen planus  11 Histopathology 53
Erosive lichen planus of the vulva and Differential diagnosis  53
autoimmune disease  11 Prognosis and treatment  55
Paraneoplastic pemphigus and Chapter  6. Lichen planopilaris 57
lichen planus  12 T narayana rao, lakshmi sowjanya
Other associations  12
Etiology and pathogenesis  57
Chapter  3. Clinical features of lichen planus 15 Clinical features  58
Shekhar s haldar, uday khopkar Classic lichen planopilaris  58
Terminology 15 Graham-little-piccardi-lassueur
Historical aspects  15 syndrome 62
Epidemiology 15 Frontal fibrosing alopecia  63
Patient profile  15 Diagnosis 63
x  Lichen planus

Dermoscopy 64 Other mediators of inflammation  99

Histopathology 64 Clinical features  99
Confocal microscopy  64 Scoring system for oral
Differential diagnosis  64 lichen planus  106
Management 65 Work up  106
Lichen planopilaris activity index  65 Histopathology 106
Treatment 65 Immunofluorescence 108
Chapter  7. Lichen planus pemphigoides 69 Treatment 109
Atul dongre, uday khopkar
Corticosteroids 109
Antifungal agents  111
Pathogenesis 69
Calcineurin inhibitors  111
Clinical features  70
Retinoids 111
Histopathology 70
Immunosuppressants and
Immunofluorescence 70
immunomodulators 111
Differential diagnosis  70
Physical treatment modalities  112
Prognosis and management   73
Surgery 112
Chapter  8. Palmoplantar lichen planus 74
Chapter  11. Vulvar lichen planus 116
Rameshwar gutte, uday khopkar
Nina madnani
Clinical variants   74
Clinical features  116
Diagnosis 80
Erosive 116
Malignant change in pplp 82
White reticulate pattern  116
Treatment 82
Papulosquamous 120
Chapter  9. Nail lichen planus 84 Hypertrophic 120
Shekhar s haldar, uday khopkar Diagnosis   120
Epidemiology 84 Histopathology 120
Clinical presentation  84 Differential diagnosis  120
Histopathological features  91 Prognosis 121
Differential diagnosis  95 Therapy 121
Nail psoriasis  95
Chapter  12. Histopathology of lichen planus
Trachyonychia (twenty nail
and its variants 123
dystrophy) 95
Bhavana S doshi, uday khopkar
Yellow nail syndrome  95
Indications for a skin or mucosal
Bowen’s disease of the nail bed  95
biopsy in lichen planus  123
Pterygium 95
Histopathology of lichen planus  123
Treatment 95
Classic lichen planus  124
Chapter  10. Oral lichen planus 97 Eruptive lichen planus  126
Prasanthi g, anandan s Micropapular lichen planus  126
Etiology 97 Vesicular lichen planus  126
Trauma 97 Actinic lichen planus  129
Infections 97 Atrophic lichen planus  129
Stress 97 Hypertrophic lichen planus  129
Genetics 97 Erosive or ulcerative lichen planus  129
Foods 98 Lichen planopilaris  131
Pathogenesis 98 Lichen planus pigmentosus  135
Autoimmunity 98 Oral lichen planus  135
Role of apc and cd4+ t cells  98 Genital lichen planus  135
Role of cd8+ t cells  98 Nail lichen planus  138
Keratinocyte apoptosis by cd8+ cells  98 Palmoplantar lichen planus  138
Role of the epidermal basement Lichen planus pemphigoides  138
membrane 98 Post-inflammatory hyperpigmentation
Lymphocyte homing mechanism  98 following lichen planus  141
 Contents  xi
Histopathologic differential diagnosis of Lichen planus pigmentosus  178
lichen planus  141 Nail lichen planus  180
Lichenoid drug eruption  141 Bullous lichen planus  181
Lichenoid keratosis  141 Chapter  15. Lichenoid drug eruptions 183
Lichen planus-lupus erythematosus Bhushan madke, chitra nayak
(le-lp) overlap  142
Epidemiology 183
Lichenoid contact dermatitis  142 Pathogenesis 183
Pityriasis lichenoides chronica  142 Clinical features  183
Lichen nitidus  142 Drugs causing lichenoid drug
Lichen striatus  143 eruptions 187
Lichen sclerosus et atrophicus  143 Histopathology 187
Lichenoid purpura  143 Diagnosis 188
Mycosis fungoides  143 Treatment 190
Graft versus host disease (gvhd) 145
Chapter  16. Lichen planus and malignancy 193
Immunohistochemistry in
Saumya panda
lichen planus  145
Malignant transformation of cutaneous
Special stains in lichen planus  145
lichen planus  193
Indirect immunofluorescence in
Cutaneous lichen planus to squamous
lichen planus  146
cell carcinoma  193
Clinicopathologic correlation  146
Cutaneous lichen planus to basal cell
Chapter  13. Dermoscopy of lichen planus 148 carcinoma 193
Shekhar s haldar, uday khopkar Malignant transformation of oral lichen
Dermoscopic signs in lichen planus  148 planus 194
Patterns seen in an active lesion   148 Lichenoid dysplasia and oral lichen
Patterns seen in a subsiding lesion   154 planus 195
Histopathological correlation  157 Is oral lichen planus intrinsically
Vascular structures  157 precancerous? 195
Nonvascular structures  157 Criteria of premalignancy in oral lichen
Dermoscopy of variants of planus 196
lichen planus  157 Role of external cofactors  197
Hypertrophic lichen planus  157 Identification of patients with oral lichen planus
lichen planopilaris  159
A
at risk of malignant transformation  197
Lichen planus pigmentosus  159 Risk attenuation of oral squamous cell
carcinoma in oral lichen planus  198
Dermoscopic differential diagnosis of
Lichen planus as a paraneoplastic
lichen planus  159
disorder 198
Chronic plaque psoriasis  159
Immunopathogenesis of malignant
Lichenoid drug eruption  159
transformation of oral and cutaneous
Lichen nitidus 159
lichen planus  199
Chapter  14. Lichen planus: differential Lichen planus/oral lichen planus and graft
diagnosis 163 vs host disease (gvhd): implications
Seetharam kolalapudi for immunopathogenesis 199
Eruptive lichen planus  163 Chapter  17. Local therapy of lichen planus 204
Annular lichen planus  166 Abir saraswat
Actinic lichen planus  166 Local therapy of cutaneous
Atrophic lichen planus  168 lichen planus  204
Hypertrophic lichen planus  169 Antipruritic agents  204
Palmoplantar lichen planus  170 Topical corticosteroids  204
Linear lichen planus  170 Topical calcineurin inhibitors  205
Lichen planopilaris  172 Other agents  205
Oral lichen planus  175 Topical therapy of mucosal
Genital lichen planus  177 lichen planus  205
xii  Lichen planus

Symptomatic treatments  205 Localized lichen planus  216

Corticosteroids 205 Hypertrophic lichen planus  216
Calcineurin inhibitors  206 Lichen planus actinicus  216
Miscellaneous agents  206 Lichen planus pigmentosus  216
Intralesional corticosteroid injections   206 Erythema dyschromicum perstans  216
Intralesional immunotherapy  207
Follicular and/or nail
Chapter  18. Systemic treatment of lichen planus 210 lichen planus  216
Kabir sardana, khushbu goel
Chapter  19. Light therapy in lichen planus 220
Drugs used for cutaneous lichen planus  210
Reena rai, cr srinivas
Retinoids 211
Photochemotherapy and phototherapy  211 Mechanism of action of phototherapy  220
Corticosteroids 212 Cutaneous lichen planus  220
Enoxaparin sodium Psoralen with uva (puva) therapy  220
(low-molecular-weight heparin)  214 Nb-uvb therapy  221
Immunosuppressives 214 Uva1 therapy  221
Biologicals 214 Oral lichen planus  221
Miscellaneous therapies  215
Type specific treatment plans   215
Generalized lichen planus  215 Index 223