Lichen Planus
Lichen planus (LP) is a chronic inflammatory skin disease mediated by skin-infiltrating T cells with autoaggressive potential. Viruses, drugs, and contact allergens constitute environmental factors that can trigger the onset of LP Memory T cells generated
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Lichen Planus Tetsuo Shiohara, Yoshiko Mizukawa, and Yoko Kano
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Lichen planus (LP) is a chronic inflammatory skin disease mediated by skin-infiltrating T cells with autoaggressive potential. Viruses, drugs, and contact allergens constitute environmental factors that can trigger the onset of LP. Memory T cells generated by a previously encountered virus could be cross-reactive with drugs, contact allergens, or alloantigens, and they are activated upon the recognition of these cross-reactive antigens to cause immunopathology. Treatment strategies of LP depend on avoidance of these environmental factors and modulation of the immune response so as to interfere with the function of skin-infiltrating T cells. The standard therapies for LP include topical and systemic corticosteroids, retinoids, antimicrobials and psoralen, and ultraviolet A. Oral ciclosporin and topical tacrolimus are safe and effective treatments for recalcitrant LP. Although biologics such as alefacept and efalizumab offer interesting novel alternative treatments, a prospective study with long-term follow-up is needed to evaluate the efficacy and safety.
Lichen planus (LP) is a chronic inflammatory skin disease that frequently involves mucous membranes and is characterized by an autoimmune attack on the epidermis by skin-infiltrating T cells. It affects 0.22–1% of the adult population with no gender predilection, although some studies found a predilection for women. The onset of LP occurs most commonly in middleaged to elderly individuals [1]. The hallmark of LP is the presence of pruritic, flat-topped, polygonal, violaceous papules that favor the extremities. Histologically, a dense, band-like lymphocytic infiltrate is seen underlying an acantholytic epidermis with basal cell damage and hypergranulosis. Lichenoid eruptions represent a heterogeneous group of conditions that resemble idiopathic LP, clinically and histologically. Although the cause of LP remains obscure, progress has been made in understanding the environmental factors, such as viral infections and drugs that trigger onset of the clinical disease. Thus, the presence of these factors should not be overlooked in the treatment of LP. As a consequence, treatment strategies depend primarily on avoidance of these environmental factors and modulation of the immune response so as to interfere with the function of skin-infiltrating T cells. In this review, we emphasize: (a) clinical features, (b) pathogenesis, and (c) treatment and treatment-related complications.
3.3.1 Clinical Features
T. Shiohara () Department of Dermatology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan e-mail: [email protected]
It is generally accepted that LP presents in varying forms, and these include annular, atrophic, bullous, erosive, hypertrophic, and linear. The nails and mucous membranes, such as oral mucosa, are also affected in 10 and up to 75% of patients with cutaneous LP, respectively [1]
T. Krieg et al. (eds.), Therapy of Skin Disea
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