![Fungal infections of skin [compatibility mode]](https://cdn.slidesharecdn.com/ss_thumbnails/fungalinfectionsofskincompatibilitymode-130321223403-phpapp01-thumbnail.jpg?width=560&fit=bounds)
More Related Content
What's hot (20)
Similar to Lichen planus (20)
Recently uploaded (20)
Lichen planus
- 1. LICHEN PLANUS By- Dr. Shweta Khushalani ( JR-1, Dept. Skin & V.D.)
- 2. Introduction Idiopathic, chronic, inflammatory disease that affects the skin, mucous membranes and appendages. History Leichen = tree moss Planus = flat Lichen planus = Eramus Wilson,1869 Wickhams striae = Wickham, 1895
- 3. Epidemiology 0.1% - 4% > 45 years of age Women > men Child : 1-4% of cases of LP; family history significant.
- 4. Etiopathogenesis Unknown, ?AUTOIMMUNE ETIOLOGY : Idiopathic. Drugs. Infections & vaccination. Associated with autoimmune disorders. Contact allergens Mechanical trauma Genetic association : HLA- A3, BW35, B8, B16, DR1, DQW1
- 5. Drugs Heavy metals Antimalarials Antibiotics AKT Diuretics Antihypertensives Anticonvulsant NSAIDS Oral hypoglycemics Antihistaminics Lipid lowering agents Miscellaneous Autoimmune disorders Ulcerative collitis Type 2 DM Myasthenia gravis Lupus erythematous Alopecia aerata Infections & vaccination Hepatitis B & C Influenza MMR DPT
- 6. Antigen specific & nonspecific killing by t- lymphocytes ( both helper & supressor cells) Th17 play imporatnt role, secrete IL-17 IL-17 upregulate and/or synergize with local inflammatory mediators and extracellular matrix injury by MMP (matrix metallo- protienases) Other cytokines- TNF-alpha, Nuclear factor-Kbeta dependent cytokines IFN-gamma IL-1alpha, IL-6, IL-8
- 7. Clinical features Extremely pruritic Flat topped Polygonal Violaceous papules or plaques 3-15mm in diameter Wickhams striae delicate, radiating, white scales Focal thickening of granular layer Positive Koebners phenomenon
- 8. Sites : Flexors surfaces of forearm & wrist, dorsal surface of hands Anterior aspect of lower legs, neck, lower back. Heal with hyperpigmentation.
- 9. Histology
- 10. Lichen Planus Verrucosus K/a Hypertrophic LP Extremely pruritic Hyperkeratotic plaques on the shin and ankles Can transform into metastatic squamous cell carcinoma (esp. distal extremeties)
- 11. Atrophic Lichen Planus Lower limbs Violaceous papules and plaques with depressed and atropic center Usually occurs after resolution of typical LP & Accentuate by potent topical steroids
- 13. Annular LP Glans & trunk Typical violaceous papules, in a ring like fashion Central clearing leaving behind active raised border Variant : AALP ( Annular Atrophic LP) Small violaceous papules Slowly grow peripherally Center:atrophic and hyperpigmented Peripherally raised Trunk, limbs
- 14. Linear LP Spontaneous Linear along Lines of Blaschko children > adults Rarely, occur at the site of healed herpes zoster scar
- 15. Bullous LP Blisters within the papules Liquefactive degeneration of the basal layer of epidermis, l/t sub epidermal blisters, MAX JOSEPH SPACES Extremities, shin (97%) > upper limbs > thigh Chronic course Family history present
- 17. LP Pemphigoides Blisters on LP lesions + non affected skin Distal limbs Histology Direct Immunofluorescence Deposition of IgG & C3 at BMZ
- 19. Actinic LP Summer months Sun exposed areas, forehead and face, dorsal surface of hands and neck Blue, brownish plaque, annular hypopigmented border with central atrophy Young adults & children NO PRURITIS NO KOEBNERIZATION
- 20. LP Pigmentosus Slate grey to brownish- black macules sun exposed areas & flexural folds Types Diffuse (most common) Blotchy Reticular Perifollicular
- 21. Lichen Planopilaris a/k/a Follicular LP Chronic lymphocytic inflammation around the upper portion of hair follicle Irregular patchy loss of hair, with loss of follicular ostia. Multifocal, patchy > diffuse Perifollicular erythema and scaling + on periphery of the lesion Disease activity, periphery>center of the alopecia patch Pruritis with dysesthesia Site frontocentral scalp & crown
- 22. 50% a/w typical LP lesions over non-follicular skin, nail, mucous membrane
- 24. Erosive LP Mucosal surface Oral cavity or genitalia Erosions on the surface of papular lesions Aggressive form of LP Eruptive LP A/k/a acute or exanthematous LP Disseminated form Trunk, dorsum of feet & wrist Self-limiting Heal in 3-9months with hyperpigmentation.
- 25. Nail LP 10% Finger nails>toe nails Adults ( 50-60 years ) In pediatric age , nail LP>skin LP Chronic course 3 presentations Typical Nail LP Twenty Nail Dystrophy (trachyonychia) Idiopathic Atrophy of Nails
- 26. TYPICAL NAIL LP diffuse nail ridging splitting dorsal pterygium TWENTY NAIL DYSTROPHY Excessive longitudnal ridging l/t nail roughness Beningn condition No nail scarring One to several nails affected IDIOPATHIC ATROPHY OF THE NAIL acute & rapid, painless, destruction of the nail OTHERS Yellow nail syndrome like changes Nail bed erosions Pigmentary changes : longitudnal melanonychia, longitudnal erythronychia
- 28. TYPICAL NAIL LP diffuse nail ridging splitting dorsal pterygium TWENTY NAIL DYSTROPHY Excessive longitudnal ridging l/t nail roughness Beningn condition No nail scarring One to several nails affected IDIOPATHIC ATROPHY OF THE NAIL acute & rapid, painless, destruction of the nail OTHERS Yellow nail syndrome like changes Nail bed erosions Pigmentary changes : longitudnal melanonychia, longitudnal erythronychia
- 30. TYPICAL NAIL LP diffuse nail ridging splitting dorsal pterygium TWENTY NAIL DYSTROPHY Excessive longitudnal ridging l/t nail roughness Beningn condition No nail scarring One to several nails affected IDIOPATHIC ATROPHY OF THE NAIL acute & rapid, painless, destruction of the nail OTHERS Yellow nail syndrome like changes Nail bed erosions Pigmentary changes : longitudnal melanonychia, longitudnal erythronychia
- 32. Palmoplantar LP Rare Highly pruritic, erythematous, scaly plaque with/out plamoplantar keratoderma Internal plantar arch & hands (NO FINGERTIPS) Young adults (20-40 years age)
- 33. Oral LP In 70-77% of cutaneous disease 25% present with oral LP Middle age (40-70 years), women 6 types (ANDREASEN CLASSIFICATION) RETICULAR PLAQUE-LIKE PAPULAR EROSIVE ATROPHIC BULLOUS Lateral margins of tongue, gingiva, lips and hard palate Chronic course STRESS, SPICY & ACIDIC FOOD- flare up Association with HCV infection Risk of malignant transformation in 0.4-1.5%
- 34. RETICULAR LP Most common Asymptomatic Irregular patchy, plaque with white streaks in a lacy pattern posterior buccal mucosa Bilateral EROSIVE ORAL LP Large, erythematous, well defines erosions on buccal mucosa with/out pseudomembrane Buccal mucosa, Dorsum & lateral borders of tongue, gingiva ATROPHIC LP Gingiva Irritaion following eating & brushing
- 36. Genital LP 25% cases with skin LP Males Shaft of penis, glans penis, prepuce, scrotum ANNNULAR LP (most common presentation)
- 37. Female Vulval and vaginal Vulval : on introitus, white lacy, reticular borders extending into vagina Dyspareunia a/w pruritis and pain Loss of normal architecture and scarring on healing VVG (VULVO-VAGINAL-GINGIVAL) SYNDROME Erosive lesions a/w HLA-DQB1*0201 allele
- 38. Esophageal LP Rare Middle age, women, with oral LP c/o dysphagia, odynophagia, or both Endoscopy Strictures & malignant transformation to Squamous cell carcinoma common
- 39. Complications Hyperpigmentation NAIL LP : dystrophy of nail, anonychia LPP SCALP : scarring alopecia GENERALISED LP : erythroderma ULCERATIVE LP ON FEET : deformity HYPERTROPHIC & MUCOSAL LP : malignant transformation
- 40. Treatment FIRST LINE Topical corticosteroids First generation antihistaminics (hydroxyzine / chloprpheniramine) Intra-lesional steroids (hypertrophic , nail & erosive LP) Immunomodulator (tacrolimus, pacrolimus) Topical minoxidil (LPP)
- 41. SECOND LINE Systemic corticosteroids (oral or IM) Oral prednisolone : 0.5-1mg/kg/day for 4-6 weeks Oral mini pulse with betamethsone IM inj. Of Triamcinolone :40-80mg, every 6-8 weeks Phototherapy NB-UVB PUVA Extracorporeal photopheresis, in recalcitrant & severe erosive LP
- 42. THIRD LINE Immunosupressive agents : azathioprine, Methotrexate ( 10-15mg/week, severe erosive & generalised LP) Cyclophosphamide Cyclosporine (severe resistant cutaneous LP & LPP) Mycophenolate mofetil Hydroxychloroquine : LPP Others Dapsone IFN-alpha Isotretenion Thalidomide sulfasalazine
- 43. MUCOSAL LP First line : Topical steroids Intralesional steroids used in localised ulcerative LP Local phototherapy : NB-UVB and PUVA excimer 308 nm laser with ECP in recalcitrant oral LP Second line : Systemic corticosteroids , short term Hydroxycholoroquine
- 44. THANKYOU