YULIA FARIDA YAHYA Dept of dermatology-Venereology Medical Faculty of University of Sriwijaya General Hospital M Hoesin - Palembang

Greel leichen, tree moss; latin planus flat unique Common inflammatory disorder affects the skin, mucous membranes, nails, hair The appearance distinctive color & morphologylichenoid papules Characterize LP4 Ps purple, polygonal, pruritic, papule

Incidence &prevalence LP unknown Overall prevalence<1% general population, estimates 0,14 0,80%0,44% in USA No racial predilection, no sexual predilection Occur 30 60 years of age usually affected 50-60 years of age, < age Less common in very young & elderly Development LP affected by seasonal & enviromental factors

Immunologic mechanism almost mediate development LP The major role in trigger Cell mediated immunity CD4 & CD8 in lesional skin LP Thr inflammatory process apoptosis The epithelial lymphocyte interaction divided 3 mayor stages - antigen recognition - lymphocyte activation - keratocyte apoptosis

Distributed lesionsymmtricaly & bilateral over the extremities Involved flexural areas wrists, arms, legs, thighs, lower back, trunk, neck Oral mucous membrnes , genitalia Symptomatic pruritic, some patients asymptomatic oral LP Isomorphc response (Koebner phenomenon)(+) Usually Heal hyperpigmentation

 Classic cutaneous lesion faintly erythematous violeceous, flattopped, polygonal papule, central umbilication Papule are grouped tend to coalesce A thin transparent, adhere scale discerned a top the lesion Fine whitish , puncta or reticulated networks Wickham striae present the surface of many well-developed papules magnifying lens or dermatoscope

Generalized LP smal flat topped violeceous papules, some grouped, some disseminated becoming confluent on the trunk

LP, linear pattern with Koebner response adjacent to clustered papules on the flexural wrist

Mucosal LP a typical lace-like whitis reticulated pattern of oral lesion buccal mucosa

Mucosal LP erosive ginggivitis LP manifest as painful erosions on the ginggiva

LP on the penis agminate pattern lesions involving the glans, sulcus & meatus on the penis (not seen)

Hypertropic LP in pretibial region lesion are nodular & very dark with violaceus sheen LP become hyperkeratotic

LP like or lichenoid eruption group of cutaneous reactions identical or similar LP LP drug eruption reported after ingestion, contact or inhalation certain chemical Typical or atypical classic LP localized or generalized eczematous papules & plaque & variable desquamation Manifestation post inflammatory hyperpigmentation, alopecia, Wickham striae (-) Mucuos membrane involvement less common often associated specific drugs & chemicals