Derm: Lichen Planus: Free MSRA Podcast

🧑‍⚕️ FREE MSRA PODCAST – Lichen Planus: Mastering the Purple Pruritic Rash🎯 A deep dive into lichen planus, one of the MSRA’s favourite inflammatory skin conditions—covering core facts, memorable mnemonics, diagnosis, management, and red flags.Key Learning Points🔍 Definition• Lichen planus is a chronic, immune-mediated inflammatory disorder affecting the skin, mucous membranes, hair, and nails.• Classic description: the “6 Ps”—Pruritic, Purple, Polygonal, Planar, Papules, and Plaques.• Wickham striae: fine, white, lacy lines seen on the surface of papules and in the mouth.💡 Causes & Risk Factors• Precise cause unknown, but believed to be T-cell mediated autoimmunity.• Strong associations: Hepatitis C infection (particularly oral LP), certain medications (e.g., NSAIDs, beta-blockers, thiazides), stress, and family history.🧬 Pathophysiology• CD8+ T-cell attack on basal keratinocytes in the skin and mucous membranes• Triggers: drugs, viral infections, genetic susceptibility🩺 Clinical Features• Itchy, purple, flat-topped, polygonal papules—flexor wrists, forearms, shins, lumbar region• Wickham striae: white, lacy lines (esp. in oral or genital mucosa)• Oral/genital ulcers may be painful and chronic• Nail changes: ridging, thinning, pterygium, or loss• Scalp involvement: lichen planopilaris—patchy, permanent hair loss• Post-inflammatory hyperpigmentation is common after lesions heal📌 Mnemonic: The 6 Ps• Pruritic (itchy)• Purple• Polygonal• Planar• Papules• Plaques📝 Differential Diagnoses• Psoriasis• Eczema• Lichenoid drug eruptions• Chronic eczema (simplex)• Oral: Thrush, leukoplakia, oral lichenoid reaction🔬 Diagnosis• Clinical appearance often sufficient• Skin or mucosal biopsy—shows “sawtooth” lymphocytic infiltrate, hypergranulosis, basal cell degeneration• Test for hepatitis C if risk factors or oral involvement💊 Management• Remove any causative drug if identified• First line: potent topical corticosteroids (with or without occlusion)• For oral/genital LP: topical steroids (mouthwashes, pastes), local anaesthetics• Widespread, severe, or resistant disease: systemic corticosteroids, immunosuppressants (azathioprine, mycophenolate), retinoids, phototherapy (UVB/PUVA)• Antihistamines for pruritus• Regular monitoring for oral/genital LP (risk of squamous cell carcinoma)📈 Prognosis• Cutaneous LP is often self-limiting (resolves in 1–2 years), but recurrences may occur• Oral/genital LP: chronic, relapsing course, higher risk of persistent symptoms and malignant change• Watch for post-inflammatory pigmentation, scarring (scalp/nails), or persistent discomfort⚠️ Complications• Malignant transformation (especially oral/genital LP; ~1% lifetime risk—higher with smoking, Hep C)• Scarring, particularly on the scalp (permanent alopecia) or nails• Persistent pain, ulceration, or impaired quality of life📎 More MSRA Revision for Lichen Planus:📝 Revision Notes: https://www.passthemsra.com/topic/lichen-planus-revision-notes/💬 Flashcards: https://www.passthemsra.com/topic/lichen-planus-flashcards/🧠 Accordion Q&A: https://www.passthemsra.com/topic/lichen-planus-accordion-qa-notes/🚀 Rapid Quiz: https://www.passthemsra.com/topic/lichen-planus-rapid-quiz/🧪 Full Quiz: https://www.passthemsra.com/quizzes/lichen-planus/🎓 Dermatology Course: https://www.passthemsra.com/courses/dermatology-for-the-msra/🌐 For the full premium revision toolkit:https://www.passthemsra.com#MSRA #LichenPlanus #Dermatology #MSRARevision #MSRAFlashcards #PassTheMSRA #FreeMSRA #MSRAExam #6Ps #WickhamStriae #SkinRash #OralLichenPlanus