A clinicopathologic study of lichen planus at a tertiary health care centre in south India

Abstract

Background: Lichen planus (LP) is a unique inflammatory papulosquamous disorder that affects the skin, hair, nail and mucous membranes, and is associated with a relapsing and remitting course. Aim: To study the clinicopathological profile in patients diagnosed with LP. Methods: A cross-sectional prospective study of 100 freshly diagnosed cases of LP over a period of 1 year, wherein following patient enrolment, they underwent a thorough clinical evaluation followed by a biopsy, that was carefully studied and evaluated. Results: A male preponderance (60%) was observed. Majority of the patients were in the 21–40 years age group (60%). Pruritus was witnessed in 84% of the patients. The morphological types of cutaneous LP encountered were classical (58.9%), hypertrophic (28.4%), linear (4.2%), lichen planopilaris (LPP) (4.2%), bullous (2.1%) and LP pigmentosus (2.1%). Out of the 42 patients with oral LP, reticulate type was present in 85.7% patients and erosive variant in the remaining 14.3%. Spotted hypergranulosis was a finding seen in 100% of the cutaneous biopsies taken. Hyperkeratosis was identified in 92.6%, pigmentary incontinence in 93.7% and subepidermal band like lymphocytic infiltrate in 92.6%. In none of the patients of LPP were the characteristic microscopic findings identifiable. In oral mucosal biopsies, dysplastic changes were evident in 50% of the participants. Conclusion: LP is a disorder more common in males usually manifesting in the 3rd to 4th decade of life, with the classical type of cutaneous LP and reticular variant of oral LP being most commonly encountered. Dysplastic changes in oral LP demonstrated a value of 50% in our study, a value much higher when compared to previous reports, thus mandating vigilant identification of the same for appropriate patient management.