When A Patient Presents With Itchy Red Plaques In The Lower Extremities

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Author(s): 
Tracey Vlahovic, DPM, FAPWCA

Keys To Treating Lichen Planus

The oral, skin and nail disease in this case led to the diagnosis clinically. For the aforementioned patient, we utilized systemic corticosteroids (prednisone taper) and injections of triamcinolone acetonide into the proximal nail fold in order to target the matrix.7 I explained to the patient that the nails may be permanently scarred and the oral lesions may remain for years. I referred the patient to an ENT physician for further evaluation of the oral lichen planus.

   Lichen planus can be a frustrating condition to treat as no truly efficient regimen has been described in the literature to date. Cutaneous lichen planus lesions generally have a life span of anywhere from six months to 18 months and have the potential to spontaneously regress. In my clinical experience, the lesions can last up to 24 months and can become a chronic relapsing phenomenon. If the skin eruption is caused by a drug, then the patient should obviously discontinue that medication.

   The first line of treatment for both the nails and the skin is a super-potent topical corticosteroid. Researchers have described the use of intralesional steroids for the nail matrix and pruritic lesions. Systemically, oral prednisone, retinoids (acitretin), griseofulvin and metronidazole have had some success. Finally, phototherapy, such as PUVA or narrowband UVB, has offered some relief in this patient population.8

   Dr. Vlahovic is an Associate Professor at the Temple University School of Medicine. She is a Fellow of the American Professional Wound Care Association and is board certified by the American Board of Podiatric Surgery.

   Dr. Vlahovic pens a bimonthly blog for Podiatry Today. For more info, visit www.podiatrytoday.com/blogs

   For further reading, see “What You Should Know About Lichen Planus” in the June 2007 issue of Podiatry Today.




References:


1. Boyd AS, Neldner KH. Lichen Planus. J Am Acad Dermatol. 1991; 25(4):593-619.
2. James WD, Berger TG, Elston DM. Lichen planus and related conditions. In: Andrews’ Diseases of the Skin: Clinical Dermatology, 10th ed. WB Saunders, Philadelphia, 2006, p. 217.
3. Silverman S, Gorsky M, Luzada-Nur F. A prospective follow-up study of 570 patients with oral lichen planus: persistence, remission, and malignant association. Oral Surg Oral Med Oral Pathol. 1985; 60(1): 30-4.
4. Bigby M. The relationship between lichen planus and hepatitis C clarified. Arch Dermatol. 2009; 145(9):1048-50.
5. Ingafou M, Leao JC, Porter SR, et al. Oral lichen planus: a retrospective study of 690 British patients. Oral Dis. 2006; 12(5):463-8.
6. Holzberg M. Common nail disorders. Dermatol Clin 2006; 24(3):349-54.
7. Grover C, Bansal S, Nanda S, et al. Efficacy of triamcinolone acetonide in various acquired nail dystrophies. J Dermatol 2005; 32(12):963-8.
8. Cribier B, Frances C, Chosidow O. Treatment of lichen planus. An evidence-based medicine analysis of efficacy. Arch Dermatol. 1998; 134(12):1521-30.







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