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  In this article
   Abstract
   Introduction
   Patients and Methods
   Results
   Discussion
   References
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STUDIES
Year : 1995  |  Volume : 61  |  Issue : 5  |  Page : 276-279

A clinico-aetiological profile of 375 cases of lichen planus




Correspondence Address:
Dilip Kachhawa


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Source of Support: None, Conflict of Interest: None


PMID: 20952988

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  Abstract 

The study of clinical, histopathological and aetiological pattern, of lichen planus (LP) in 375 patients was done in this part of Western Rajasthan. The incidence of LP was 0.8%. 58.7% cases were male and maximum number of cases (46.93%) were in age group of 20-39 years. In 70.66% of patients only skin was involved while in 10.18% of cases only mucous membrane was involved. In 61.6% patients the lower extremities were involved. Familial LP was seen in 8 families. Association of LP was found with hypertension (2.4%), polymorphic light eruption (2.1%), vitiligo (1.9%) and diabetes mellitus (1.6%). 48.5% of cases showed lymphocytosis with raised ESR. Actinic LP was seen in 14.1% of cases. 13.1% of patients showed combination of typical LP or its variants to which term lichen planus variata was given


Keywords: Lichen planus, Actinicus, Varlata


How to cite this article:
Kachhawa D, Kachhawa V, Kalla G, Gupta L. A clinico-aetiological profile of 375 cases of lichen planus. Indian J Dermatol Venereol Leprol 1995;61:276-9

How to cite this URL:
Kachhawa D, Kachhawa V, Kalla G, Gupta L. A clinico-aetiological profile of 375 cases of lichen planus. Indian J Dermatol Venereol Leprol [serial online] 1995 [cited 2019 Jul 18];61:276-9. Available from: http://www.ijdvl.com/text.asp?1995/61/5/276/4239



  Introduction Top


Lichen planus (LP) is a disorder of worldwide distribution. The incidence as well as pettern of LP changes according to geographical areas. A higher incidence of LP has been seen in Middle East countries. Its incidence appears to be higher in India also.[1],[2] Lichen planus actinicus (LPA), which has been frequently reported from arid zone countries of middle east,[3] has been observed in Western Rajasthan also which has vast arid zone. This work was designed to study the clinical, histopathological and aetiological patterns of LP in this part of Western Rajasthan.


  Patients and Methods Top


375 patients of LP attending our department were the subjects of this study. From each patient, a detailed history and clinical findings were recorded laying emphasis on symptoms, duration, mode of onset, occupation, drug intake at the time of onset of disease, morphology of lesions, sites of involvement and systemic examination to rule out any associated disease. Biopsy was taken in as many cases as possible to confirm the clinical diagnosis.


  Results Top


The total number of new cases registered during the period of study were 49633. Thus the incidence of LP was 0.8%. The registration of LP cases was more during the spring and summer season (February to September). Out of 375 patients 220 were male and 155 were female. The oldest patient was 90 years old while youngest was 5 years old.

Maximum number of cases (46.9%) were in age group of 20-39 years followed by 29.0% cases in 40-59 years age group [Table - 1]. Duration of LP varied from 5 days to 30 years. In majority of cases (70.66%), only skin was involved while in 19.16% cases it was involved with mucous membrane. Only mucous membrane was involved in 10.18% cases [Table - 2]. The involvement of lower extremities was found to be highest (61.9%) followed by upper extremities (60.5%), trunk (35.5%), back (27.7%), face (23.7%), oral mucosa (25.9%), genitalia (9.3%), soles (4.3%), palms (3.5%), nails (6.4%) and scalp (5.3%). 72.8% cases were symptomatic while 27.2% cases were asymptomatic. 2.4% cases were associated with hypertension while other associated diseases were polymorphous light eruption (2.1%), vitiligo (1.9%), diabetes mellitus (1.6%), discoid lupus erythematosus (0.8%), rheumatoid arthritis and scabies (0.4%). In 8 families, more than one member suffered with LP or its variant [Table - 3]. Out of 113 biopsies,95 showed histopathological features of LP or its variants while features of chronic non specific dermatitis was seen in 18 biopsies.40.5% cases showed lymphocytosis with raised ESR; while 2.9% and 6.9% cases showed lymphocytosis only and raised ESR only respectively.


  Discussion Top


The incidence of LP in this study was 0.8%. This is in accordance with reports from Western countries (0.5 to 1.2%)[4] and also from India (0.76%).[2] However, a higher incidence of 1.4% has also been reported from India.[1] Our study shows that maximum cases were registered during February to September. It is similar to a report from Middle-East.[5] No seasonal variation has been reported by some authors.[1],[2] On the contrary a study[4] reported a low incidence of LP in May, June and November and high incidence in December and January. Predominance of males was in accordance with report of a few[2] while opposite ratio has also been reported.[1] Equal ratio has also been reported.[1] Maximum number of cases were in 20-39 years age group like others[1],[2] from India. Reports from Western countries[4] show 30-60 years age group to be more commonly involved. Duration in our study was similar to others. [1,2] Involvement of skin with mucous membrane was found to be low compared to other.[1],[2] The involvement of skin alone in 70.66% cases agree with reports of others.[1],[2] In our study mucous membrane alone was involved in 10.18% cases. It differs with other studies. [1,2] Nail changes in 6.4% cases varied from thinning of nail plate to pterygium unguis in finger nails and even complete destruction of toe nails in one case. The nail involvement in our study was found to be low as compared to others.[6] In their study, Sehgal and Rege did not find any case while Singh and Kanwar[2] reported it in 1.6% cases.

A unique and clinically distinct type of LP reported from Middle East notably Egypt, Israel, Iraq, East Africa and also from India, was found in this study. The condition was called actinic LP[7] or subtropical LP. [3,5] In Ethiopia, it was called "Melanodermatite Lichenoide".[8] In this study 19.2% cases of actinic LP (ALP) were seen. Out of which, 14.1% had ALP only while 5% patients had associated lesions of typical LP or its variants. It's incidence was low in comparison to other reports from Middle East. [3,5] One report from India[2] reports ALP in 7.48% cases. Men were slightly more involved while a study[5] reports the reverse. The disease was found more in poor and middle class people particularly those having jobs that require prolonged exposure to sun. The incidence was much more higher during the summer.

Some of the following combinations seen in our patients have not been highlighted in literature.

LP + lichen planus hypertrophicus (LPH) -20, ALP + LP - 14, ALP + LPH - 2, LP + LPH + lichen planus annularis - 1, lichen planopilaris (LPP) + LP -3, LPH + LPP + LP -3, LPP + ALP + LP -1, LP + LP linearis -2, LP + LP annularis - 1, LPA + LPH+LPP + LP annularis -1, LP pigmentosus + LPP -1. For such cases, we suggest the term "lichen planus variata".

2.4% cases had hypertension while in other reports[9] this association was seen in more cases. Its association with vitiligo in 1.9% cases supports the possible role of auto-immunity in pathogenesis of LP. LP was seen in association with diabetes mellitus also similar to other reports.[10] Association of LP with discoid lupus erythematosus as overlap syndrome has been reported by others also.[11] Cases of familial LP were also recorded like others.[12] The finding of increased number of lymphocytes is in contrast to other report.[4] Lastly the patients of ALP from Thar desert of Western Rajasthan were almost compatible clinically and histopathologically with those reported from subtropical countries where the environmental conditions are almost same.

 
  References Top

1.Sehgal VN, Rege VL. Lichen planus: an appraisal of 147 cases. Ind J Dermatol Venereol 1974;40:104.  Back to cited text no. 1    
2.Singh OP, Kanwar AJ. Lichen planus in India: an appraisal of 441 cases. Int J Dermatol 1976;15:752.  Back to cited text no. 2  [PUBMED]  
3.Dostrovsky A, Sagher F. Lichen planus In subtropical countries. Arch Dermatol Syphilol 1949;59:308.  Back to cited text no. 3    
4.Mellgren L, Hersle K. Lichen plauns: a clinical study with statistical methods. Ind J Dermatol 1965;11:1.  Back to cited text no. 4    
5.Dilaimy M. Lichen planus subtropicus. Arch Dermatol 1976;122:1251.  Back to cited text no. 5    
6.Zalas N. The nail in LP. Arch Dermatol 1970;101:264.  Back to cited text no. 6    
7.Katzenellenbogen: Lichen planus actinicus (Lichen planus in subtropical countries). Dermatologica 1962;124:10.  Back to cited text no. 7    
8.Greppic, Soustek Z. Lamelano dermatite lichenoide in Soggetti etiopici. Minerva Dermatologica 1966;41:153.  Back to cited text no. 8    
9.Altman J, Perry NC. The variation and course of lichen planus. Arch Dermatol 1961;84:179.  Back to cited text no. 9    
10.Lowe NJ, Cudworth AG, Clough SA, Bullen MF. Carbohydrate metabolism in lichen planus. Br J Dermatol 1976;95:9.  Back to cited text no. 10    
11.Coperman PWM, Schroeter AL, Kierland RR. An unusual variant of lupus erythematosus or lichen planus. Br J Dermatol 1970;83:269.  Back to cited text no. 11    
12.Copeman PWM, Tan RSH. Tamilin D. Samman PD. Familial lichen planus. Br J Dermatol 1978;98:573.  Back to cited text no. 12    


    Tables

[Table - 1], [Table - 2], [Table - 3]

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