Management Of Childhood Lichen Planus

Abstract

Childhood lichen planus (LP) is a rare entity, with less than 23% of all cases seen in patients under 20 years of age. LP in childhood is common in subtropical countries such as India. The most common clinical type of LP in Indian children is the classic form. Approximately 115% of patients with LP demonstrate nail involvement, but disease of the nails without skin involvement is rare. LP is diagnosed by history, clinical findings, biopsy results, and, in some cases, features on direct immunofluorescence (DIF). LP tends to have a chronic course. Depending on disease severity, however, LP may respond to a combination of topical or systemic therapies. The response to therapy may be similar to that seen in adults. Moderately potent or super potent steroids are the treatment of choice. Topical steroid can be combined with oral steroid in tapering doses over 2-12 weeks period. This is useful for children with widespread involvement or cutaneous LP lesions associated with significant morbidity. Intralesional steroid is effective for hypertrophic LP unresponsive to topical steroid. Topical steroid in adhesive base used several times a day for several months is a treatment of choice for symptomatic oral LP. Topical steroid in combination with systemic steroid can be given in a tapering dose over 3-6 weeks in very symptomatic cases in early stages. In severe unresponsive cases of both cutaneous and oral LP, oral retnoid are the preferred option. Treatment options for the nail LP in young children are oral steroid given as tapering dose over 4-12 weeks and oral retinoid. Intralesional steroid as nail matrix injection are the third option for older children. Most pediatric patients with LP respond to treatment with full clearance over 1-6 months. Poor response to treatment is a feature of hypertrophic LP and lichen planopilaris. Key words Children, Lichen planus, Nail lichen planus, Oral lichen planus IntroductionLichen planus is a pruritic papulosquamous dermatoses of unknown etiology characterized by presence of violaceous, polygonal, flat-topped papules, affecting the skin, nails and mucous membranes. It usually resolves after a variable period of time leaving behind residual areas of hyperpigmentation.