Successful Treatment of a Child With Generalized Lichen Ruber Planus

摘要

Lichen planus is an autoimmune inflammatory mucocutaneous disease. The etiology of LP is poorly understood, but is believed to be the result of an autoimmune disorder including misled CD8+-T-Cells targeting basal keratinocytes (Lehman, J.S., M.M. Tollefson, and L.E. Gibson, Int J Dermatol, 2009. 48(7): p. 682–694). Multiple other associated factors, such as cytokines, hepatitis C and drugs are discussed.It occurs in 0.5–1% (Weston, G. and M. Payette, International Journal of Women's Dermatology, 2015. 1(3): p. 140–149.) of the population and is rarely seen in children (1-4% of total cases)( Pandhi, D., A. Singal, and S.N. Bhattacharya, Pediatr Dermatol, 2014. 31(1): p. 59–67.), although a higher proportional percentage has been reported in certain studies (Kumar, V., et al., J Dermatol, 1993. 20(3): p. 175–177;). Although a racial predilection has not been shown for LP, 5 of 9 existing large LP-childhood-studies have been carried out in India (Payette, M.J., et al., Clin Dermatol, 2015. 33(6): p. 631–643.). Furthermore an U.S.-study showed a higher incidence of LP in African-American patients (Walton, K.E., et al., Pediatr Dermatol, 2010. 27(1): p. 34–38). No gender prevalence has been shown in the majority of the large childhood-studies. ([Table 1]) Table 1 Treatment strategies of LP during childhood. Author, Year Study type/number of cases/age Used therapy or treatment recommendations D. Pandhi et al., 2014Record of cases/316 patients/2–14 yearsLimited disease: topical steroids (medium/high potency)Widespread disease: systemic dapsone (1.5 mg/kg/d)Extensive or fast exploring disease: oral prednisolone (1 mg/kg/d)Oral disease: topical tacrolimus (0,03)Nail involvement: oral acitrecin (0.5 mg/kg/d)A. Kanwar et al., 2010Record of cases/100 patients/2–18 yearsErosive cutaneous lesions: Oral corticosteroids until one month after disappearance of the last lesiondapsone (1.5 mg/kg/d) if the initial erosion disappeared after oral corticosteroids treatmentD. Cohen et al., 2009Case report/1 patient/6 years2 weeks topical corticosteroidsOral prednisolon (1 mg/kg/day) for 4 days, then slightly decrease of the dosisP. Basak, 2002Case report/1 patient/9 yearsDapsone (1.5 mg/kg/d) for 8 monthssymptoms still appeared: increase of the dosis to Dapsone (2.5 mg/kg/d)R. Sharma et al., 1999Record of cases/50 patients/0–14 yearsFirst line: topical steroids and antihistamineseruptive and widespread exanthema: oral prednisolone at first consultation for 10 daysThere is a great variety to clinical presentations of LP. Our 11-year old patient suffered from classical cutaneous lesions with darker pigmented, nearly violaceous flat-topped papules, partly coalescing, covering the whole integument and responded very well to the treatment.