Wickham stria is present in:
Ref: Papulosquamous disorders. In: Thappa DM, editor. Essentials in Dermatology, 2nd edn., New Delhi: Jaypee brothers medical publishers (Pi Ltd 2009:82-98.Explanation:LICHEN PLANUSIt is a pruritic, inflammatory papulosquamous disorder affecting the skin, mucous membranes, nails and hair follicles.Etiology - UnknownGenetic predisposition: HLA B8- oral LP: HLA-Bw 35-cutaneous LPExogenous: Primary biliary cirrhosis, alcoholic cirrhosis, hepatitis B, hepatitis CDrugs cause lichenoid drug eruptionsMetals like mercury (dental amalgams), palladium, gold - oral lichenoid eruptions* Clinical features:3 0-60 years; ehildren-4% of cases, childhood LP more common in IndiaSkindeg Intensely pruritic, flat topped, shiny, polygonal, violaceous papules and plaquesdeg Predominantly flexor distribution -flexor of wrist, forearm, legs, trunk, glans penis (cf- psoriasis another papulosquamous disorder has predominant extensor distribution)deg Wickham's striae- network of greyish white streaks on papules seen on pressing with glass slide after application of oil - corresponds to wedge shaped hypergranulosis seen on histopathologv deg Koebner/isomorphic phenomenon commondeg Annular LP- glans penisdeg Hypertrophic LP- shins deg Actinic LP-sun exposed areasOral-Classical type is reticulate pattern- white/ violaceous lacy reticular network of coalesent papules in buccal mucosa and tongue; usually asymptomaticMost common pattern - ulcerative/erosive LPNail:5-10% casesThinning of nail plate (cf psoriasis - thickening of nail plate ), longitudinal ridging, roughening of nail plate {trachyonychia) and nail dystrophy involving all 20 nails called 20 nail dystrophy (also seen in alopecia areata)Classical/characteristic nail finding (but not common finding) - pterygium formation (proximal nail fold fuses with nail bed.)Hair follicles: lichen planopilaris - scarring alopeciaHistopathology:HyperkeratosisWedge shaped hypergranulosis (psoriasis - hypogranulosis)Irregular acanthosis (psoriasis - regular acanthosis)Saw tooth rete ridges (psoriasis - elephant foot/camel foot like/club shaped rete ridges) Basal layer vacuolar degeneration Band like dermal lymphocytic infiltrate hugging epidermisMax Joseph spaces - subepidermal clear zone (subepidermal clear zone in lepromatous leprosy is called Grenz zone)Melanin incontinenceTreatment - steroids (topical/intralesionsal/ systemic), retinoids, cyclosporine, PUVA photochemotherapy, dapsone, methotrexate- Lichen planus- "8 P's"Papulosquamous disorderPruriticPlane toppedPolygonal/polvangularPurple colouredPapulesPlaquesPigmentation after healingPterygium formation in nailsPsoriasis -Pruritic papulosquamous disorderWell defined erythematous papules and plaques covered by silvery white micaceous scales Predominant extensor distribution.Mucosal lesions are very rare- annular plaques, diffuse erythema, geographic tonguePityriasis rosea-Papulosquamous disorder with pruritic or asymptomatic lesionsInitial herald or mother patch on trunk followed by daughter patches two weeks laterChristmas tree pattern along lines of cleavage with a peripheral collarette of scale producing the hanging curtain sign when stretched.No oral lesions.Common in adolescents and young adultsEczemaPruritic papulovesicular dermatitisCharacterized by oozing, erythema, edema and crusting in acute phase,Crusting and scaling in subacute phaseHyperkeratosis and lichenification in chronic phase.
Lichen Planus
Psoriasis
Pityriasis rosea
Eczema
Erythmato-Squamous and Lichenoid Eruption