Successful Treatment of a Child With Generalized Lichen Ruber Planus

Introduction

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., 2014	Record of cases/316 patients/2–14 years	Limited 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., 2010	Record of cases/100 patients/2–18 years	Erosive cutaneous lesions: Oral corticosteroids until one month after disappearance of the last lesion dapsone (1.5 mg/kg/d) if the initial erosion disappeared after oral corticosteroids treatment
D. Cohen et al., 2009	Case report/1 patient/6 years	2 weeks topical corticosteroids Oral prednisolon (1 mg/kg/day) for 4 days, then slightly decrease of the dosis
P. Basak, 2002	Case report/1 patient/9 years	Dapsone (1.5 mg/kg/d) for 8 months symptoms still appeared: increase of the dosis to Dapsone (2.5 mg/kg/d)
R. Sharma et al., 1999	Record of cases/50 patients/0–14 years	First line: topical steroids and antihistamines eruptive and widespread exanthema: oral prednisolone at first consultation for 10 days

There 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.