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ORIGINAL ARTICLE
Year : 2020  |  Volume : 9  |  Issue : 3  |  Page : 161-163

Lichen planus in children: A prospective study over a period of 2.5 years


Department of DVL, GSL Medical College, Rajahmahendravaram, Andhra Pradesh, India

Date of Submission27-Jun-2020
Date of Acceptance28-Jun-2020
Date of Web Publication30-Sep-2020

Correspondence Address:
Dr. Sravanthi Kotha
Department of DVL, GSL Medical College, Rajahmahendravaram - 533 296, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JDRNTRUHS.JDRNTRUHS_99_20

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  Abstract 


Introduction: Lichen planus (LP) was considered to be rare in childhood with global data showing 2-3% of total LP cases. There were very few studies reported.
Aims and Objectives: To find out the prevalence of LP in children in a tertiary hospital and to evaluate the epidemiological and clinical features.
Materials and Methods: Children aged <16 years were screened for lichen planus. Biopsy was done for confirmation in doubtful cases. Various clinical and epidemiological features were documented.
Results: Of the total 54 children, 34 were males and 20 females. The mean age of children was 10.4 years, and the mean age at the onset of disease was 6.8 years. Preceding infection was noted in 16%, and there was no history of vaccination in any in preceding 6 months. Family history was noted in 4.5% of cases. Comorbidities were observed in 35 (65%) of our study subjects, of which obesity was noted in 15 (28%).
Conclusion: Lichen planus is not uncommon in children. Classical papular form is common. Obesity is commonly associated comorbidity larger sample need to be studied for metabolic syndrome.

Keywords: Children, lichen planus, metabolic syndrome


How to cite this article:
Kolalapudi SA, Saka S, Konala S, Kotha S, Palakurthi SS, Arumilli PC. Lichen planus in children: A prospective study over a period of 2.5 years. J NTR Univ Health Sci 2020;9:161-3

How to cite this URL:
Kolalapudi SA, Saka S, Konala S, Kotha S, Palakurthi SS, Arumilli PC. Lichen planus in children: A prospective study over a period of 2.5 years. J NTR Univ Health Sci [serial online] 2020 [cited 2020 Oct 29];9:161-3. Available from: https://www.jdrntruhs.org/text.asp?2020/9/3/161/296833




  Introduction Top


Lichen planus was considered to be rare in childhood. The prevalence in children was 2–3% world wide. There were only few reports. In India few studies reported as high as 11–19% in Indian children.[1],[2],[3],[4],[5],[6] There is a possible genetic susceptibility for lichen planus in children of Indian origin as it was reported more in children of Indian origin even in studies from other parts of the world.[5] Similar susceptibility noted in Arab and Afro-Caribbean back ground.[7] Familial Lichen planus comprised 1–4% of all cases of childhood LP. It has autosomal dominant type of inheritance involving HLA B7 and BR10.[6]


  Materials and Methods Top


A prospective study was conducted for 2.5 years, from November 2016 to April 2019 in our dermatology department. Institutional ethics committee has approved the study (GSLMC IEC/IRB Ref No: 380-EC/380/09/16 on 16.9.2016). Children aged <16 attending to our OPD with lichen planus were included. Biopsy was done for confirmation in doubtful cases. A detailed demographic data, history of preceding infection, vaccination, and family history were recorded. Morphological patterns, Koebner phenomena, mucosal involvement, and associated conditions were documented.


  Results Top


During 2.5 years, 582 LP patients attended our OPD and 54 (9.27%) were children, 34 were males, and 20 were females. The mean age of children was 10.4 years, and the mean age at the onset of disease was 6.8 years [Table 1]. Youngest was 3 years old. Preceding infection was noted in 16%, and there was no history of vaccination in any, in preceding 6 months. Family history of LP was noted in 3 (5.5%) cases. Classical papular form was seen in 56%, followed by lichen planus hypertrophicus (LPH) (18%), eruptive (12%), actinic (8%), and linear forms (6%). Koebner phenomena was observed in 32% of cases. Palmoplantar lesions were seen in 16%, oral in 10%, genital 8%, and nails were involved in 14%. Thirty-five children (65%) had associated conditions, Obesity (15), atopy (9), hypothyroidism (6), and vitiligo (5). Children with BMI ≥95 percentile (Equivalent to BMI ≥30 in adults) were considered as obese.
Table 1: Demographic and Clinical Data of 54 Children with Lichen Planus

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  Discussion Top


Lichen planus in children is rarely reported. The prevalence in children was 2-3% world wide, but it was slightly more in Indian children, 11–19%.[1],[2],[3],[4],[5],[6] Handa et al. reported a prevalence of 2.5% in their series.[1] Kumar et al. and Pandhi et al. reported 11.2% and 18.7% in children from India, respectively in their series of all LP cases and it was 7.5% from Middle east countries.[2],[5],[6] We had seen 582 LP patients in our OPD during study period of 2.5 years and 9.27% were children.

The mean age of children in our study group was 10.4 years, with mean age of onset was 6.8 years. Kumar et al. reported mean age of onset as11.61 years,[2] Kanwar et al.[6] and Pandhi et al.[5] reported 7.1 and 10.28 years, respectively in their series. LP is uncommon in infants and the youngest reported was 3 months old, whereas our youngest patient was 3 years old. Many had the disease between 5 and 9 years of age.[1]

LP was documented almost equally in both sexes,[5] though some have shown male preponderance including ours (1.4:1)[3] and in some studies girls were affected more than boys.[2],[7] Family history of LP was reported in 4.8%-12% of cases and we observed family history in 5.5%.[2],[8] Those with family history had early onset and more recurrences. Familial LP was reported to have earlier age of onset, severe form of disease, mucosal involvement, and frequent recurrences.[9]

Lichen planus has also been reported as complication of hepatitis B vaccination.[10],[11] But in our study there was no history of vaccination in any, in preceding 6 months.

Similar to other studies,[1],[3],[12] the most common clinical type of lichen planus in our patients was classic papular form (56%), followed by lichen planus hypertrophicus (18%). LPH was documented in 26% by Sharma et al.[3] and in 8% by Kanwar et al.[6] In our study eruptive LP was found in 12%, but others have reported 4.8%[3] and 13%.[6] Actinic LP occurs uncommonly in children as it is seen more in middle aged people. We observed actinic LP in 8% of the total cases, while Kanwar et al. reported 5%.[6] A little higher incidence of actinic LP (11.5%) was found in study done by Handa et al.[1] Palmoplantar lesions (16%) were seen more in our study when compared to other studies done by Pandhi et al. (4%)[5] and Shilpasree et al. (7.8%).[13] Linear LP was found in only 6% of our cases, while higher frequency was found by Balasubramaniam et al. (19%).[14] In our study classic papular LP was more common (56%), followed by hypertrophic (18%), palmoplantar (16%) and actinic (8%) variants.

Mucosal involvement is uncommon in children. 10% of children in our series had oral involvement. Sharma et al.[3] and Nanda et al.[12] had reported mucosal involvement in 30% and 39% respectively and a lower incidence was found in 2 other studies.[4],[15] Nail involvement is not very commonly seen in children. It is seen in 1–10% of adult cases. Most studies showed no involvement or very little incidence of nail LP[3],[6],[7] Our study showed 14% nail involvement, whereas Kumar et al.[2] reported in, 42.9% and Kanwar et al. reported in 19% of their patients with nail involvement.[6] Koebner phenomena was seen in 32% of our cases. It is considered to be common in children and was observed between 24 and 28% in various studies.[1],[3],[14] But 73.8% of patients showed Koebner's in the study by Kumar et al.[2] Genital lesions were present in 8% in our study. Only few studies have reported genital involvement,[1],[5] which emphasizes the importance of evaluation of genital sites in children.

Comorbidities were observed in 65% of our study subjects, of which obesity was noted in 15 (28%). Metabolic syndrome was observed in lichen planus in adults,[16],[17] but in children, this association was not documented. As obesity is observed in 28% of the children with LP in our study, it is to be studied further with all the components of metabolic syndrome to know the prevalence of metabolic syndrome in children with LP. Atopy was seen in 8% of our patients which was similar to study done by Nanda et al.[12] But higher incidence of atopic dermatitis (34.6%) was reported by Balasubramaniam et al.[14] in UK which can be explained by higher prevalence of the disease in that area. The other associated conditions found in our study are hypothyroidism (17%) and vitiligo (9%). Kumar et al. observed hypothyroidism in 7% of their series of LP in children.[2] LP in association with vitiligo and psoriasis in the same patient was reported. This co-localization could be because of increased production of proinflammatory molecules such as IL-1, IL-6 and IL-8, TNF-α and vasoactive intestinal peptides.[18]


  Conclusion Top


Lichen planus in children is not uncommon. Actinic, hypertrpophic, and palmoplantar variants were slightly more in our study, compared to other studies. Vaccination does not have any role. Obesity was more frequent comorbidity; hence, a larger sample needs to be studied for metabolic syndrome.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Handa S, Sahoo B. Childhood lichen planus: A study of 87 cases. Int J Dermatol 2002;41:423-7.  Back to cited text no. 1
    
2.
Kumar A, Mendiratta V, Agarwal S, Chander R, Sanke S. Childhood lichen planus: A series of 42 patients. Indian J Paediatr Dermatol 2018;19:116-9.  Back to cited text no. 2
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3.
Sharma R, Maheshwari V. Childhood lichen planus: A report of fiftycases. Pediatr Dermatol 2002;16:345-8.  Back to cited text no. 3
    
4.
Kumar V, Garg BR, Baruah MC, Vasireddi SS. Childhood lichen planus (LP). J Dermatol 1993;20:175-7.  Back to cited text no. 4
    
5.
Pandhi D, Singal A, Bhattacharya SN. Lichen planus in childhood: A series of 316 patients. Pediatr Dermatol 2014;31:59-67.  Back to cited text no. 5
    
6.
Kanwar AJ, De D. Lichen planus in childhood: Report of 100 cases. Clin Exp Dermatol 2010;35:257-62.  Back to cited text no. 6
    
7.
Walton KE, Bowers EV, Drolet BA, Holland KE. Childhood lichen planus: Demographics of a U.S. population. Pediatr Dermatol 2010;27:34-8.  Back to cited text no. 7
    
8.
Mahood JM. Familial lichen planus-A report of nine cases from four families with a brief review of the literature. Arch Dermatol 1983;119:292-4.  Back to cited text no. 8
    
9.
Singal A. Familial mucosal lichen planus in three successive generations. Int J Dermatol 2005;44:81-82.  Back to cited text no. 9
    
10.
Limas C, Limas CJ. Lichen planus in children: A possible complication of hepatitis B vaccines. Pediatr Dermatol 2002;19:204-9.  Back to cited text no. 10
    
11.
Agrawal A, Shenoi SD. Lichen planus secondary to hepatitis B vaccination. Indian J Dermatol Venereol Leprol 2004;70:234-5.  Back to cited text no. 11
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12.
Nanda A, Al-Ajmi HS, Al-Sabah H, Al-Hasawi F, Alsaleh QA. Childhood lichen planus: A report of 23 cases. Pediatr Dermatol 2001;18:1-4.  Back to cited text no. 12
    
13.
Ravikiran SP, Jaiswal AK, Anupama YG, Madan Mohan NT, Reddy PK. Lichen planus in children: A retrospective study in 76 patients at a tertiary care center in South India. Indian J Paediatr Dermatol 2017;18:209-13.  Back to cited text no. 13
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14.
Balasubramaniam P, Ogboli M, Moss C. Lichen planus in children: Review of 26 cases. Clin Exp Dermatol 2008;33:457-9.  Back to cited text no. 14
    
15.
Kanwar AJ, Handa S, Ghosh S, Kaur S. Lichen planus in childhood: A report of 17 patients. Pediatr Dermatol 1991;8:288-91.  Back to cited text no. 15
    
16.
Geetharani G, Sumithra S, Devaprabha S, Kothandaramasamy R. Eruptive lichen planus, a marker of metabolic syndrome. Indian J Dermatol 2019;64:299-302.  Back to cited text no. 16
[PUBMED]  [Full text]  
17.
Singla R, Ashwini P K, Jayadev B. Lichen planus and metabolic syndrome: Is there a relation? Indian Dermatol Online J 2019;10:555-9.  Back to cited text no. 17
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18.
Neelagiri S, Janardhan B, Ramireddy KS, Sreedhar V. Co-occurrence of psoriasis, vitiligo, and lichenplanus in a single patient. Indian J Paediatr Dermatol 2018;19:157-60.  Back to cited text no. 18
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