LICHEN-PLANUS IN CHILDREN - 12 CASES

Objective. Lichen planus is in children uncommon and poorly understood . The classical description is comparable to lichen planus in adults. We conducted a retrospective analysis of 12 cases in children. Patient s and methods. Twelve children with lichen planus consulted the Saint- Louis or Robert-Debre hospitals between February 1994 and March 1996. Data collected included: age, sex, ethnic origin, drug use, anti-hepat itis vaccination status, disease history, physical examination, skin h istology, liver tests, hepatitis B and C serology, treatment and outco me. Histological proof was obtained in all cases but one (a child with isolated ungueal involvement whose sister had histologically proven u ngueal lichen planus). Results and discussion. The clinical features c lassically described in adults were atypical in all our childhood case s. A rapidly extensive eruption was the main sign in 6 cases. The loca lizations were unusual with lesions involving all four limbs and the t runk as well as the face in 5 cases and the scalp in 1. Mucosal involv ement, observed in 65 p. 100 of adult cases was only found in one of o ur children. Unguel involvement also appears robe uncommon in children .The etiological pattern was also unusual since we did not observe a s ingle case related to drugs or hepatitis B or C infection. Three child ren developed a lichen eruption after anti-hepatitis B infection. Four other cases of lichen planus after anti-hepatitis B vaccination have been reported in the literature. Mean delay between the booster Vaccin ation and onset of eruption is reported to be 40 days. The increased i ncidence of childhood lichen planus in tropical zones suggests ethnic, genetic and climatic factors may be involved. Prognosis is poorly def ined in the literature. Certain authors emphasize the long duration of the disease and resistance to treatment in cases of childhood lichen planus. Currently, there is no consensus on treatment. Dermocorticoids in combination with antihistaminics are usually prescribed. General c orticosteroid therapy would appear to be warranted in extensive progre ssive forms with important functional and esthetic impact (scalp invol vement with cicatricial alopecia, pigmentation sequellae). The role of other drugs, particularly retinoids, remains to be defined. This retr ospective series was not statistically significant. Data in the litera ture are rather discordant, emphasizing the need for a prospective ana lysis to acquire a better understanding of the real incidence of child hood lichen planus and better define the therapeutic strategy.