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UPSC MainsPHILOSOPHY-PAPER-II20243 Marks
Q22.

Name the disease that is a prototype of lichenoid reaction.

How to Approach

This question requires precise dermatological knowledge. The approach should be direct – identifying the disease that serves as the classic example of a lichenoid tissue reaction pattern. The answer should define lichenoid reaction, briefly explain its histological features, and then definitively state the prototype disease. No extensive elaboration is needed, but clarity and accuracy are paramount. Focus on conciseness and medical accuracy.

Model Answer

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Introduction

A lichenoid tissue reaction is a pattern of inflammation seen in skin biopsies, characterized by damage to the basal keratinocytes along with a dense band of lymphocytes at the dermoepidermal junction. This pattern is not specific to a single disease but is observed in a variety of inflammatory dermatoses. Recognizing the prototypical disease exhibiting this reaction pattern is crucial for accurate diagnosis and management. Understanding the histological hallmarks of this reaction is key to differentiating it from other inflammatory skin conditions.

Lichenoid Reaction: A Histopathological Pattern

A lichenoid reaction is a specific type of inflammatory response in the skin. Histologically, it is defined by the following features:

  • Basal Keratinocyte Damage: Individual keratinocyte necrosis or vacuolar degeneration of basal cells.
  • Lymphocytic Infiltration: A dense band of lymphocytes hugging the dermoepidermal junction.
  • Melanocyte Damage: Often, melanocytes are also affected, leading to hypopigmentation.

The Prototype Disease: Lichen Planus

Lichen Planus (LP) is considered the prototype of a lichenoid reaction. It is a chronic inflammatory condition affecting the skin, mucous membranes, hair, and nails. The histological features of LP perfectly exemplify the lichenoid tissue reaction pattern described above.

Clinical Features of Lichen Planus

  • Pruritic, Flat-topped Papules: Typically violaceous in color.
  • Wickham's Striae: Fine, white lines on the surface of the papules.
  • Mucosal Involvement: Common, particularly in the mouth.
  • Nail Changes: Longitudinal ridging, thinning, and splitting.

Histopathological Confirmation

A skin biopsy demonstrating the characteristic lichenoid inflammation confirms the diagnosis of Lichen Planus. The presence of colloid bodies (apoptotic keratinocytes) is also frequently observed in LP biopsies.

Other Conditions Exhibiting Lichenoid Reaction

While Lichen Planus is the prototype, other conditions can also display a lichenoid reaction pattern, including:

  • Drug eruptions
  • Graft-versus-host disease
  • Lupus erythematosus
  • Certain types of eczema

However, the histological and clinical features in these conditions differ from classic Lichen Planus, allowing for differential diagnosis.

Conclusion

In conclusion, Lichen Planus is unequivocally the disease that serves as the prototype for a lichenoid tissue reaction. Its characteristic clinical presentation, coupled with the hallmark histological features of basal keratinocyte damage and a dense lymphocytic infiltrate at the dermoepidermal junction, make it the defining example of this inflammatory pattern. Recognizing this prototype is essential for dermatologists in accurately diagnosing and managing a range of skin conditions.

Answer Length

This is a comprehensive model answer for learning purposes and may exceed the word limit. In the exam, always adhere to the prescribed word count.

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Additional Resources

Key Definitions

Keratinocyte
The predominant cell type in the epidermis, the outermost layer of the skin. Keratinocytes produce keratin, a fibrous protein that provides strength and protection to the skin.

Key Statistics

The estimated prevalence of Lichen Planus ranges from 0.1% to 1% of the general population.

Source: American Academy of Dermatology (as of knowledge cutoff 2023)

Approximately 70% of patients with Lichen Planus experience involvement of the skin, while 20-30% have mucosal involvement.

Source: UpToDate (as of knowledge cutoff 2023)

Examples

Oral Lichen Planus

A 45-year-old female presents with painful ulcers in her mouth, making eating and speaking difficult. A biopsy reveals a lichenoid tissue reaction, confirming a diagnosis of oral lichen planus. Treatment with topical corticosteroids provides symptomatic relief.

Frequently Asked Questions

▶Is Lichen Planus contagious?

No, Lichen Planus is not contagious. It is an autoimmune condition, meaning the body's immune system mistakenly attacks its own skin cells.

Topics Covered

MedicineDermatologyLichenoid ReactionSkin Diseases
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