Lichen planus and lichenoid reactions as a systemic disease

Lichen planus following COVID-19 vaccination: a narrative review

Lichen planus (LP) is an inflammatory disease that afflicts the skin, mucous membranes and cutaneous appendages. Moreover, LP represents a prototype of lichenoid dermatosis, being characterized by the presence of a dense dermal cell infiltrate. Although most cases of LP are idiopathic, infectious and drug-related factors must also be considered in the aetiology. In this context, the occurrence of LP and lichenoid drug eruptions following different types of vaccination is a possible event. Therefore, the aim of our review is to provide a broad perspective to clinicians by analysing the current literature of cases of LP and lichenoid eruptions following COVID-19 vaccination, and also investigating the possible pathogenetic mechanisms underlying this phenomenon. In total, 61 cases of LP and lichenoid eruption following COVID-19 vaccination have been collected. However, the number of cases of LP and lichenoid drug eruption is extremely low compared with the number of vaccines administered overall, suggesting that the risk of LP and lichenoid eruption following COVID-19 vaccination is extremely low. Certainly, further studies are desirable to identify the population most at risk and the possibility of taking preventive measures.

Cutaneous Manifestations Associated with Diabetes Mellitus-A Retrospective Study

Diabetes mellitus (DM) is one of the world's most important health problems, affecting more than half a billion of the world's population today, with an ever-increasing prevalence. Among the most common manifestations of diabetes are skin manifestations, with 30-70% of patients experiencing skin complications during the course of the disease. Conditions such as acanthosis nigricans, diabetic dermopathy, necrobiosis lipoidica, bacterial infections, fungal infections, skin xerosis, and metabolic prurigo are often associated with diabetes and often precede its diagnosis. We conducted a retrospective study on a group of 103 patients hospitalized between January 2018 and December 2022, in a clinic of a county hospital, using as criteria the diagnosis of diabetes mellitus complicated by cutaneous manifestations frequently associated with diabetes. The aim was to observe which are the most common manifestations and whether they correlate with data in the research literature. In the present study, manifestations such as diabetic foot (20% of patients), bacterial (35%) and fungal infections, and cutaneous xerosis (45%) were predominant. Often, the integumentary involvement may precede the diagnosis of the underlying disease. It is therefore very important to recognize, investigate and treat these manifestations as soon as possible.

Vulvovaginal erosive lichen planus refractory to topical therapies: What's next? A case report

A 60-year-old woman was referred for progressive and severe vulvovaginal pain characterized by erosions and Wickham's stria for the past 7 months. Her condition had not responded to oral fluconazole, topical estrogen cream, and topical clobetasol cream. Vulvar and vaginal biopsies were obtained under general anesthesia to verify the diagnosis of erosive lichen planus given the failed response to ultrapotent topical steroids. Tacrolimus cream was added but not tolerated. Oral and cutaneous lesions of lichen planus also developed. In the absence of evidence-based guidelines, three different systemic treatments were administered sequentially (hydroxychloroquine, mycophenolate, and finally cyclosporin) before a satisfactory, well-tolerated, and sustained clinical response was obtained. Topical betamethasone ointment in a taper was continued to assist in sustaining a vulvovaginal response after cyclosporin was discontinued.

Muscarinic cholinergic receptors in minor salivary gland tissues of patients with oral lichen planus: A case-control study

BACKGROUND

Oral lichen planus (OLP) is a common, chronic immunological and inflammatory condition. Many of the OLP patients complain of xerostomia. The M3 muscarinic cholinergic receptors (MR3) are the main receptors in the salivary glands responsible for water secretion into the saliva. This study aimed to assess the level of M3 muscarinic cholinergic receptors in minor salivary glands of OLP patients.

METHODS

This case-control cross-sectional study evaluated 40 OLP patients and 22 controls. All participants completed two questionnaires (xerostomia and xerostomia inventory). Stimulated and unstimulated saliva samples were collected. The saliva flow rate was calculated by dividing the saliva volume (in milliliters) by time (in minutes). Six minor salivary glands were also surgically removed from the lower lip of patients and controls, and weighed using a digital scale with 10^-4  g accuracy. They were then frozen at -80°C, and the level of M3 receptors of the glands was determined using the ELISA kit.

RESULTS

The unstimulated and stimulated saliva flow rate was significantly lower in OLP patients. The xerostomia inventory score was significantly higher in the OLP group. The level of M3 muscarinic receptors in minor salivary glands of OLP patients was significantly higher than that in controls.

CONCLUSIONS

It may be concluded that the reduction in saliva flow significantly increases the number of M3 receptors in an attempt to compensate for this shortage and prevent xerostomia (compensatory upregulation).

Epidemiologic and Clinical Differences Between Classic and Hypertrophic Lichen Planus in Nigeria

Introduction. Lichen planus is a chronic inflammatory skin disease known to have several clinical variants with attended variable clinical outcomes. Certain complications have been observed in the hypertrophic type, which were not found in association with the classic variant.

Objective: To identify the epidemiologic and clinical differences between the classic and hypertrophic lichen planus and clinical correlates.

Material and Methods. Of 104 participants with lichen planus included in the study, 49 had classic and 55 hypertrophic lichen planus. Demographic and clinical information was obtained. Diagnosis of lichen planus was made clinically and confirmed with histology. The participants were screened for metabolic syndrome, hepatitis B, and C.

Results: Mean age of all patients was 37.20±13.39 years, with no age and gender differences between the participants with classic and hypertrophic lichen planus. Classic lichen planus was more likely to be painful, (8.2% vs 0.0, p=0.046), generalized (95.9% vs 16.4%, p<0.001), involve the oral mucosa (38.8% vs 0.0, p<0.001), the nails (38.8% vs 1.8, p<0.001), present with kobnerisation (55.1% vs 5.5%,<0.001), Wickhiam striae (69.4% vs 16.4%, p<0.001), associated with Hepatitis B vaccination (16.3% vs 3.6%, p<0.028) and anti HCV positivity (16.3% vs 0.0%, p=0.002). Hypertrophic lichen planus was significantly associated with impaired glucose tolerance/diabetes mellitus (16.4% vs 2.0%, p=0.013), dyslipidemia (74.5% vs 40.8%, p=0.001) and saw-tooth histologic appearance compared to classic type.

Conclusion: Hypertrophic lichen planus is more likely to be associated with metabolic complications compared to the classic type. Further studies are needed to loink this difference t chronic inflamation.

Comparison of serum lipid parameters between patients with classic cutaneous lichen planus and oral lichen planus

OBJECTIVES

Previous studies have shown that patients with lichen planus (LP) have an increased occurrence of inflammation-related dyslipidemia. Although classic cutaneous LP (CCLP) and oral LP (OLP) are basically known as the different subtypes of the same disease sharing the common histopathological features, they actually have significant differences both in the clinical behavior and in the molecular inflammatory pathogenesis. We aimed to compare the lipid profile of patients with CCLP and OLP.

MATERIALS AND METHODS

This study included 120 patients, 30 with isolated CCLP, 30 with isolated OLP, 30 with CCLP + OLP, and 30 controls consecutively admitted to the outpatient clinics of Dermatology Department of Dokuz Eylul University Hospital, Izmir, Turkey.

RESULTS

Triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) values, TC/high-density lipoprotein cholesterol (HDL-C), and LDL-C/HDL-C atherogenic indexes were significantly higher, and HDL-C values were significantly lower in all LP subtypes compared with the controls. Among LP subtypes, although the differences were not statistically significant, TG, TC, and LDL-C values were markedly higher in OLP and OLP + CCLP patients compared with CCLP patients. OLP and CCLP + OLP patients also showed significantly higher TC/HDL-C and LDL-C/HDL-C atherogenic indexes compared with CCLP patients.

CONCLUSIONS

Patients with OLP have a more impaired lipid metabolism and significantly higher atherogenic indexes compared with patients with CCLP. The differences in the molecular inflammatory pathways between OLP and CCLP and the longer disease duration of OLP leading to long-lasting inflammation may elucidate this distinction.

CLINICAL RELEVANCE

We recommend to pay close attention to the early recognition of coexisting atherogenic dyslipidemia and to apply the early protective measures against the development of cardiovascular disease in OLP patients.

Dynamic thiol/disulfide homeostasis in patients with lichen planus

OBJECTIVE

Lichen planus (LP) is an autoimmune inflammatory disease of the mucocutaneous tissue, whose exact pathological course remains unclear. Abnormal thiol/disulfide homeostasis has been postulated to be responsible for a number of diseases predominated by chronic inflammation. To be able to contribute complicated and unclear pathogenesis of LP, we aimed to investigate dynamic thiol/disulfide homeostasis in patients with LP, using an original automated method developed by Erel and Neselioglu in this study.

METHODS

The study group consisted of 81 unrelated patients with LP and 80 unrelated healthy controls with no LP lesions in their personal history or on clinical examination. Thiol/disulphide homeostasis tests have been measured with a novel automatic spectrophotometric method developed and the results have been compared statistically.

RESULTS

Native thiol and total thiol levels were found as significantly higher in patients with LP than the control group (P = 0.026 and 0.035, respectively). There was no significant difference between the disulfide levels of the patients with LP and the control group.

CONCLUSIONS

We provide evidence that that thiol/disulphide homeostasis impaired in favor of thiol levels in LP patients compared to the control group based on the data of our study. To the best of our knowledge, the present study is the first examination on the correlation between thiol and disulfide homeostasis in patients with LP.

Association of classic lichen planus with human herpesvirus-7 infection

BACKGROUND

Lichen planus is a mucocutaneous papulosquamous itchy disease with unknown etiology. A number of factors such as immune mechanisms, viral agents, and drugs have been implicated in pathogenesis of lichen planus. In recent years, several studies have indicated the role of viral agents in this disease, including human herpesvirus-7 (HHV-7). Studies have given contradictory results, which is why we decided to study the possible association between lichen planus with HHV-7.

METHODS

In this case-control study, which was conducted on 60 cutaneous classic lichen planus samples as well as 60 healthy control skin samples after matching the two groups in terms of gender and age, tissue samples of patients and controls were studied by real time polymerase chain reaction to detect for HHV-7.

RESULTS

According to this study, HHV-7 DNA was found in 18 samples of the case group (30.0%) and in six (10.0%) of the control group (P = 0.006).

CONCLUSION

The results of this study support the likely role of HHV-7 in pathogenesis of lichen planus. As an exogenous antigen, this virus may be involved in cellular immune-mediated destruction of keratinocytes.

Terbinafine-induced lichenoid drug eruption

Drug-induced lichen planus has been induced by antibiotics, anticonvulsants, antidiabetics, antimalarials, antitubercular drugs, antihypertensives, psychiatric drugs, chemotherapeutic agents, diuretic, heavy metals, NSAIDs, etc. Terbinafine, an antifungal agent, is widely used for dermatophyte infections and onychomycosis. Cutaneous adverse effects of terbinafine are rarely reported. Here, we report a case of terbinafine-induced lichenoid drug eruption in a 22-year-old who presented with generalized lichenoid eruption 2 weeks after terbinafine initiation of. The body and lip cleared completely after 8 weeks of drug withdrawal; nail change cleared after 12 weeks.

The skin as a target organ in multisystemic diseases II

Progress in medical science has given a new reading to the claim that the skin could be a mirror of the pathological changes found in the internal organs. The concept that we previously promoted is furthered in this issue; namely that the greatest part of skin diseases are systemic ones. In this issue we focus on another group of diseases with systemic involvement and skin manifestations. We review such inflammatory conditions as lichen planus, autoinflammatory syndromes, and pyoderma gangrenosum focusing on their systemic involvement. We have not missed such classic examples of systemic involvement as scleroderma. In this issue we have included two infectious diseases with multi-organ involvement: Lyme disease and Herpes simplex. In contrast to our previous work, we have also addressed neoplastic diseases - namely mycosis fungoides.