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Gan C, Mahil S, Pink A, Rodrigues M. Atopic dermatitis in skin of colour. Part 2: considerations in clinical presentation and treatment options. Clin Exp Dermatol 2023; 48:1091-1101. [PMID: 37119261 DOI: 10.1093/ced/llad162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 03/09/2023] [Accepted: 04/24/2023] [Indexed: 05/01/2023]
Abstract
Recent advances in atopic dermatitis (AD) present the condition as a heterogeneous disease of distinct endotypes across ethnic groups. AD in people with skin of colour may appear psoriasiform, lichenoid, scaly or papular, with a violaceous colour and there is a higher prevalence of post-inflammatory dyspigmentation compared with affected individuals of White ethnicity. These differences in clinical presentation may limit the use of AD assessment tools in people with skin of colour, leading to the potential for misdiagnosis and underestimation of severity, particularly in relation to assessment of erythema. Recent targeted therapies for AD have been studied in multiple ethnic groups; however, ethnicity-based subgroup analysis is often not performed. Further research is required to understand whether treatment responses or safety may differ among ethnic groups.
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Affiliation(s)
- Christian Gan
- Department of Dermatology, The Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Dermatology, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Satveer Mahil
- St John's Institute of Dermatology, Guy's and St Thomas NHS Foundation Trust and King's College London, London, UK
| | - Andrew Pink
- St John's Institute of Dermatology, Guy's and St Thomas NHS Foundation Trust and King's College London, London, UK
| | - Michelle Rodrigues
- Department of Dermatology, The Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
- Chroma Dermatology, Pigment and Skin of Colour Centre, VIC, Australia
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Monasterio C, Decker A, Schauer F, Büttner N, Schmidt A, Schmitt-Gräff A, Kreisel W. [Esophageal Lichen Planus - An Underdiagnosed Disease]. Laryngorhinootologie 2023; 102:272-281. [PMID: 37040750 DOI: 10.1055/a-1861-7187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
An involvement of the esophagus in patients with lichen planus was described for the first time in 1982. Ever since, it has been seen as a rarity. However, studies over the last 10 years have shown a higher prevalence than expected. It may even be supposed that esophageal lichen planus (ELP) is more common than eosinophilic esophagitis. ELP mostly affects middleaged women. The principal symptom is dysphagia. Endoscopically, ELP is characterized by denudation and tearing of the mucosa, trachealization and hyperkeratosis and esophageal stenosis may occur in patients with long courses of the disease. Histologic findings including mucosal detachment, T-lymphocytic infiltrate, intraepithelial apoptosis (civatte bodies) and dyskeratosis are crucial. Direct immunofluorescence shows fibrinogen deposits along the basement membrane zone. So far, there is no well-established therapy but a treatment with topic steroids is effective in 2/3 of the patients. Common therapy of lichen planus of the skin seems to be ineffective for treatment of ELP. Symptomatic esophageal stenosis should be endoscopically dilated. ELP joins the group of "new" immunologic diseases of the esophagus.
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Affiliation(s)
- Carmen Monasterio
- Klinik für Innere Medizin II, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, 79106 Freiburg, Germany
| | - Annegrit Decker
- Klinik für Innere Medizin II, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, 79106 Freiburg, Germany
| | - Franziska Schauer
- Klinik für Dermatologie und Venerologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Germany
| | - Nico Büttner
- Klinik für Innere Medizin II, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, 79106 Freiburg, Germany
| | - Arthur Schmidt
- Klinik für Innere Medizin II, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, 79106 Freiburg, Germany
| | - Annette Schmitt-Gräff
- Medizinische Fakultät, Universitätsklinikum Freiburg, Albert-Ludwigs-Universität Freiburg, Freiburg, Germany
- Institut für Dermatohistologie, Pathologie und Molekularpathologie, Dr. Helmut Laaff, Freiburg, Germany
| | - Wolfgang Kreisel
- Klinik für Innere Medizin II, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, 79106 Freiburg, Germany
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Monasterio C, Decker A, Schauer F, Büttner N, Schmidt A, Schmitt-Gräff A, Kreisel W. Der Lichen planus des Ösophagus – Eine unterschätzte Erkrankung. AKTUELLE DERMATOLOGIE 2023. [DOI: 10.1055/a-1753-7120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
ZusammenfassungEine Beteiligung des Ösophagus bei der Hauterkrankung Lichen planus wurde erstmals 1982 beschrieben und fast 30 Jahre lang als eine Rarität angesehen. Untersuchungen der letzten 10 Jahre aber zeigen, dass diese Erkrankung weniger selten ist als angenommen. Es ist sogar anzunehmen, dass der ösophageale Lichen planus (Esophageal Lichen planus, ELP) häufiger ist als die Eosinophile Ösophagitis (EoE). Die Ösophagusbeteiligung betrifft meist Frauen im mittleren Alter. Das Hauptsymptom ist eine Dysphagie. Endoskopisch erkennt man in der Speiseröhre eine charakteristische Schleimhautablösung, eine Trachealisierung, und gelegentlich Hyperkeratosen und bei langem Bestehen auch Stenosen. Wegweisend ist die Histologie mit einer subepithelialen Ablösung sowie einem bandförmigen Infiltrat aus T-Lymphozyten, dem Nachweis von apoptotischen Keratinozyten (Civatte Bodies) und Dyskeratosen. Die direkte Immunfluoreszenz zeigt Fibrinogen-Ablagerungen entlang der Basalmembran. Eine etablierte Therapie gibt es bisher nicht. Die Behandlung mit topischen Steroiden ist in ⅔ der Fälle wirksam. Eine Therapie wie beim klassischen Lichen planus scheint unwirksam zu sein. Bei symptomatischen Stenosen kann eine Dilatation indiziert sein. Der ELP reiht sich in die Gruppe der „neuen“ immunologisch vermittelten Erkrankungen des Ösophagus ein.
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Affiliation(s)
- Carmen Monasterio
- Klinik für Innere Medizin II, Gastroenterologie, Hepatologie, Endokrinologie und Infektiologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
| | - Annegrit Decker
- Klinik für Innere Medizin II, Gastroenterologie, Hepatologie, Endokrinologie und Infektiologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
| | - Franziska Schauer
- Klinik für Dermatologie und Venerologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
| | - Nico Büttner
- Klinik für Innere Medizin II, Gastroenterologie, Hepatologie, Endokrinologie und Infektiologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
| | - Arthur Schmidt
- Klinik für Innere Medizin II, Gastroenterologie, Hepatologie, Endokrinologie und Infektiologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
| | - Annette Schmitt-Gräff
- Medizinische Fakultät, Universitätsklinikum Freiburg, Albert-Ludwigs-Universität Freiburg
- Institut für Dermatohistologie, Pathologie und Molekularpathologie, Dr. Helmut Laaff, Freiburg
| | - Wolfgang Kreisel
- Klinik für Innere Medizin II, Gastroenterologie, Hepatologie, Endokrinologie und Infektiologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
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Decker A, Schauer F, Lazaro A, Monasterio C, Schmidt AR, Schmitt-Graeff A, Kreisel W. Esophageal lichen planus: Current knowledge, challenges and future perspectives. World J Gastroenterol 2022; 28:5893-5909. [PMID: 36405107 PMCID: PMC9669830 DOI: 10.3748/wjg.v28.i41.5893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/17/2022] [Accepted: 10/27/2022] [Indexed: 11/09/2022] Open
Abstract
Lichen planus (LP) is a frequent, chronic inflammatory disease involving the skin, mucous membranes and/or skin appendages. Esophageal involvement in lichen planus (ELP) is a clinically important albeit underdiagnosed inflammatory condition. This narrative review aims to give an overview of the current knowledge on ELP, its prevalence, pathogenesis, clinical manifestation, diagnostic criteria, and therapeutic options in order to provide support in clinical management. Studies on ELP were collected using PubMed/Medline. Relevant clinical and therapeutical characteristics from published patient cohorts including our own cohort were extracted and summarized. ELP mainly affects middle-aged women. The principal symptom is dysphagia. However, asymptomatic cases despite progressed macroscopic esophageal lesions may occur. The pathogenesis is unknown, however an immune-mediated mechanism is probable. Endoscopically, ELP is characterized by mucosal denudation and tearing, trachealization, and hyperkeratosis. Scarring esophageal stenosis may occur in chronic courses. Histologic findings include mucosal detachment, T-lymphocytic infiltrations, epithelial apoptosis (Civatte bodies), dyskeratosis, and hyperkeratosis. Direct immuno-fluorescence shows fibrinogen deposits along the basement membrane zone. To date, there is no established therapy. However, treatment with topical steroids induces symptomatic and histologic improvement in two thirds of ELP patients in general. More severe cases may require therapy with immunosuppressors. In symptomatic esophageal stenosis, endoscopic dilation may be necessary. ELP may be regarded as a precancerous condition as transition to squamous cell carcinoma has been documented in literature. ELP is an underdiagnosed yet clinically important differential diagnosis for patients with unclear dysphagia or esophagitis. Timely diagnosis and therapy might prevent potential sequelae such as esophageal stenosis or development of invasive squamous cell carcinoma. Further studies are needed to gain more knowledge about the pathogenesis and treatment options.
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Affiliation(s)
- Annegrit Decker
- Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg 79106, Germany
| | - Franziska Schauer
- Department of Dermatology, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg 79104, Germany
| | - Adhara Lazaro
- Department of Medicine, Institute of Exercise and Occupational Medicine, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg 79106, Germany
| | - Carmen Monasterio
- Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg 79106, Germany
| | - Arthur Robert Schmidt
- Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg 79106, Germany
| | - Annette Schmitt-Graeff
- Institute for Dermatohistology, Pathology, and Molecular Pathology Prof. Dr. Laaf, Freiburg, Germany and: University of Freiburg, Freiburg 79106, Germany
| | - Wolfgang Kreisel
- Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg 79106, Germany
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Saab-Chalhoub MW, Correa H, Anderson JL, Kovach AE, Salaria SN. Civatte Bodies in Pediatric Esophageal Biopsies: Does Lichen Esophagitis Pattern Occur in Children? Pediatr Dev Pathol 2022; 25:458-465. [PMID: 35452319 DOI: 10.1177/10935266221090081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE AND CONTEXT Civatte bodies (CB) are associated with cutaneous and mucosal lichen planus in adults. They are a distinct feature of Lichen Esophagitis Pattern, which is not well described in children. We characterized clinicopathologic associations of archival esophageal CB at our Children's Hospital to determine whether lichen planus or Lichen Esophagitis Pattern occurs in children. METHOD Pathology records were queried for pediatric esophageal biopsy diagnoses containing "CB," "apoptosis, "necrosis," or "dyskeratosis." Cases with concurrent eosinophilic/acute esophagitis were excluded. H&E slides and clinical reports were reviewed. KEY RESULTS Biopsies with CB or similar were identified from 19 patients and had been termed "dyskeratotic cells" in 8 reports. Patients had variable age and presenting symptoms, male predominance (74%), and frequent clinical history of polypharmacy (47%), Crohn disease (42%), and/or celiac disease (21%). Civatte bodies were prominent in the distal esophagus (95%), as few isolated cells (63%), and with variable chronic inflammation (absent, pauci-inflammatory, and lichen planus-like in approximately one-third of cases each). CONCLUSIONS We show that esophageal CB from pediatric patients are under-recognized and may have different features and implications compared to Lichen Esophagitis Pattern in adults. Recognition and documentation of pediatric esophageal CB is needed to understand their clinical significance.
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Affiliation(s)
- Mario W Saab-Chalhoub
- Division of Gastrointestinal Pathology, Department of Pathology, Microbiology & Immunology, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hernán Correa
- Division of Pediatric Pathology, Department of Pathology, Microbiology & Immunology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 21629Vanderbilt University Medical Center, Nashville, TN, USA
| | - Julia L Anderson
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alexandra E Kovach
- Division of Pediatric Pathology, Department of Pathology, Microbiology & Immunology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 21629Vanderbilt University Medical Center, Nashville, TN, USA
| | - Safia N Salaria
- Division of Gastrointestinal Pathology, Department of Pathology, Microbiology & Immunology, 12328Vanderbilt University Medical Center, Nashville, TN, USA
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Progress in the application of reflectance confocal microscopy in dermatology. Postepy Dermatol Alergol 2021; 38:709-715. [PMID: 34849113 PMCID: PMC8610039 DOI: 10.5114/ada.2021.110077] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 12/10/2019] [Indexed: 12/23/2022] Open
Abstract
Reflectance confocal microscopy (RCM) is abbreviated as skin three-dimensional computed tomography, which can help clearly observe the structure of the epidermis and superficial dermis. It is a non-invasive skin disease examination method and provides fast access to real-time, dynamic skin micro-anatomical images. Therefore, RCM is widely used in the clinical diagnosis of skin diseases. For example, the RCM features of vitiligo are as follows: pigment loss or partial pigment loss in the lesion area, loss of the basal layer pigment ring. The RCM findings of Riehl melanosis are as follows: basal cell liquefaction and degeneration. The RCM results for verruca plana show: the Rose-like structure. The characteristics of psoriasis under RCM include: hyperkeratosis, parakeratosis, thickening of the spinous layer, capillary dilatation and hyperaemia, peripheral inflammatory cell infiltration. Epidermal brain-like structure was observed under RCM of seborrheic keratosis. With RCM, image acquisition and preservation of the skin is convenient, and the technique is convenient for comparing the development of lesions during long-term follow-up observation. Therefore, it helps to understand disease development in real time and dynamically and can be used to evaluate the curative effect. In this article, we briefly review the technical principles, diagnostic criteria for RCM application and RCM-related research progress in the diagnosis of pigmentary diseases, inflammatory diseases, skin tumours, and other common skin diseases.
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Monasterio C, Decker A, Schauer F, Büttner N, Schmidt A, Schmitt-Gräff A, Kreisel W. [Esophageal Lichen Planus - an Underdiagnosed Disease]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2021; 59:460-469. [PMID: 33831967 DOI: 10.1055/a-1378-9380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
An involvement of the esophagus in patients with lichen planus was described for the first time in 1982. Ever since, it has been seen as a rarity. However, studies over the last 10 years have shown a higher prevalence than expected. It may even be supposed that esophageal lichen planus (ELP) is more common than eosinophilic esophagitis. ELP mostly affects middle-aged women. The principal symptom is dysphagia. Endoscopically, ELP is characterized by denudation and tearing of the mucosa, trachealization and hyperkeratosis and esophageal stenosis may occur in patients with long courses of the disease. Histologic findings including mucosal detachment, T-lymphocytic infiltrate, intraepithelial apoptosis (civatte bodies) and dyskeratosis are crucial. Direct immunofluorescence shows fibrinogen deposits along the basement membrane zone. So far, there is no well-established therapy but a treatment with topic steroids is effective in 2/3 of the patients. Common therapy of lichen planus of the skin seems to be ineffective for treatment of ELP. Symptomatic esophageal stenosis should be endoscopically dilated. ELP joins the group of "new" immunologic diseases of the esophagus.
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Affiliation(s)
- Carmen Monasterio
- Klinik für Innere Medizin II, Gastroenterologie, Hepatologie, Endokrinologie und Infektiologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
| | - Annegrit Decker
- Klinik für Innere Medizin II, Gastroenterologie, Hepatologie, Endokrinologie und Infektiologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
| | - Franziska Schauer
- Klinik für Dermatologie und Venerologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
| | - Nico Büttner
- Klinik für Innere Medizin II, Gastroenterologie, Hepatologie, Endokrinologie und Infektiologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
| | - Arthur Schmidt
- Klinik für Innere Medizin II, Gastroenterologie, Hepatologie, Endokrinologie und Infektiologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
| | - Annette Schmitt-Gräff
- Medizinische Fakultät, Universitätsklinikum Freiburg, Albert-Ludwigs-Universität Freiburg.,Institut für Dermatohistologie, Pathologie und Molekularpathologie, Dr. Helmut Laaff, Freiburg
| | - Wolfgang Kreisel
- Klinik für Innere Medizin II, Gastroenterologie, Hepatologie, Endokrinologie und Infektiologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg
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Yukkaldıran A, Erdogan O, Dundar R, An İ, Aksoy M. Evaluation of inner ear and hearing functions in lichen planus patients. J Cosmet Dermatol 2021; 21:776-780. [PMID: 33811428 DOI: 10.1111/jocd.14124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/09/2021] [Accepted: 03/29/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Lichen planus (LP), which affects skin, nails, hair, and mucosal surfaces, is a chronic, autoimmune, and inflammatory disease, and autoimmune diseases may affect the inner ear. AIMS This study aims to investigate hearing and inner ear functions of the LP patients. PATIENTS/METHODS The present study was formed by 49 patients who were clinically and histopathologically diagnosed with LP and did not receive any treatment. The healthy group consisted of 52 healthy individuals. Pure tone audiometry (PTA) and distortion product otoacoustic emission tests were used in the hearing evaluation. RESULTS At frequencies of 1, 2, 4, 6, and 8 kHz in the right ear and 0.5, 1, 2, 4, 6, and 8 kHz in the left ear in PTA, the lichen group's hearing thresholds were higher than the healthy group's. Upon comparing the hearing thresholds of LP patients with oral mucosa involvement and LP patients without oral mucosa involvement, there were significant differences between the groups at 1, 4, and 8 kHz in the right ear and at 0.25, 0.5, 2, 4, 6, and 8 kHz in the left ear. CONCLUSION Because of the increasing hearing thresholds, we think that hearing and inner ear functions of LP patients, particularly with oral mucosal involvement, are negatively affected.
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Affiliation(s)
- Ahmet Yukkaldıran
- Department of Otorhinolaryngology, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
| | - Osman Erdogan
- Department of Otorhinolaryngology, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
| | - Rıza Dundar
- Department of Otorhinolaryngology, Eskişehir Acıbadem Hospital, Eskisehir, Turkey
| | - İsa An
- Department of Dermatology, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
| | - Mustafa Aksoy
- Department of Dermatology, Harran University Faculty of Medicine, Sanliurfa, Turkey
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Mitchell JC, Burden JG, Williams JV. Extensive pruritic eruption in a child. Pediatr Dermatol 2020; 37:e81-e82. [PMID: 33283929 DOI: 10.1111/pde.14303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 06/08/2020] [Accepted: 07/04/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Julia C Mitchell
- Ocean Lakes High School, Math and Science Academy, Virginia Beach, Virginia, USA
| | - Julia G Burden
- Children's Specialty Group, Division of Dermatology, Children's Hospital of The King's Daughters, Norfolk, Virginia, USA
| | - Judith V Williams
- Children's Specialty Group, Division of Dermatology, Children's Hospital of The King's Daughters, Norfolk, Virginia, USA
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Sidikov A, Zaslavsky D, Sadykov A, Megna M, Garcia T, Aristizabal M, Chuprov I, Olisova О, Grekova Е, Ibragimova N, Kozlova D, Nasyrov R, Shalaeva EV. The new differential diagnostic test for the lichenoid drug eruption. Dermatol Ther 2020; 33:e13784. [PMID: 32510667 DOI: 10.1111/dth.13784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/28/2020] [Accepted: 05/31/2020] [Indexed: 12/23/2022]
Abstract
The differential diagnosis between lichenoid drug eruption (LDE) and lichen planus (LP) is difficult due to similar clinical and histological signs but important for treatment and prognosis. The purpose of this study was to propose the new diagnosis method for differentiate LDE from LP. During 2015-2018, 20 patients with confirmed LDE, 13 patients with LP and 134 controls were examined and treated at the Lenoblcenter. All enrolled patients were underwent the injection of 0.5 mL of the 2% lidocaine solution by insulin syringe into the papule with following histological examination. The formation of a blister (bulla) at the site of injection was considered a positive test result. Among LDE, 18 of 20 patients were found positive for developing blister (bulla) and two results were questionable. In 12 of 13 LP patents, bulla on the site of injection was not identified and the result of one patient was nonspecific. All control patients were negative for the proposed test. The histological sections showed that the bulla has corresponded to the separation of the epidermis from the dermis. Intracutaneous injection of 0.5 mL of lidocaine into the papule is an easy highly specific and sensitive method to differentiate LDE from LP.
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Affiliation(s)
- Akmal Sidikov
- Department of Dermatovenereology, St. Petersburg State Pediatric Medical University, 2A, Litovskaya, Saint Petersburg, 194100, Russian Federation
| | - Denis Zaslavsky
- Department of Dermatovenereology, St. Petersburg State Pediatric Medical University, 2A, Litovskaya, Saint Petersburg, 194100, Russian Federation
| | - Aslan Sadykov
- Department of dermatovenereology, Medical Center XXI century, 45, Bol'shoy Sampsonievsky prospect, Saint-Petersburg, 194044, Russian Federation
| | - Matteo Megna
- Department of Dermatovenereology, St. Petersburg State Pediatric Medical University, 2A, Litovskaya, Saint Petersburg, 194100, Russian Federation
| | - Torres Garcia
- Department of Dermatovenereology, St. Petersburg State Pediatric Medical University, 2A, Litovskaya, Saint Petersburg, 194100, Russian Federation
| | - Mikhea Aristizabal
- Department of Dermatovenereology, St. Petersburg State Pediatric Medical University, 2A, Litovskaya, Saint Petersburg, 194100, Russian Federation
| | - Igor Chuprov
- Department of Pathomorphology, I.I. Mechnikov North-Western State Medical University, 47, Piskarevsky prospect, St. Petersburg, 195067, Russian Federation
| | - Оlga Olisova
- V.A. Rakhmanov Department of Skin and Venereal Diseases, I.M. Sechenov First Moscow State Medical University, 19c1, Bol'shaya Pirogovskaya, Moscow, 119146, Russian Federation
| | - Еkaterina Grekova
- V.A. Rakhmanov Department of Skin and Venereal Diseases, I.M. Sechenov First Moscow State Medical University, 19c1, Bol'shaya Pirogovskaya, Moscow, 119146, Russian Federation
| | - Nargiza Ibragimova
- Department of dermatovenereology, Republican Scientific and Practical Center of Sports Medicine, 6, Almazar street, Tashkent, 100003, Uzbekistan
| | - Darya Kozlova
- Department of Dermatovenereology, St. Petersburg State Pediatric Medical University, 2A, Litovskaya, Saint Petersburg, 194100, Russian Federation
| | - Ruslan Nasyrov
- Department of Dermatovenereology, St. Petersburg State Pediatric Medical University, 2A, Litovskaya, Saint Petersburg, 194100, Russian Federation
| | - Evgeniya V Shalaeva
- Department of dermatovenereology, Tashkent Medical Academy, 2, Ferobiy, Tashkent, 100109, Uzbekistan
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Schauer F, Monasterio C, Technau-Hafsi K, Kern JS, Lazaro A, Deibert P, Hasselblatt P, Schwacha H, Heeg S, Brass V, Küllmer A, Schmidt AR, Schmitt-Graeff A, Kreisel W. Esophageal lichen planus: towards diagnosis of an underdiagnosed disease. Scand J Gastroenterol 2019; 54:1189-1198. [PMID: 31608788 DOI: 10.1080/00365521.2019.1674375] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: Although lichen planus (LP) is a common skin disorder, the prevalence of esophageal involvement (ELP) and its clinical manifestations are poorly defined. We aimed to establish diagnostic criteria and characterize disease outcomes of ELP.Methods: Clinical, endoscopic, histological, and immunofluorescence data from consecutive patients with known LP between 2013 and 2018 were analyzed. We established endoscopic (denudation and tearing of the mucosa, hyperkeratosis and trachealization) and histological criteria (mucosal detachment, T-lymphocytic infiltrate, intraepithelial apoptosis, dyskeratosis, and fibrinogen deposits along the basement membrane) to grade disease severity. Endoscopic findings were correlated with clinical symptoms. Response to medical therapy was monitored.Results: Fifty-two consecutive patients (median age 59.5 years) were analyzed. According to our grading system, 16 patients were considered as severe and 18 as mild ELP. Dysphagia was the only symptom which differentiated patients with severe (14/16) or mild ELP (8/18) from patients without ELP (1/18). Concomitant oral and genital involvement of LP was associated with the presence of ELP, while oral involvement alone was not. Follow-up of 14/16 patients with severe EPL for at least one year revealed that most of these patients responded to topical corticosteroids (budesonide: n = 9/10 or fluticasone n = 2/2). Three budesonide patients experienced a resolution of symptomatic esophageal stenosis.Conclusions: Esophageal involvement of LP is frequent, but may be asymptomatic. ELP can be diagnosed using the diagnostic criteria proposed here. Dysphagia and combined oral and genital manifestation are associated with ELP. Therapy with topical corticosteroids appears to be a prudent therapeutic approach for ELP.
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Affiliation(s)
- Franziska Schauer
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Carmen Monasterio
- Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kristin Technau-Hafsi
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Johannes Steffen Kern
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Dermatology, Royal Melbourne Hospital, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia
| | - Adhara Lazaro
- Department of Medicine, Institute of Exercise and Occupational Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Deibert
- Department of Medicine, Institute of Exercise and Occupational Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Hasselblatt
- Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Henning Schwacha
- Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Steffen Heeg
- Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Volker Brass
- Kliniken des Landkreises Lörrach GmbH, Gastroenterology, Germany
| | - Armin Küllmer
- Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Arthur Robert Schmidt
- Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Annette Schmitt-Graeff
- Institute of Clinical Pathology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Wolfgang Kreisel
- Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Abstract
Lichen nitidus is a rare, chronic dermatosis which occurs more often in children than in adults. It presents with tiny, monomorphous, lichenoid, mostly asymptomatic papules in regional or disseminated distribution which show a pathognomonic histological pattern. The pathogenesis is unclear; however, immunologic phenomena and genetic factors are under discussion. In rare cases, an association with other dermatoses and systemic diseases has been described. Moreover, medical treatments have been incriminated as triggers. Considering the self-limited course in mostly young patients, treatment must be thoroughly weighed. Possible therapeutic options include topical corticosteroids and calcineurin inhibitors as well as oral antihistamines, corticosteroids and narrow-band ultraviolet B phototherapy. Lichen striatus is an acquired, usually asymptomatic dermatosis occurring mostly in preschool children. The characteristic feature is the arrangement of small, flat, light red- to skin-colored papules along the lines of Blaschko. Therefore, a postzygotic mutation of epidermal progenitor cells induced to express new surface antigens by trigger factors as infections, vaccinations or trauma with consecutive immune reaction is assumed. Nail involvement of the affected limb can rarely occur. Lichen striatus usually heals without scarring within several months, so that therapies with severe side effects are obsolete. Mild topical corticosteroids or calcineurin inhibitors may be used, especially if patients exceptionally suffer from pruritus. A postinflammatory hypopigmentation can persist for months to years.
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13
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Cusenza A, Koushk-Jalali B, Oellig F, Tigges C, Lehmann P, Kreuter A. Ein 7‑jähriger Junge mit leicht juckenden, weißlichen, stecknadelkopfgroßen Papeln. Hautarzt 2019; 70:312-314. [DOI: 10.1007/s00105-019-4365-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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14
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Thandar Y, Maharajh R, Haffejee F, Mosam A. Treatment of cutaneous lichen planus (Part 1): A review of topical therapies and phototherapy. COGENT MEDICINE 2019. [DOI: 10.1080/2331205x.2019.1582467] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Yasmeen Thandar
- Department of Basic Medical Sciences, Faculty of Heath Sciences, Durban University of Technology, Durban, South Africa
| | - Rivesh Maharajh
- Department of Basic Medical Sciences, Faculty of Heath Sciences, Durban University of Technology, Durban, South Africa
| | - Firoza Haffejee
- Department of Basic Medical Sciences, Faculty of Heath Sciences, Durban University of Technology, Durban, South Africa
| | - Anisa Mosam
- Department of Dermatology, University of KwaZulu-Natal & Nelson Mandela School of Medicine, Durban, South Africa
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15
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Okpala IC, Akinboro AO, Ezejoifor IO, Onunu AN, Okwara BU. Metabolic Syndrome and Dyslipidemia among Nigerians with Lichen Planus: A Cross-Sectional Study. Indian J Dermatol 2019; 64:303-310. [PMID: 31516140 PMCID: PMC6714181 DOI: 10.4103/ijd.ijd_111_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Lichen planus (LP) is an inflammatory skin disease of unknown etiology associated with chronic inflammation, oxidative stress induction, and cardiovascular risk factors. Objectives: To document the prevalence of metabolic syndrome (MetS), dyslipidemia, and associated factors in Nigerian patients with LP. Methods: A cross-sectional design was made to evaluate 90 patients with LP and 90 controls for MetS and dyslipidemia in two Nigerian teaching hospitals. Diagnosis of LP was made with the aid of histology, and MetS and dyslipidemia were diagnosed using the National Cholesterol Education Program Adult Treatment Panel III criteria. Results: The prevalence of MetS was insignificantly higher in LP than in control (18.9% vs. 13.5, P = 0.311), and dyslipidemia was significantly associated with LP (60% vs. 40%, P = 0.007). LP was associated with higher mean of serum triglyceride (1.21 ± 0.34 vs. 1.08 ± 0.32 mmol/L, P = 0.003), low-density lipoprotein cholesterol (3.47 ± 0.89 vs. 3.12 ± 0.77 mmol/L, P = 0.007), and T-cholesterol (5.32 ± 0.88 vs. 4.92 ± 0.86, P = 0.002). LP patients with MetS were older (P < 0.001) and less likely to have Wickham's striae (P = 0.028) compared to those without MetS. Female LP patients were older (P = 0.047), obese (P = 0.043), and had insignificant increase in MetS prevalence compared to the males. Hypertrophic LP was more frequent in patients with dyslipidemia (63.0% vs. 27.8%, P = 0.002), and the family history of diabetes mellitus (DM) was an independent predictor of MetS in LP patients (odds ratio: 4.4, confidence interval: 1.0–19.1, P = 0.047). Limitation: Availability of fund is a significant factor that limited the sample size to the minimum required as always in a poor-resource setting. Conclusions: LP has an insignificant association with MetS and a significant association with dyslipidemia among Nigerians. The family history of DM is an independent predictor of MetS in LP patients. LP patients should be routinely screened for MetS and its components.
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Affiliation(s)
- Ifeanyi Chibuzor Okpala
- Department of Medicine, Dermatology Unit, Nnamdi Azikiwe University Awka and Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Adeolu Oladayo Akinboro
- Department of Internal Medicine, Dermatology Unit, Ladoke Akintola University of Technology, Ogbomoso and LAUTECH Teaching Hospital, Ogbomoso, Oyo State, Nigeria
| | - Ifeanyi Ogochukwu Ezejoifor
- Department of Medicine, Dermatology Unit, Nnamdi Azikiwe University Awka and Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Abel N Onunu
- Department of Medicine, Dermatology Unit, University of Benin and University of Benin Teaching Hospital, Benin, Edo State, Nigeria
| | - Benson Uchechukwu Okwara
- Department of Medicine, Dermatology Unit, University of Benin and University of Benin Teaching Hospital, Benin, Edo State, Nigeria
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16
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Thandar Y, Maharajh R, Haffejee F, Mosam A. Treatment of cutaneous lichen planus (part 2): a review of systemic therapies. J DERMATOL TREAT 2018; 30:633-647. [DOI: 10.1080/09546634.2018.1544411] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Yasmeen Thandar
- Faculty of Heath Sciences, Department of Basic Medical Sciences, Durban University of Technology, Durban, South Africa
| | - Rivesh Maharajh
- Faculty of Heath Sciences, Department of Basic Medical Sciences, Durban University of Technology, Durban, South Africa
| | - Firoza Haffejee
- Faculty of Heath Sciences, Department of Basic Medical Sciences, Durban University of Technology, Durban, South Africa
| | - Anisa Mosam
- Department of Dermatology, University of KwaZulu-Natal and Nelson Mandela School of Medicine, Durban, South Africa
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18
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Kim J, Park S, Jung CM, Oh CW, Kwon JW. A Case of Cycloserine-Induced Lichenoid Drug Eruption Supported by the Lymphocyte Transformation Test. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2017; 9:281-284. [PMID: 28293936 PMCID: PMC5352581 DOI: 10.4168/aair.2017.9.3.281] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 12/12/2016] [Accepted: 12/21/2016] [Indexed: 01/20/2023]
Abstract
Lichenoid drug eruption (LDE) is a rare form of delayed-type drug eruption. Among anti-tuberculosis (Tb) agents, cycloserine (CS) has been reported as a rare cause of LDE. Positive results on the lymphocyte transformation test (LTT) have not been reported in patients with LDE. In the present case, we performed LTT and a patch test, and successfully proved CS as the offending drug in this patient, who had been treated with multiple anti-Tb drugs. These observations suggest that CS should be considered a possible cause of LDE and that LTT can be an option for the diagnosis of LDE.
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Affiliation(s)
- Jakyoung Kim
- Department of Pediatrics, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Shinyoung Park
- The Research Department, Kangwon Regional Cancer Center, Kangwon National University Hospital, Chuncheon, Korea
| | - Chul Min Jung
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Chee Won Oh
- Department of Dermatology, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Jae Woo Kwon
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea.,Department of Allergy and Clinical Immunology, Kangwon National University School of Medicine, Chuncheon, Korea.
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19
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Abstract
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.
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Affiliation(s)
- Yue Zheng
- a Department of Dermatovenereology , the Third Affiliated Hospital of Sun Yat-Sen University , Guangzhou, Guangdong , P.R. China and
| | - Jie Zhang
- a Department of Dermatovenereology , the Third Affiliated Hospital of Sun Yat-Sen University , Guangzhou, Guangdong , P.R. China and
| | - Haiyan Chen
- a Department of Dermatovenereology , the Third Affiliated Hospital of Sun Yat-Sen University , Guangzhou, Guangdong , P.R. China and
| | - Wei Lai
- a Department of Dermatovenereology , the Third Affiliated Hospital of Sun Yat-Sen University , Guangzhou, Guangdong , P.R. China and
| | - Howard I Maibach
- b Department of Dermatology , University of California, School of Medicine , San Fransico, CA, USA
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