Update on lichen planus and its clinical variants

Vaccine-Induced Annular Atrophic Lichen Planus

Annular atrophic lichen planus (AALP) is a chronic subtype of lichen planus that classically does not respond to treatment with topical steroids. An inflammatory reaction in the dermal infiltrate may play a role in the development of AALP, but the exact pathogenesis remains unclear. We present the case of a 54-year-old-female with lesions on her trunk and extremities that developed following vaccination. Her failed treatment response warranted further workup for AALP, which was confirmed around 1 year after initiation. Although vaccine-induced lichen planus is not common, it has been reported in various cases. We present a rare case of AALP following vaccination and then provide an in-depth discussion of factors associated with the condition and current treatment response.

Lichen Planus Initially Presenting as Poikiloderma: A Challenging Case Report

Lichen planus (LP) is a chronic inflammatory disorder that affects the skin, mucous membranes, nails, and hair. Cutaneous LP (CLP) is characterized by violaceous, polygonal, flat-topped papules and plaques that are intensely pruritic. Although it can develop on any part of the body, it most commonly affects the flexor surfaces of the wrists, lower back, and ankles. This report presents an atypical case of LP in a 33-year-old woman who initially exhibited poikilodermatous changes with bluish-gray patches, persisting for a decade. Due to the overlapping clinical and histopathological features, an extensive diagnostic workup including pan-computed tomography, lymph node biopsy, and immunohistochemistry was performed to exclude poikilodermatous mycosis fungoides. One year later, skin examination and histopathological evaluation revealed the classical features of LP, leading to a definitive diagnosis. This case highlights an unusual presentation in which poikiloderma preceded the classic clinical picture of LP. Our findings contribute to the existing knowledge of LP by emphasizing the importance of recognizing atypical presentations for accurate diagnosis and management.

Distinct Immunological Features Compared to Lichen Planus and Oral Lichen Planus

Purpose

Lichen planus (LP) and oral lichen planus (OLP) share clinical and histological similarities, yet their distinct immunopathological mechanisms make differentiation and management challenging. Clarifying these differences is essential for accurate diagnosis and treatment. This study aimed to investigate the systemic immune profile of OLP using single-cell transcriptomics, identifying distinct immune cell subsets and signaling pathways contributing to its chronic inflammatory state. Additionally, it sought to compare the inflammatory lesion microenvironments of OLP and LP by analyzing key immune pathways and cellular interactions.

Methods

Peripheral blood mononuclear cells (PBMCs) were obtained from 16 OLP patients and 5 healthy controls. Single-cell transcriptomic data from PBMCs and lesion tissues of OLP and LP were analyzed to profile immune and inflammatory signatures. Key molecular findings were validated using independent datasets and enzyme-linked immunosorbent assays (ELISA).

Results

Prostaglandin D2 synthase (PTGDS), a pivotal enzyme in prostaglandin metabolism, emerged as a diagnostic marker with elevated expression in NK cells from OLP patients. Additionally, a novel CXCR4 high-TSC22D3 high CD4 cytotoxic T cell subset with enhanced cytotoxicity was identified, potentially contributing to OLP pathogenesis. OLP blood samples also demonstrated significant upregulation of TNF and TLR signaling in NK cells, indicating a heightened chronic inflammatory state. Comparative tissue analysis revealed intensified TNF-driven inflammation and a disrupted HIF1A- vascular endothelial growth factor (VEGF) interactions in OLP, contrasting with LP's robust VEGF-mediated angiogenesis.

Discussion

These findings highlight distinct immunopathogenic mechanisms between OLP and LP. The upregulation of PTGDS in NK cells and CXCR4 high-TSC22D3 high CD4 cytotoxic T cells in PBMCs indicates systemic immune dysregulation in OLP, while tissue-level differences suggest impaired vascular remodeling and chronic inflammation. These insights underscore the need for targeted immunomodulatory therapies.

Conclusion

This study identifies distinct immune signatures that differentiate OLP from LP, highlighting potential therapeutic targets that require further validation for personalized treatment strategies.

Hypertrophic Lichen Planus and Hypertrophic Skin Lesions Associated with Histological Lichenoid Infiltrate: A Case Report and Literature Review

Hypertrophic lichen planus (HLP) is a chronic inflammatory skin condition defined by verrucous, pruritic, papules and plaques usually affecting the lower limbs. The diagnosis of HLP is primarily clinical. However, due to its feasible generalized presentation and similarities with other hypertrophic cutaneous disorders, histological evaluation is often necessary. Many dermatological conditions that present with a hypertrophic clinical appearance can arise from a histological lichenoid infiltrate (HCLI). Hence, we provide an overview of the clinical, histopathological, and prognostic features of selected HCLI, including HLP, hypertrophic lichenoid dermatitis, hypertrophic lichen sclerosus (HLS), lichen simplex chronicus (LSC), squamous cell carcinoma (SCC), keratoacanthoma (KA), pseudoepitheliomatous hyperplasia (PEH), viral warts, and lupus erythematosus/lichen planus (LE/LP) overlap. Choosing the appropriate procedure and the anatomical site for an incisional biopsy requires thoughtful consideration to ensure sufficient depth and improve diagnostic accuracy by identifying the histological features specific to each hypertrophic condition.

Association of lichen planopilaris with cardiovascular and metabolic disorders: a systematic review and meta-analysis

BACKGROUND

Lichen planopilaris (LPP) is among the most common types of immune-mediated scarring alopecia. Observational studies have reported conflicting findings regarding the association of LPP with different comorbidities.

OBJECTIVES

We conducted a systematic review and meta-analysis to elucidate the association between LPP and different cardiovascular and metabolic disorders.

METHODS

We systematically searched four electronic databases (PubMed, Web of Science, Embase and Cochrane Library) for relevant studies published from their inception to 1 August 2024. A random-effects model was used to perform a pooled analysis and calculate odds ratios or incidence rate ratios with 95% confidence intervals.

RESULTS

The meta-analysis included 10 case-control studies involving 7516 patients with LPP and 64 719 097 controls. The results demonstrated no significant associations between LPP and hypertension, diabetes mellitus or hyperlipidaemia. The results of the pooled analyses also revealed that patients with LPP did not have significantly higher risks of obesity or heart failure than did controls. All pooled analyses revealed high levels of heterogeneity across the studies, but no significant publication bias was detected.

CONCLUSIONS

LPP is not significantly associated with most cardiovascular and metabolic disorders, including hypertension, diabetes mellitus, hyperlipidaemia, obesity and heart failure.

Comparative Analysis of Sociodemographic, Clinical Features, Laboratory Findings, and Treatment Protocols in Generalized and Localized Cutaneous Lichen Planus

BACKGROUND

Lichen planus (LP) is a chronic, inflammatory, and mucocutaneous disease that can present in various clinical forms, affecting the skin, mucosa, and appendages of the skin. A more extensive form of cutaneous LP, known as generalized cutaneous LP (GCLP), involves a significant portion of the body surface area. Because of the accompanying intense pruritus and difficulties with its treatment, the diagnosis and treatment of GCLP are gaining importance. In this study, we aimed to compare the characteristics of cutaneous LP with localized involvement and those of GCLP.

METHODS

We retrospectively analyzed patients' sociodemographic characteristics (age, gender), clinical features (localization and duration of lesions), laboratory findings, treatments received, and relapse rates following treatment using electronic medical records obtained from our university's digital registry system.

RESULTS

Among the patients with cutaneous LP, 24.7% (n=46) had localized cutaneous LP (LCLP), and 22.5% (n=42) had GCLP. Involvement of the trunk and flexural regions was higher among the patients with GCLP than LCLP (p<0.001 and p=0.012, respectively). Hypertriglyceridemia and hepatitis B core antibody positivity were also observed more frequently in the patients with generalized than LCLP (p=0.005 and p=0.016, respectively). Narrowband ultraviolet B and acitretin were more effective in treating patients with GCLP (p<0.001 and p=0.001, respectively). When the relapse rates in both LP groups were compared, relapses were more frequent in the patients with GCLP (p=0.022).  Conclusions: The lesion localization, treatment needs, and relapse rates of patients with GCLP differ from those of patients with LCLP.  This article was previously presented as an e-poster at the 32nd National Turkish Dermatology Congress on November 24, 2024.

Update vulval dermatology - diagnostics and therapy

The vulva is a periorificial skin area and as such represents a transitional zone with unique functional and physiological characteristics. Knowledge of its anatomy is limited among both the general population and healthcare professionals, and unrealistic expectations of normal proportions are common. Ignorance of anatomical variations can cause unnecessary anxiety. In Germany, specialists in gynecology and obstetrics most commonly treat neoplastic vulvar dermatoses, while chronic inflammatory dermatoses commonly affecting the female genitalia (such as psoriasis, atopic dermatitis, hidradenitis suppurativa, and vitiligo) are typically treated by dermatologists. Both specialties treat infectious vulvar dermatoses and sexually transmitted infections. Certain dermatoses, such as lichen sclerosus, lichen planus, and lichen simplex chronicus, tend to affect the vulva preferentially; however, terminology can be confusing. Therefore, this article provides basic information on vulvar anatomy and physiology and summarizes recommendations for the diagnosis and management of the most common vulvar dermatoses, with a special focus on chronic inflammatory dermatoses, to provide a useful guide for all involved specialists in daily practice. Interdisciplinary collaboration and the establishment of dedicated consultation hours may help to improve the clinical care of vulvar dermatoses.

Case report: Rare case of laryngeal hypertrophic lichen planus

INTRODUCTION AND IMPORTANCE

Lichen planus is an inflammatory and chronic disease with multifactorial causes. Hypertrophic subtype of lichen planus is an extremely rare lesion when found in the larynx. This article describes the case of a man with such a lesion.

CASE PRESENTATION

A 54-year-old man presented after respiratory distress with a suspicious mass on the left hemilarynx. The patient consumed a lot of tobacco and alcohol. He underwent nasofibroscopy, CT scan and numerous direct laryngoscopies with biopsy. Histopathological analysis finally revealed a mucosal hypertrophic lichen planus. Nowadays, the patient has undergone a partial laryngectomy.

CLINICAL DISCUSSION

Lichen planus is a chronic immune disease with multifactorial causes like stress or genetic susceptibility, for example. Presentations may vary, and histological features include hyperkeratosis and lymphocytic infiltration, which could be the primary cause of tissue damage. Hypertrophic lichen planus is an extremely rare laryngeal lesion, and there are few examples of how it is treated. As in topical treatments for other types of lichen planus, corticosteroids may be helpful. In addition, the potential carcinogenic transformation of this type of lesion is not well known, and follow-up care is therefore required.

CONCLUSION

A patient presented with a hypertrophic lichen planus lesion in the larynx, which is an extremely rare location. Thus far, he has undergone surgery to treat it.

Lichen Planopilaris in Children: A Systematic Review

BACKGROUND

Lichen planopilaris (LPP) is the most common form of scarring alopecia in adults. The disease may also occur in children and adolescents. The aim of this systematic review is to evaluate clinical, trichoscopic, and histopathologic features of pediatric LPP. Therapeutic management is also discussed.

METHODS

The systematic review was performed according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines by searching PubMed, Scopus, and EBSCO databases with the last search on June 18, 2024.

RESULTS

A total of 12 studies including 20 children were analyzed. Male predominance was observed. The typical presentation of LPP in children included scarring, perifollicular erythema, scaling, and plugging; atrophy, and follicular hyperkeratotic papules, located most commonly in the vertex. The most common trichoscopic findings were scaling and blue-gray dots, perifollicular erythema, and the absence of follicular ostia. Histopathological examination revealed perifollicular fibrosis, perifollicular interface lymphocytic inflammation, pigment incontinence, cytoid bodies, and scarring in the dermis. Complete or partial response was observed in children treated with topical, intralesional, and systemic corticosteroids, methotrexate, pioglitazone, and tocilizumab.

CONCLUSIONS

LPP is a rare cause of scarring alopecia in children. The disease should be taken into consideration in the differential diagnosis of patchy hair loss in children.

Immune Checkpoint Inhibitor-Associated Cutaneous Adverse Events: Mechanisms of Occurrence

Immunotherapy, particularly that based on blocking checkpoint proteins in many tumors, including melanoma, Merkel cell carcinoma, non-small cell lung cancer (NSCLC), triple-negative breast (TNB cancer), renal cancer, and gastrointestinal and endometrial neoplasms, is a therapeutic alternative to chemotherapy. Immune checkpoint inhibitor (ICI)-based therapies have the potential to target different pathways leading to the destruction of cancer cells. Although ICIs are an effective treatment strategy for patients with highly immune-infiltrated cancers, the development of different adverse effects including cutaneous adverse effects during and after the treatment with ICIs is common. ICI-associated cutaneous adverse effects include mostly inflammatory and bullous dermatoses, as well as severe cutaneous side reactions such as rash or inflammatory dermatitis encompassing erythema multiforme; lichenoid, eczematous, psoriasiform, and morbilliform lesions; and palmoplantar erythrodysesthesia. The development of immunotherapy-related adverse effects is a consequence of ICIs' unique molecular action that is mainly mediated by the activation of cytotoxic CD4+/CD8+ T cells. ICI-associated cutaneous disorders are the most prevalent effects induced in response to anti-programmed cell death 1 (PD-1), anti-cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4), and anti-programmed cell death ligand 1 (PD-L1) agents. Herein, we will elucidate the mechanisms regulating the occurrence of cutaneous adverse effects following treatment with ICIs.

Vulvo-Vaginal-Oral Lichen Planus: A Case Report and Literature Review

Vulvo-vaginal-oral lichen planus (VVO-LP) is a chronic inflammatory condition affecting the mucous membranes of the oral cavity, skin, and genital areas. The exact etiology remains unclear, although immune-mediated mechanisms are considered likely contributors. It is a rare form of lichen planus, which typically presents in adults and is more common in middle-aged women. Key clinical features include painful ulcerative lesions in the oral, vaginal, and cutaneous regions, often resistant to conventional treatment. This condition can significantly impact the patient's quality of life due to persistent symptoms and complications such as scarring and infection. In this review, we present a case of a 43-year-old Saudi female who presented to our Oral Medicine Clinic with recurrent painful ulcerative lesions affecting the mouth, skin, and vaginal mucosa. Her medical history included type II diabetes mellitus and hypercholesterolemia. Oral biopsy results confirmed the diagnosis of lichen planus, with no signs of dysplasia. The patient was treated with a variety of topical and systemic therapies, including corticosteroids and immunosuppressants, but showed only temporary improvement. Despite short-term remission with all provided medications, the lesions recurred after discontinuation of treatment in a more severe form. This case report emphasizes the challenges associated with the diagnosis and management of VVO-LP, particularly its resistance to standard therapies. The patient's case underscores the need for further research into novel treatment strategies and long-term management plans for this rare and debilitating condition.

Zoon's Vulvitis and Coexisting Lichen Planus: A Rare Vulval Dermatosis

This case report describes Zoon's vulvitis or plasma cell vulvitis (PCV) with coexisting lichen planus (LP) treated with methotrexate. PCV is a rare, chronic, benign idiopathic inflammatory condition of the vulvar mucosa, characterized by a bright-red, chronic lesion of mucosa. Typically, it presents as atrophic, shiny, red plaques that can affect any part of the vulva and can spread symmetrically and bilaterally with the propensity of chronicity and gradual coalescence. LP is an uncommon inflammatory dermatosis that can affect skin, nails, and mucosa. There is a strong association between vulvovaginal and oral LP. Clinical presentation is similar to PCV, however, LP has the potential for malignant transformation between 0 % and 5.6%. Our patient was a 60-year-old diabetic female who had a nine-month history of progressive vulvar irritation and itch associated with dyspareunia, urinary stream disturbance, and occasional mouth soreness. Pelvic examination revealed well-demarcated red-orange areas of erythema covering the clitoral hood with effacement, obvious peri-urethral scarring, and fusion of the labia. Oral buccal mucosa revealed bilateral buccal mucosal lichenoid changes with erosive gums in addition to white stria or Wickham stria classic of LP. The potent topical steroid, Clobetasol propionate, provided relief initially, but the patient became intolerant following long-term use and stayed non-respondent, which prompted the vulval mucosal skin biopsy. Histology showed erosion of the surface epithelium with a dense band-like infiltrate of plasma cells in the underlying sub-epithelium with lymphocytes and neutrophils. The presence of 90% plasma cell-rich lichenoid inflammatory infiltrates with less than 1% of lymphocytes and neutrophils. The clinicopathological diagnosis was suggestive of PCV with coexisting LP. There is convincing evidence from studies that early and accurate diagnosis is important, as, unlike Zoon's balanitis, PCV is benign. However, the coexisting LP makes it necessary for regular dermatology follow-up.

Markedly Exophytic Hypertrophic Lichen Planus in a Patient With Ichthyosis Vulgaris

Hypertrophic lichen planus (HLP) is an idiopathic inflammatory condition characterized by hyperkeratotic plaques or nodules, typically occurring bilaterally on the wrists, ankles, or lower extremities. This variant of lichen planus is more common among African-American patients and occupies a broad differential with other keratotic skin conditions, some of which are malignant, making recognition and accurate diagnosis essential. We present an unusual case of a 49-year-old African-American woman with four markedly exophytic, horn-like lesions on her shins, ultimately diagnosed as HLP. Her medical history was also notable for ichthyosis vulgaris. Although no known interaction exists between HLP and ichthyosis vulgaris, the combination of these conditions may have contributed to intense pruritus, leading to increased excoriation. This excoriation could have influenced the unusual growth pattern, as mechanical disruption is associated with increased keratin production in hyperkeratotic conditions.

Oral Lichen Planus: A Narrative Review Navigating Etiologies, Clinical Manifestations, Diagnostics, and Therapeutic Approaches

Background/Objectives: Oral Lichen Planus (OLP) is a common immune-mediated inflammatory disorder affecting the oral mucosa, impacting 0.5% to 2% of the global population, primarily middle-aged women. Immunological dysregulation is a key factor in OLP's pathogenesis, involving CD4+ T helper and CD8+ T cytotoxic cells. The World Health Organization (WHO) classifies OLP as a potentially malignant disorder, with a risk of oral squamous cell carcinoma (OSCC) developing in up to 2% of lesions. This narrative review aims to provide a comprehensive overview of the etiopathogenesis, clinical manifestations, diagnostic criteria, and therapeutic strategies for OLP, informing clinical practice and guiding future research. Methods: A review of the literature from the PubMed and Google Scholar databases was conducted up to December 2023, focusing on studies addressing the etiopathogenesis, diagnosis, clinical manifestations, and treatment of OLP. Results: OLP's pathogenesis is driven by immune dysregulation, with CD4+ and CD8+ cells playing crucial roles. Clinically, OLP presents as reticular, erosive, bullous, and plaque-like lesions. Diagnosis relies on clinical examination, histopathology, and direct immunofluorescence. Recent advancements in diagnostic markers and imaging techniques have improved detection and monitoring. Treatment primarily involves corticosteroids, but novel therapies such as curcumin, retinoids, and laser therapy are increasingly used for their effectiveness and reduced side effects. These treatments show promise in symptom reduction and recurrence prevention, although long-term data are needed. Conclusions: Regular screenings and biopsies are essential due to OLP's likelihood of malignant transformation. This study urges further investigation into long-term results, improved diagnostic techniques, and evidence-based treatment regimens.

Intra-lesional Corticosteroids Versus Platelet-Rich Plasma Versus Platelet-Rich Fibrin for the Treatment of Oral Lichen Planus: A Systematic Review and Network Meta-Analysis

Oral lichen planus (OLP) is a potentially malignant disorder affecting the oral mucosa. Platelet concentrates, including platelet-rich plasma (PRP) and platelet-rich fibrin (PRF), have emerged as promising alternative treatments to corticosteroids. This study aims to comprehensively evaluate the effectiveness of PRP and PRF in the management of patients with OLP. We conducted a comprehensive search of PubMed, Scopus, Web of Science, and the Cochrane Library for randomized controlled trials (RCTs) involving patients with OLP comparing intralesional PRP or PRF with corticosteroids up to August 2024. The primary outcomes assessed were changes in lesion size, pain scores, and Thongprasom scores. Network meta-analysis (NMA) was used. Data were pooled using summary effect sizes with corresponding 95% confidence intervals (CIs) in a random-effects model based on the DerSimonian-Laird method. Eight studies comprising 157 patients and 250 lesions were included in the final analysis. Compared to corticosteroids, no significant differences were observed among PRF and PRP in terms of changes in lesion size, pain scores, clinical severity scores, and adverse events. NMA ranking showed that PRF was the best-ranking treatment in reducing lesion sizes (SUCRA values: 72.6%, 75.8%, 66.2%, 80.8%, and 77.5% at first, second, third, fourth, and eighth weeks of assessment), followed by corticosteroids, and PRP. Moreover, PRF was the best-ranking treatment in reducing pain score at the first, third, and eighth weeks of assessment (SUCRA values: 91.8%, 86%, and 85.9%), while PRP was the best intervention at the second and fourth weeks of assessment (SUCRA values: 61.3%, and 90.2%). Also, PRF was the best intervention in terms of Thongprasom scores at eight weeks of assessment (SUCRA value: 77.3%), while PRP was the best intervention at the fourth week of assessment with value of 78.1%. PRF and PRP showed comparable results with intralesional corticosteroids in all studied parameters. Considering treatments ranking, PRF was the best intervention. The optimal treatment modality for OLP varies on different clinical conditions.

A Review of Linear Lichen Planus Case Reports

ABSTRACT

Lichen linear planus is a rare variant of lichen planus that appears as pruritic, polygonal, purple papules in a blaschkoid distribution. This review critically assesses all reported cases of linear lichen planus (LLP) for proposed etiology, clinical and histologic traits, treatment options, and recurrence. A PubMed search from inception through March 2023, followed by article screening and full-text review, identified 51 unique cases of LLP. Data from each case including the sex of the patient, anatomic distribution of lesions, biopsy results, proposed etiology, treatment, and recurrence were recorded. LLP did not show a significant gender or age predilection, most frequently presented unilaterally with pruritus, and involved numerous anatomic regions. Various triggers including metal implants, vaccinations, infections, malignancy, and pregnancy were identified. The most common histopathologic descriptions included band-like lymphocytic or lichenoid infiltrate, basal liquefactive, vacuolar degeneration, hypergranulosis, hyperkeratosis, civatte or colloid bodies, melanin incontinence, and orthokeratosis. Treatment options, duration of treatment, and recurrence rate of LLP lesions were variable. Although LLP is rare, dermatologists should be aware of this presentation and appropriate diagnostic and treatment options because swift diagnosis can reduce patient morbidity.

Coexistence of myasthenia gravis and lichen planus: A case report and systematic review of related case reports from 1971 to 2024

Key Clinical Message

The co-occurrence of myasthenia gravis (MG) and lichen planus (LP) is a rare phenomenon, with only 13 cases reported in the English literature between 1971 and 2024. Patients with MG or LP, regardless of the thymoma status, require close monitoring for other autoimmune diseases.

Abstract

Myasthenia gravis (MG) is an uncommon autoimmune disease, resulting in fatigable muscle weakness in the ocular, bulbar, and respiratory muscles, as well as muscles of the extremities. Lichen planus (LP) is an autoimmune mucocutaneous disease, presenting with pruritic and violaceous plaques on the skin and mucosal surfaces. So far, MG and LP co-occurrence is only reported in anecdotal individuals. This study reports a patient with MG and LP and systematically reviews the English literature on this rare co-occurrence from 1971 to 2024, indicating only 13 cases with similar conditions. A 67-year-old man presented with ocular and progressive bulbar symptoms, a year after being diagnosed with generalized LP. Laboratory evaluations were normal except for the high anti-AchR-Ab titer and a positive ANA titer. Neurologic examinations revealed asymmetric bilateral ptosis, weakness and fatigability in proximal muscles, and a severe reduction in the gag reflex. He was diagnosed with late-onset, seropositive MG. The treatment included pyridostigmine (60 mg, three times daily), intravenous immunoglobulin (25 g daily for 5 days), and oral prednisolone. There was no evidence of thymoma in the chest x-ray and CT scan without contrast. However, a CT scan with contrast was not performed due to the patient's unstable condition. A common autoimmune mechanism may underlie the unclear pathophysiology of MG and LP co-occurrence, with or without thymoma. Patients with MG, LP, or thymoma require close monitoring and assessment for other possible autoimmune diseases.

PD-1 Inhibitor Induced Hypertrophic Lichen Planus: A Case Report

BACKGROUND AND OBJECTIVE

PD-1 inhibitors have revolutionized cancer therapies and are being used to treat an expanding array of cancers. To best serve patients, clinicians should be familiar with the spectrum of skin manifestations associated with PD-1 inhibitor therapy. Here, we report a unique case of hypertrophic lichen planus (HLP) in a 64-year-old man treated with pembrolizumab; the presentation initially suggested a squamous cell carcinoma (SCC) morphology, then evolved into a morphology more typical of hypertrophic lichen planus. This case underscores the need for caution in diagnosing eruptive SCCs associated with PD-1 inhibitor therapy. In such instances, maintaining a high suspicion for lichenoid reactions as sequelae of PD-1 inhibitor treatment and starting an empiric trial of therapy for lichenoid dermatitis may be warranted to ensure timely management of lesions.

METHODS

We describe a case of hypertrophic lichen planus mimicking squamous cell carcinoma in the setting of PD-1 inhibitory therapy with pembrolizumab. A PubMed literature review was conducted to identify other cases and determine the incidence of lichenoid reactions imitating squamous cell carcinoma in the setting of PD-1 inhibitor use.

RESULTS

Our case is one of the few available pieces of literature describing eruptive hypertrophic lichen planus imitating SCC in the setting of PD-1 inhibitor use. Initial skin nodule biopsy appeared histologically compatible with squamous cell carcinoma. Repeat biopsy of the skin lesions revealed histological features consistent with hypertrophic lichen planus. Over time, lower extremity lesions evolved into a more typical appearance of hypertrophic lichen planus. Treatment with topical 0.05% clobetasol ointment and oral acitretin 25 mg led to complete resolution of lesions within 2-3 months.

CONCLUSIONS

This case underscores the significance of maintaining vigilance for lichenoid reactions as potential sequelae of PD-1 inhibitor therapy. It highlights the variability in initial presentation and the potential for lesions to transform over time. Timely recognition and appropriate management, including high-potency topical corticosteroids and oral acitretin, are crucial for achieving favorable outcomes in patients experiencing such reactions. More studies are necessary to fully analyze the rate of HLP occurrence as a consequence of PD-1 inhibitor use.

Hypertrophic Lichen Planus: An Up-to-Date Review and Differential Diagnosis

CONTEXT.—

Hypertrophic lichen planus (HLP) is a variant of lichen planus that can be difficult to diagnose based on histopathologic features alone. Thus, patient clinical history and clinicopathologic correlation are essential considerations to make the correct diagnosis.

OBJECTIVE.—

To discuss the clinical and histologic presentation of HLP and provide a thorough review of commonly encountered mimickers in the differential diagnosis.

DATA SOURCES.—

Data were derived from a literature review, personal clinical and research experiences, and a review of cases in the archives of a tertiary care referral center.

CONCLUSIONS.—

In general, HLP involves the lower extremities and is characterized by thickened, scaly nodules and plaques that are often pruritic and chronic in nature. HLP affects both males and females and is most common in adults 50 to 75 years of age. Unlike conventional lichen planus, HLP tends to have eosinophils and classically displays a lymphocytic infiltrate most concentrated around the tips of rete ridges. The differential diagnosis for HLP is broad and encompasses numerous entities in many different categories, including premalignant and malignant neoplasms, reactive squamoproliferative tumors, benign epidermal neoplasms, connective tissue disease, autoimmune bullous disease, infection, and drug-related reactions. Therefore, a high index of suspicion must be maintained to avoid a misdiagnosis and potential inappropriate treatments.

Dermoscopy of Actinic Lichen Planus in Skin of Color

INTRODUCTION

Actinic Lichen Planus (ALP) is a rare photosensitive variant of lichen planus. Four subtypes can be distinguished: pigmented, annular (AALP), plaque-like and dyschromic ALP.

METHODS

This is a retrospective; descriptive and analytical study investigating the dermoscopic patterns of different subtypes of ALP in skin of color.

RESULTS

Sixteen adult patients were included in this study; the majority of them were young females, while five patients with the pigmented subtype of ALP were more than 50 years old. This subtype was more prevalent in patients with phototype IV. AALP was described in men with a very dark phototype.In pigmented melasma-like ALP, dermoscopy showed an annular granular pattern, white reticular and circular Wickham striae (WS) with hypopigmentation lacking skin creases, dots inside circles and an eccentric pigmentation on circles. In ALP, annular, circular WS; and perifollicular white halos with follicular plugs were described. The black hole pattern with dotted vessels was seen in the dyschromic ALP. White-yellow-bluish WS were noticed in plaque-type ALP with circumferential radial lines at the periphery.

CONCLUSIONS

This descriptive study of dermoscopic patterns of various subtypes of ALP in skin of color highlighted new dermoscopic descriptions that vary according to the clinical variant or the morphology; lesions distribution; and phototype. Also, many epidemiological differences were found between our results and the literature concerning the older age of onset in melasma-like pigmented ALP, and the male predominance in annular ALP.

HIV: Inflammatory dermatoses

Patients living with HIV may experience a variety of inflammatory dermatoses, ranging from exacerbations of underlying conditions to those triggered by HIV infection itself. This article presents a current literature review on the etiology, diagnosis and management of atopic dermatitis, psoriasis, pityriasis rubra pilaris, lichen planus, seborrheic dermatitis, eosinophilic folliculitis, pruritic papular eruption and pruritus, in patients living with HIV.

Lichen Planus Pigmentosus Inversus: A Case Report of a Man Presenting With a Pigmented Lichenoid Axillary Inverse Dermatosis (PLAID)

Lichen planus pigmentosus is an uncommon subtype of lichen planus and lichen planus pigmentosus inversus is a rare variant of lichen planus pigmentosus. Lichen planus pigmentosus inversus typically presents as hyperpigmented patches or plaques, particularly in the intertriginous areas such as the axillae, the groin and inguinal folds, and in the submammary region. In some patients with lichen planus pigmentosus inversus, the condition can present as a pigmented lichenoid axillary inverse dermatosis (PLAID) when the lesions are in the axillae. A 49-year-old Hispanic man who had hyperlipidemia and diabetes mellitus developed lichen planus pigmentosus inversus and presented with a PLAID. Skin biopsies established the diagnosis of lichen planus pigmentosus inversus. The clinical differential diagnosis of lichen planus pigmentosus inversus includes inherited disorders, primary cutaneous dermatoses, acquired dyschromias, and reactions to topical or systemic medications. Friction in intertriginous areas has been related to the development of lichen planus pigmentosus inversus. Factors that can precipitate lichen planus pigmentosus inversus include not only topical exposure to almond oil, amala oil, cold and cosmetic creams, henna, and paraphenyldiamine but also either topical contact or consumption of mustard oil and nickel. Lichen planus pigmentosus inversus can be associated with autoimmune conditions (hypothyroidism), endocrinopathies (diabetes mellitus), and hyperlipidemia. The dyschromia found in patients with lichen planus pigmentosus inversus is frequently refractory to treatment. Initial management includes removal of potential disease triggers such as eliminating tight clothing to stop friction with the adjacent skin. Topical corticosteroids do not result in improvement; however, topical calcineurin inhibitors such as tacrolimus have been reported to be efficacious. In conclusion, inverse lichen planus and lichen planus pigmentosus inversus can present with a PLAID; whereas topical corticosteroids may be helpful to resolve inverse lichen planus lesions, topical tacrolimus may be useful to improve the dyschromia in lichen planus pigmentosus inversus.

Metabolic syndrome in patients with lichen planus: A case-control study

BACKGROUND

Lichen Planus (LP) is a chronic dermatosis affecting the skin and mucous membranes. Chronic inflammation and oxidative stress in patients with LP is a trigger predisposing to Metabolic Syndrome.

OBJECTIVES

To study the association of Metabolic Syndrome in patients with LP.

MATERIALS AND METHODS

A hospital-based prospective case-control study was conducted from April 2021 to January 2023 including 75 histopathologically confirmed patients with LP and 82 age and sex-matched controls according to the inclusion and exclusion criteria. Metabolic Syndrome was diagnosed using Modified National Cholesterol Education Programme Adult Treatment Panel III criteria. Statistical analysis of the data was performed using Statistical Package for the Social Sciences software, version 26. The chi-square test was used for data analysis.

RESULTS

The majority (30.6%) of the patients belonged to the age group 31-40 years. The mean age of patients with LP was 46.13 ± 14.9 years. Female predominance (69.3%) was observed in our study. Patients with classic LP (54.6%) were predominantly observed. Metabolic Syndrome was significantly prevalent in LP patients than in controls (32% vs. 13.4%, p = 0.005, OR 3.037) and was significantly associated with morphology (only oral mucosal involvement, 61.5%, p 0.027, OR 3.9), severity (severe LP, 58.6%, p < 0.001, OR 7.79), and duration of the disease (≥6 months, 55.5%, p 0.001, OR 5.42). 71% of Metabolic Syndrome was observed in females (p 0.847). Among patients with metabolic syndrome, the majority belonged to the age group between 31 and 40 years (37.5%, p 0.378). Systolic and Diastolic Blood Pressure values (≥130/85 mm of Hg), Serum Triglycerides (≥150 mg/dl), and Low-Density Lipoprotein (>130 mg/dl) were significantly elevated, and High-Density Lipoprotein (<40 mg/dl) was significantly low in LP than in controls (p < 0.05).

CONCLUSION

The study showed a significant association of Metabolic Syndrome in patients with LP. Thus, patients with LP need to be screened to avoid complications associated with Metabolic Syndrome that is, Diabetes Mellitus, Cardiovascular Disease, colorectal cancer, and stroke.

Oral Lichen Planus: An Update on Diagnosis and Management

Oral lichen planus (OLP) is a chronic inflammatory disease whose pathogenesis involves a T-cell mediated, epithelium-directed inflammation in response to unknown antigen(s). The disease evolves by intermittent flares and displays polymorphous clinical features (reticular, erosive, atrophic, plaque, papular, bullous, etc.). When present, symptoms vary depending on the clinical form and range from discomfort to severe pain. Topical superpotent corticosteroids constitute the first-line treatment of symptomatic flares, whereas a wide range of second/third-line treatments are available among topical calcineurin inhibitors, systemic corticosteroids, systemic retinoids, topical/systemic immunomodulators, etc. Follow-up of patients is necessary to detect transformation into squamous cell carcinoma, occurring in approximately 1% of patients.

Inverse Lichen Planus Associated With Nail Dystrophy

Lichen planus is a chronic inflammatory disorder affecting skin and mucosal surfaces. There are multiple variants of lichen planus described in the literature. We report a case of inverse lichen planus in a healthy 50-year-old male who presented to our dermatology clinic with multiple violaceous to hyperpigmented patches affecting both axillae and groin for three months. A skin biopsy confirmed the diagnosis of lichen planus. The patient subsequently developed nail dystrophy affecting his fingernails consistent with nail lichen planus. Early recognition and treatment of nail lichen planus is important to prevent irreversible scarring.

A Generalized Lichen Planus Following COVID-19 Vaccination: A Case Report

As part of the efforts to overcome the ongoing coronavirus disease 2019 (COVID-19) pandemic, mass vaccination programs against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been initiated. Since then, an increasing number of cutaneous adverse events associated with the COVID-19 vaccines have been reported. Lichen planus (LP) is a rare inflammatory mucocutaneous disease with various clinical presentations, although uncommon, occurring following vaccination. There have been several cases of LP reported following COVID-19 vaccination. However, there has been no report of generalized LP following the COVID-19 vaccine to our knowledge. Herein, we report a case of generalized LP following the Oxford/AstraZeneca (AZD1222) vaccine. A 68-year-old female presented with widespread, erythematous pruritic papules and plaques on the trunk and both limbs, which developed 2 to 3 days after administration of the AZD1222 vaccine. Histopathological examinations revealed cellular interface dermatitis. The patient was diagnosed with generalized LP and was successfully treated with systemic corticosteroid and cyclosporine. As the vaccination campaign against COVID-19 is ongoing and early recognition and treatment are essential to reduce the morbidity of this condition, clinicians should be aware that LP could follow COVID-19 vaccination regardless of the type of vaccine administered.

Evaluating the Appropriateness of Existing Health-Related Quality of Life Measures in Lichen Planus

INTRODUCTION

Lichen planus (LP) is an inflammatory skin disorder that can present in various forms across the body, including lesions on the skin (cutaneous LP [CLP]), scalp (lichen planopilaris [LPP]) and mucosal regions (mucosal LP [MLP]). Several existing patient-reported outcome measures (PROMs) were identified for potential use in LP clinical development programs. This study aimed to assess the content validity and psychometric measurement properties of the Dermatology Life Quality Index (DLQI), Epworth Sleepiness Scale (ESS), Scalpdex and Oral Lichen Planus Symptom Severity Measure (OLPSSM) in an LP population.

METHODS

Patients completed the PROs at various time points as part of an international Phase 2 clinical study in adults with MLP (n = 37), LPP (n = 37) and CLP (n = 37). Test-retest reliability, construct validity and sensitivity to change were assessed. In addition, qualitative cognitive debriefing interviews were conducted with adults with MLP (n = 20), LPP (n = 19) and CLP (n = 19) in the USA and Germany to examine the PROM content validity.

RESULTS

The DLQI demonstrated adequate reliability and validity, although its ability to detect change was modest and most items were considered not relevant in qualitative interviews. The ESS had good reliability but limited evidence of validity and ability to detect change. Conceptual relevance varied according to the qualitative interview data. The Scalpdex was miscellaneous across domains, but the 'Symptoms' domain performed well overall. Overall, Scalpdex concepts were reported as relevant by most LPP patients interviewed. The OLPSSM demonstrated good psychometric properties and strong evidence of content validity.

CONCLUSIONS

The psychometric and qualitative findings support the use of the OLPSSM and Scalpdex within specific LP subtypes but cautioned use of the DLQI. Administration of the ESS is not recommended in LP because of its poor psychometric performance. Given these limitations, further validation of non-specific disease measures is needed and/or the development of additional LP-specific PROMs.

TRIAL REGISTRATION

NCT04300296.

A Case of Linear Hypertrophic Lichen Planus in a Pediatric Patient

Lichen planus (LP) is a chronic inflammatory disease of the skin and mucosa. Of the various types, the hypertrophic type is characterized by thickened, purplish hyperkeratotic plaques and nodules. The course of hypertrophic LP tends to be more chronic than those of other types. A 12-year-old girl presented with a 2-year history of warty papules and plaques in a zosteriform configuration along one flank. Histopathology revealed hyperkeratosis and papillomatosis with wedge-shaped hypergranulosis. A lichenoid lymphocytic infiltrate with vacuolar change in the basal layer was evident. She was prescribed oral doxycycline, a topical corticosteroid, and tacrolimus. After 7 weeks, the skin lesions became significantly flattened and faded. LP is less common but more severe in children than in adults. The unilateral, linear hypertrophic type of LP is uncommon. Herein, we report a rare case of linear hypertrophic LP in a child.

An exotic pathogenetic mechanism of angiogenesis in oral lichen planus-A systematic review

OBJECTIVE

Angiogenesis plays a vital role at the molecular level in various inflammatory lesions, that lead to their chronicity. Oral lichen planus is an immune-mediated chronic inflammatory disorder. The angiogenetic role and exact mechanisms in oral lichen planus are still unclear due to a dearth of studies. Its clinical significance with angiogenesis also requires further elucidation necessitating a thorough review of the studies that have been conducted so far. The present review was designed to identify the dependence of oral lichen planus progression on angiogenesis which could aid in devising metronomic treatments required to halt the progression of this disease.

MATERIALS AND METHODS

A thorough search was made using MEDLINE by PubMed, Scopus, Google scholar, Cochrane library, and EMBASE databases. Original research articles, that immunohistochemically evaluated angiogenesis in oral lichen planus were included for review. Risk of bias was analysed for each study using Modified Newcastle-Ottawa scale and Review Manager 5.4 was used to output its result.

RESULTS

Twenty-nine published articles were included for data synthesis. The most commonly employed antibody was CD34, however, upregulated VEGF expression was the principal while ICAM-1, VCAM-1, and PECAM-1 were critical angiogenic factors to mediate angiogenesis in oral lichen planus.

CONCLUSION

The current evidence supports that angiogenesis, a fundamental pathogenetic mechanism of oral lichen planus, leads to its persistence and chronicity. However, studies with a larger sample size, standard evaluation criteria, different subtypes, and adequate follow-up are warranted.

Patient Experience of Lichen Planus: A Qualitative Exploration of Signs, Symptoms, and Health-Related Quality of Life Impacts

INTRODUCTION

Lichen planus (LP) is an inflammatory skin disorder that can present in various forms across the body, including lesions on the skin (cutaneous LP [CLP]), scalp (lichen planopilaris [LPP]), and mucosal regions (mucosal LP [MLP]). Qualitative exploration of the patient experience of LP, notably symptoms and impacts on health-related quality of life (HRQoL), is limited. A scarcity of research was also identified relating to emotional wellbeing impacts of CLP patients. Two qualitative studies were conducted with LP patients to address these gaps.

METHODS

Study 1 consisted of exit interviews conducted with a subset of adult patients with MLP (n = 5), CLP (n = 4), and LPP (n = 4) enrolled in an LP clinical study in the United States (US) to explore the patient experience. Study 2 consisted of independent qualitative interviews conducted with adult CLP patients (n = 13) from the US and Germany to further explore impacts on emotional wellbeing.

RESULTS

Exit interviews found that itch , pain, and skin lesions were most frequently reported as signs/symptoms of LP. Itch and skin lesions were experienced across all LP subtypes, while pain was only reported by CLP and MLP patients. These signs/symptoms impacted HRQoL including emotional wellbeing (frustration, embarrassment), daily activities (oral hygiene, clothing options), social functioning (intimacy, social activities), and physical functioning (chewing/swallowing, opening/moving mouth). Impacts on activities of daily living (ADL) and physical functioning were mostly experienced by MLP patients. Independent qualitative interviews, which further explored impacts of CLP on patients' emotional wellbeing, identified frustration, worry, sadness, embarrassment, and depression as the most frequently experienced.

CONCLUSION

The findings contribute to the literature by providing qualitative insights into signs/symptoms and HRQoL impacts of LP, from the adult patient perspective. The findings also highlight the importance of considering assessment of HRQoL impacts in future clinical LP research, particularly impacts on emotional wellbeing when selecting instruments for assessment of HRQoL in the CLP population.

TRIAL REGISTRATION

NCT04300296.

Pembrolizumab-Induced Lichen Planus Pemphigoides in a Patient with Metastatic Adrenocortical Cancer: A Case Report and Literature Review

While the advent of immune-checkpoint inhibitors has revolutionized cancer therapy, immune-related adverse effects (irAEs) have also been on the rise. Cutaneous toxicities are among the most common irAEs, especially in the context of programmed cell death protein-1 (PD-1) inhibitors like pembrolizumab. Herein, we report a case of anti-PD-1-induced lichen planus pemphigoides (LPP)-a rare autoimmune blistering disorder with characteristics of both lichen planus and bullous pemphigoid. To our knowledge, this is the first reported case of LPP following anti-PD-1 therapy for metastatic adrenocortical cancer. Recognizing that LPP is within the spectrum of irAEs is important, especially as the indications for immunotherapy grow to include rarer malignancies like adrenocortical cancer. In addition to our case presentation, we also provide a comprehensive review of the literature surrounding immunotherapy-induced LPP-highlighting key characteristics towards the early recognition and clinical management of this cutaneous irAE.

The Role of Sex and Gender in Dermatology - From Pathogenesis to Clinical Implications

BACKGROUND

Sex and gender have increasingly been recognized as significant risk factors for many diseases, including dermatological conditions. Historically, sex and gender have often been grouped together as a single risk factor in the scientific literature. However, both may have a distinct impact on disease incidence, prevalence, clinical presentation, severity, therapeutic response, and associated psychological distress.

OBJECTIVES AND PROJECT DESCRIPTION

The mechanisms that underlie differences in skin diseases between males, females, men, and women remain largely unknown. The specific objectives of this review paper are:To highlight the biological differences between males and females (sex), as well as the sociocultural differences between men and women (gender) and how they impact the integumentary system.To perform a literature review to identify important sex- and gender-related epidemiological and clinical differences for various skin conditions belonging to a range of disease categories and to discuss possible biological and sociocultural factors that could explain the observed differences.To discuss dermatological skin conditions and gender-affirming treatments within the transgender community, a population of individuals who have a gender identity which is different than the gender identity they were assigned at birth.

FUTURE IMPACT

With the rising number of individuals that identify as non-binary or transgender within our increasingly diverse communities, it is imperative to recognize gender identity, gender, and sex as distinct entities. By doing so, clinicians will be able to better risk-stratify their patients and select treatments that are most aligned with their values. To our knowledge, very few studies have separated sex and gender as two distinct risk factors within the dermatology literature. Our article also has the potential to help guide future prevention strategies that are patient-tailored rather than using a universal approach.

HIV-associated photodermatitis in African populations

Photosensitive dermatoses are seen in 5% of HIV-infected persons. These include drug- and chemical-induced photoallergic and phototoxic reactions, chronic actinic dermatitis of HIV, photo lichenoid drug eruptions, and porphyria. Data on photodermatitis in HIV are limited to case reports and series. The pathogenesis is not completely understood and includes a th2 phenotype in HIV which results in impaired barrier function and resultant allergen sensitisation as well as immune dysregulation. The objective of this manuscript is to review the literature on the clinical phenotype, pathogenesis, role of photo and patch testing, outcomes, and treatment of photodermatitis in HIV in an African population.

[Esophageal Lichen Planus - An Underdiagnosed Disease]

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.

[Esophageal Lichen Planus - An Underdiagnosed Disease]

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.

Actinic Lichen Planus: Significance of Dermoscopic Assessment

Actinic lichen planus (LP) is a rare variant of the already infrequent LP. LP is a chronic inflammatory skin disorder seen in 1-2% population of the world. The classical presentation is in the form of the four P's namely pruritic, purplish, polygonal, papules and plaques. On the contrary in this variant of actinic LP, although the lesions look similar in appearance they are characteristically distributed over the photo-exposed areas of the body like the face, extensors of the upper limbs, and dorsum of hands. Koebner's phenomenon which is characteristic of LP is absent. The commonest differentials that leave the clinician in a fix are usually discoid lupus erythematosus, granuloma annulare, and polymorphous light eruptions. A detailed clinical history followed by histopathological examination aids in the final diagnosis in such cases. In scenarios where the patient is not willing for a minor interventional procedure such as a punch biopsy, dermoscopic assessment comes to the rescue. Dermoscopy being an inexpensive, non-invasive, and minimal time-consuming procedure helps in the early diagnosis of a wide range of cutaneous disorders. Fine, reticulate white streaks over the surface of papules or plaques of LP known as "Wickham's striae" act as the diagnosis clincher for most cases of LP. The numerous variants of LP have consistent biopsy findings and the mainstay for treatment remains topical or systemic corticosteroids. We report this case of a 50-year-old female farmer that presented with multiple violaceous plaques on photo-exposed areas of the body owing to its rarity and use of dermoscopy in enabling a prompt diagnosis that helped improve the patient's quality of life.

Mucocutaneous diseases with manifestations in the head and neck region: 24 years of experience in a Dermatology service

BACKGROUND

This study aimed to evaluate the clinicopathological features of mucocutaneous diseases with manifestation in the head and neck region.

MATERIAL AND METHODS

A retrospective analysis of a dermatology reference center database was carried out. Over 24 years. Clinicopathological data were collected from medical records and the data was analyzed by descriptive statistics.

RESULTS

A total of 11.538 medical records were analyzed, being 152 cases of mucocutaneous diseases with manifestations in the head and neck region. Cutaneous lupus erythematosus was the most prevalent diagnosis (66.4%). Face (44.1%), females (79.6%), and patients with 45 years mean age were the most common features. In the oral cavity, the most affected region was the buccal mucosa (37.5%).

CONCLUSIONS

Mucocutaneous diseases with head and neck manifestation were rare in the sample analyzed (1.3%), with cutaneous lupus erythematosus and lichen planus being the most common lesions in this region.

Painless Plaques Evolving to Bullae and Painful Erosions on the Penis: A Quiz

Abstract is missing (Quiz)

Reflectance confocal microscopy-assisted diagnosis of lichen planus pigmentosus distributed along multiple unilateral Blaschko's lines in a child: A case report

A boy with a 2-year history of asymptomatic, linear pigmented macules involving the right side of the trunk and right upper limb. RCM revealed the dermal papillary rings were destroyed, and numerous irregular particulate structures with high refractive values were distributed in the superficial dermis. The RCM features implied the possibility of interface dermatitis. RCM was a complementary diagnostic tool for linear pigmented macules.

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.

Esophageal lichen planus: Current knowledge, challenges and future perspectives

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.

Efficacy and safety of oral methotrexate versus oral mini pulse betamethasone therapy in the treatment of lichen planus: a comparative study

BACKGROUND

Lichen planus (LP) is a chronic inflammatory mucocutaneous disease. Systemic corticosteroids are the treatment of choice for generalized LP but their use is limited due to side effects. Oral mini pulse (OMP) therapy represents a good alternative. Also, Methotrexate (MTX) can be used as an alternative and safe modality in LP.

OBJECTIVES

To compare the efficacy and safety of oral MTX versus OMP betamethasone in the treatment of different types of LP.

PATIENTS AND METHOD

The study included 40 patients presenting with LP who were randomly divided into two groups. Group A for oral MTX 7.5 mg weekly & group B for OMP betamethasone 3 mg weekly for a maximum of 12 weeks. Basic laboratory investigations were done on both groups. Follow-up investigations were done on the 2nd, 4th, 8th and 12th weeks. The percentage of improvement in each patient was calculated on a scale according to the appearance of new lesions, degree of pruritus/pain, subsidence of cutaneous lesions and clearance of the oral lesion.

RESULTS

In the MTX group, 55% of patients showed excellent improvement, 25% showed good improvement and 20% showed partial improvement. In the OMP group, 85% of patients showed excellent improvement, 10% showed good improvement and 5% showed partial improvement. The reported clinical and laboratory adverse effects were tolerable and didn't lead to the discontinuation of treatment.

CONCLUSION

OMP betamethasone and low dose MTX may be considered effective and safe lines of treatment for different types of LP and may represent good and safe alternative options for conventional daily corticosteroid therapy.

Annular lichenoid diseases

Annular lichenoid diseases encompass a diverse range of pathologies that present as circular, raised, or flat lesions that may vary in size and number. Examples include annular lichenoid dermatitis of youth, annular lichen planus, erythema dyschromicum perstans, erythema multiforme, fixed drug eruption, lichen sclerosus, neonatal lupus, porokeratosis, subacute cutaneous lupus erythematosus, and lichenoid syphilis. Clinical morphology and histopathology can differentiate these entities.

JAK inhibitors in lichen planus: A review of pathogenesis and treatments

Lichen planus (LP) is an auto-inflammatory skin disorder identified by a presence of T-cell lymphocytes at the dermal-epidermal junction. It is hypothesized that the INF-γ/CXCL10 axis fulfills a major role in the onset and persistence of chronic inflammation in LP. Since Janus kinases (JAKs) are involved in the transduction of INF-γ signals, they may be good targets for LP treatment. Several case reports and case series described the safety and efficacy of upadacitinib (2 articles), tofacitinib (6 articles), baricitinib (4 articles), and Ruxolitinib (1 Article) in the treatment of LP variants. The predominant variants that JAK inhibitors improved were lichen planopilaris, nail LP, and erosive LP. Considering the role of the JAK pathway in LP pathogenesis and the evidence provided by these reports, it seems JAK inhibitors would be effective therapeutic agents for LP treatment. Hence, these agents should be trialed and evaluated further.

Acquired Dermal Macular Hyperpigmentation Mimicking Dowling Degos Disease: A Case Report

Acquired dermal macular hyperpigmentation (ADMH) is a recently coined term to encompass lichen planus pigmentosus (LPP), erythema dyschromicum perstans (EDP), and Riehl’s melanosis. Here we report a 60 -year- old female, with an insignificant past medical history, who presented to the dermatology clinic, with slightly itchy skin lesions on her body. The lesions were slowly increasing in number over the last 10 years. The patient was otherwise healthy and was not taking any medications. A review of systems was unremarkable. There was no similar case in the family and the parents did not show consanguinity. Skin examination revealed multiple well-defined non-scaly brownish macules scattered on her body. In addition, bilateral macules and papules were present in the inframammary folds. There were no skin lesions in the axillae, groin, and intergluteal folds. Differential diagnoses include Dowling Degos Disease (DDD), LPP, and EDP. A 4 mm punch skin biopsy was taken from skin lesions under the breast. It revealed hyperkeratosis, hypergranulosis, and acanthosis. The dermis showed a band-like infiltrate of mononuclear histiocytic cellular infiltrate with basal layer degeneration. According to the above clinicopathological findings, the diagnosis of lichen planus was made. The patient was reassured. She was started on hydroxychlorquine 200 mg tab bid, a topical steroid, and topical calcineurin inhibitors, and was asked to follow up regularly in the dermatology clinic.