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Whittington CP, Saleh JS, Bresler SC, Patel RM. Hypertrophic Lichen Planus: An Up-to-Date Review and Differential Diagnosis. Arch Pathol Lab Med 2024; 148:659-665. [PMID: 37327190 DOI: 10.5858/arpa.2022-0515-ra] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 06/18/2023]
Abstract
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.
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Affiliation(s)
- Carli P Whittington
- From the Departments of Pathology (Whittington, Saleh, Bresler, Patel) and Dermatology (Whittington, Saleh, Bresler, Patel), University of Michigan, Ann Arbor
- the Department of Cutaneous Pathology, WCP Laboratories Inc, Maryland Heights, Missouri (Patel)
| | - Jasmine S Saleh
- From the Departments of Pathology (Whittington, Saleh, Bresler, Patel) and Dermatology (Whittington, Saleh, Bresler, Patel), University of Michigan, Ann Arbor
- the Department of Cutaneous Pathology, WCP Laboratories Inc, Maryland Heights, Missouri (Patel)
| | - Scott C Bresler
- From the Departments of Pathology (Whittington, Saleh, Bresler, Patel) and Dermatology (Whittington, Saleh, Bresler, Patel), University of Michigan, Ann Arbor
- the Department of Cutaneous Pathology, WCP Laboratories Inc, Maryland Heights, Missouri (Patel)
| | - Rajiv M Patel
- From the Departments of Pathology (Whittington, Saleh, Bresler, Patel) and Dermatology (Whittington, Saleh, Bresler, Patel), University of Michigan, Ann Arbor
- the Department of Cutaneous Pathology, WCP Laboratories Inc, Maryland Heights, Missouri (Patel)
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2
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Kelati A, Rasso A, Chiheb S. Dermoscopy of Actinic Lichen Planus in Skin of Color. Dermatol Pract Concept 2024; 14:dpc.1402a101. [PMID: 38810036 PMCID: PMC11136104 DOI: 10.5826/dpc.1402a101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2023] [Indexed: 05/31/2024] Open
Abstract
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.
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Affiliation(s)
- Awatef Kelati
- Dermatology Department, University Hospital Cheikh khalifa, and the University Hospital Mohammed VI. Faculty of Medicine, Mohammed VI University of Health and sciences (UM6SS), Casablanca, Morocco
| | - Asmae Rasso
- Dermatology Department, Provincial Hospital of Tantan, Tantan, Morocco
| | - Soumia Chiheb
- Dermatology Department, University Hospital Cheikh khalifa, and the University Hospital Mohammed VI. Faculty of Medicine, Mohammed VI University of Health and sciences (UM6SS), Casablanca, Morocco
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Bouquerel M, Baubion E, Dufrenot Petitjean Roget L, Amazan E, Olivier N. An atypical association of lichen planus pigmentosus and bullous lichen planus. Ann Dermatol Venereol 2024; 151:103262. [PMID: 38507959 DOI: 10.1016/j.annder.2024.103262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/07/2023] [Accepted: 02/15/2024] [Indexed: 03/22/2024]
Affiliation(s)
- M Bouquerel
- Dermatology Department, University Hospital of Martinique, 97200 Fort de France, Martinique, France.
| | - E Baubion
- Dermatology Department, University Hospital of Martinique, 97200 Fort de France, Martinique, France
| | | | - E Amazan
- Dermatology Department, University Hospital of Martinique, 97200 Fort de France, Martinique, France
| | - N Olivier
- Dermatology Department, University Hospital of Martinique, 97200 Fort de France, Martinique, France
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Bobotsis R, Brathwaite S, Eshtiaghi P, Rodriguez-Bolanos F, Doiron P. HIV: Inflammatory dermatoses. Clin Dermatol 2024; 42:169-179. [PMID: 38142786 DOI: 10.1016/j.clindermatol.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
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.
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Affiliation(s)
- Robert Bobotsis
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Shakira Brathwaite
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Panteha Eshtiaghi
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Fabian Rodriguez-Bolanos
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Philip Doiron
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada.
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5
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Cohen PR, Erickson CP, Calame A. Lichen Planus Pigmentosus Inversus: A Case Report of a Man Presenting With a Pigmented Lichenoid Axillary Inverse Dermatosis (PLAID). Cureus 2024; 16:e56995. [PMID: 38681353 PMCID: PMC11046377 DOI: 10.7759/cureus.56995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 05/01/2024] Open
Abstract
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.
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Affiliation(s)
- Philip R Cohen
- Dermatology, University of California Davis Health, Sacramento, USA
- Dermatology, Touro University California College of Osteopathic Medicine, Vallejo, USA
| | | | - Antoanella Calame
- Dermatology/Dermatopathology, Compass Dermatopathology, San Diego, USA
- Dermatology, Scripps Memorial Hospital, La Jolla, USA
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6
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Mathur M, Thakur N, Jaiswal S, Das G, Shah S, Maharjan S, Paudel S, Shrestha A, Upadhyay HP. Metabolic syndrome in patients with lichen planus: A case-control study. SKIN HEALTH AND DISEASE 2024; 4:e315. [PMID: 38312252 PMCID: PMC10831556 DOI: 10.1002/ski2.315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/09/2023] [Accepted: 11/09/2023] [Indexed: 02/06/2024]
Abstract
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.
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Affiliation(s)
- Mahesh Mathur
- Department of Dermatology, Venereology and LeprologyCollege of Medical Sciences and Teaching HospitalBharatpurNepal
| | - Neha Thakur
- Department of Dermatology, Venereology and LeprologyCollege of Medical Sciences and Teaching HospitalBharatpurNepal
| | - Sunil Jaiswal
- Department of Dermatology, Venereology and LeprologyCollege of Medical Sciences and Teaching HospitalBharatpurNepal
| | - Gautam Das
- Department of Dermatology, Venereology and LeprologyCollege of Medical Sciences and Teaching HospitalBharatpurNepal
| | - Swati Shah
- Department of Dermatology, Venereology and LeprologyCollege of Medical Sciences and Teaching HospitalBharatpurNepal
| | - Srijana Maharjan
- Department of Dermatology, Venereology and LeprologyCollege of Medical Sciences and Teaching HospitalBharatpurNepal
| | - Supriya Paudel
- Department of Dermatology, Venereology and LeprologyCollege of Medical Sciences and Teaching HospitalBharatpurNepal
| | - Anjali Shrestha
- Department of Dermatology, Venereology and LeprologyCollege of Medical Sciences and Teaching HospitalBharatpurNepal
| | - Hari Prasad Upadhyay
- Department of Community MedicineCollege of Medical Sciences and Teaching HospitalBharatpurNepal
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Jawad ASM, Petrushkin H. Challenges in the diagnosis of Behçet's disease. Int J Rheum Dis 2024; 27:e14914. [PMID: 37712444 DOI: 10.1111/1756-185x.14914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/03/2023] [Indexed: 09/16/2023]
Affiliation(s)
- Ali S M Jawad
- The London Behçet's Centre of Excellence, Royal London Hospital, London, UK
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8
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Louisy A, Humbert E, Samimi M. Oral Lichen Planus: An Update on Diagnosis and Management. Am J Clin Dermatol 2024; 25:35-53. [PMID: 37713153 DOI: 10.1007/s40257-023-00814-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2023] [Indexed: 09/16/2023]
Abstract
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.
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Affiliation(s)
- Agathe Louisy
- Université François Rabelais, Tours, France
- Maxillofacial Surgery and Stomatology Department, CHU Tours, Tours, France
| | - Eiryann Humbert
- Université François Rabelais, Tours, France
- Department of Dermatology, CHU Tours, Avenue de la République, 37170, Tours, France
| | - Mahtab Samimi
- Université François Rabelais, Tours, France.
- Department of Dermatology, CHU Tours, Avenue de la République, 37170, Tours, France.
- INRA, UMR 1282, Tours, France.
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9
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Alrefaie Y, Alraddadi A, Alhathal Y, Bamefleh H. Inverse Lichen Planus Associated With Nail Dystrophy. Cureus 2023; 15:e49823. [PMID: 38045628 PMCID: PMC10693224 DOI: 10.7759/cureus.49823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2023] [Indexed: 12/05/2023] Open
Abstract
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.
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Affiliation(s)
| | - Ali Alraddadi
- Dermatology Department, King Abdulaziz Medical City, Riyadh, SAU
| | | | - Hanaa Bamefleh
- Pathology Department, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
- Pathology Department, King Abdulaziz Medical City, Riyadh, SAU
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10
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Doh JY, Lee JH. A Generalized Lichen Planus Following COVID-19 Vaccination: A Case Report. Ann Dermatol 2023; 35:S260-S264. [PMID: 38061717 PMCID: PMC10727909 DOI: 10.5021/ad.22.026] [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: 01/25/2022] [Revised: 03/14/2022] [Accepted: 04/24/2022] [Indexed: 12/20/2023] Open
Abstract
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.
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Affiliation(s)
- Jee Yun Doh
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Hyun Lee
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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11
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Mahon-Smith A, Skingley G, Ayala-Nunes L, Batish A, Sharp R, Naujoks C, Schruf E, Compagno N, Moreno SG. Evaluating the Appropriateness of Existing Health-Related Quality of Life Measures in Lichen Planus. Dermatol Ther (Heidelb) 2023; 13:2817-2837. [PMID: 37794275 PMCID: PMC10613190 DOI: 10.1007/s13555-023-00990-4] [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: 05/17/2023] [Accepted: 07/19/2023] [Indexed: 10/06/2023] Open
Abstract
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.
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Affiliation(s)
- Aoife Mahon-Smith
- Patient-Centered Outcomes, Adelphi Values Ltd, Bollington, Cheshire, UK.
| | - George Skingley
- Patient-Centered Outcomes, Adelphi Values Ltd, Bollington, Cheshire, UK
| | - Lara Ayala-Nunes
- Patient-Centered Outcomes, Adelphi Values Ltd, Bollington, Cheshire, UK
| | - Anjali Batish
- Patient-Centered Outcomes, Adelphi Values Ltd, Bollington, Cheshire, UK
| | - Rosie Sharp
- Patient-Centered Outcomes, Adelphi Values Ltd, Bollington, Cheshire, UK
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12
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Lee JJ, Kim R, Lee MY, Byun JY, Choi YW, Choi HY. A Case of Linear Hypertrophic Lichen Planus in a Pediatric Patient. Ann Dermatol 2023; 35:S256-S259. [PMID: 38061716 PMCID: PMC10727884 DOI: 10.5021/ad.21.300] [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: 12/14/2021] [Revised: 02/09/2022] [Accepted: 03/27/2022] [Indexed: 12/20/2023] Open
Abstract
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.
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Affiliation(s)
- Jin Ju Lee
- Department of Dermatology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Rosa Kim
- Department of Dermatology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Min Young Lee
- Department of Dermatology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Ji Yeon Byun
- Department of Dermatology, Ewha Womans University College of Medicine, Seoul, Korea
| | - You Won Choi
- Department of Dermatology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Hae Young Choi
- Department of Dermatology, Ewha Womans University College of Medicine, Seoul, Korea.
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13
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Keerthika R, Kamboj M, Girdhar A, Narwal A, Devi A, Anand R, Juneja M. An exotic pathogenetic mechanism of angiogenesis in oral lichen planus-A systematic review. J Oral Pathol Med 2023; 52:803-810. [PMID: 37553286 DOI: 10.1111/jop.13472] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 05/09/2023] [Accepted: 07/18/2023] [Indexed: 08/10/2023]
Abstract
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.
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Affiliation(s)
- R Keerthika
- Department of Oral and Maxillofacial Pathology and Microbiology, Post Graduate Institute of Dental Sciences, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Mala Kamboj
- Department of Oral and Maxillofacial Pathology and Microbiology, Post Graduate Institute of Dental Sciences, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Akhil Girdhar
- Department of Oral and Maxillofacial Pathology and Microbiology, Post Graduate Institute of Dental Sciences, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Anjali Narwal
- Department of Oral and Maxillofacial Pathology and Microbiology, Post Graduate Institute of Dental Sciences, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Anju Devi
- Department of Oral and Maxillofacial Pathology and Microbiology, Post Graduate Institute of Dental Sciences, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Rahul Anand
- Department of Oral and Maxillofacial Pathology, Dr D Y Patil Dental College and Hospital, Dr D Y Patil Vidyapeeth, Pimpri, Pune, India
| | - Manish Juneja
- Oral and Maxillofacial Pathologist, Franklin, Massachusetts, USA
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Mahon-Smith A, Clifford M, Batish A, Sharp R, Panter C, Naujoks C, Schruf E, Compagno N, Moreno SG. Patient Experience of Lichen Planus: A Qualitative Exploration of Signs, Symptoms, and Health-Related Quality of Life Impacts. Dermatol Ther (Heidelb) 2023; 13:2001-2017. [PMID: 37505393 PMCID: PMC10442305 DOI: 10.1007/s13555-023-00968-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/14/2023] [Indexed: 07/29/2023] Open
Abstract
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.
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Affiliation(s)
- Aoife Mahon-Smith
- Patient-Centered Outcomes, Adelphi Values Ltd, Bollington, Cheshire, UK.
| | - Molly Clifford
- Patient-Centered Outcomes, Adelphi Values Ltd, Bollington, Cheshire, UK
| | - Anjali Batish
- Patient-Centered Outcomes, Adelphi Values Ltd, Bollington, Cheshire, UK
| | - Rosie Sharp
- Patient-Centered Outcomes, Adelphi Values Ltd, Bollington, Cheshire, UK
| | - Charlotte Panter
- Patient-Centered Outcomes, Adelphi Values Ltd, Bollington, Cheshire, UK
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15
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Madan V, Marchitto MC, Sunshine JC. Pembrolizumab-Induced Lichen Planus Pemphigoides in a Patient with Metastatic Adrenocortical Cancer: A Case Report and Literature Review. Dermatopathology (Basel) 2023; 10:244-258. [PMID: 37606485 PMCID: PMC10443361 DOI: 10.3390/dermatopathology10030033] [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: 07/14/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/23/2023] Open
Abstract
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.
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Affiliation(s)
| | | | - Joel C. Sunshine
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (V.M.)
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16
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Lagacé F, D’Aguanno K, Prosty C, Laverde-Saad A, Cattelan L, Ouchene L, Oliel S, Genest G, Doiron P, Richer V, Jfri A, O’Brien E, Lefrançois P, Powell M, Moreau L, Litvinov IV, Muntyanu A, Netchiporouk E. The Role of Sex and Gender in Dermatology - From Pathogenesis to Clinical Implications. J Cutan Med Surg 2023; 27:NP1-NP36. [PMID: 37401812 PMCID: PMC10486181 DOI: 10.1177/12034754231177582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/29/2023] [Accepted: 04/09/2023] [Indexed: 07/05/2023]
Abstract
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.
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Affiliation(s)
- François Lagacé
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | | | - Connor Prosty
- Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Alexandra Laverde-Saad
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Leila Cattelan
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Lydia Ouchene
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Sarah Oliel
- Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Genevieve Genest
- Division of Allergy and Immunology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Philip Doiron
- Division of Dermatology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vincent Richer
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Abdulhadi Jfri
- Department of Dermatology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Elizabeth O’Brien
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Philippe Lefrançois
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Mathieu Powell
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Linda Moreau
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Ivan V. Litvinov
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Anastasiya Muntyanu
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Elena Netchiporouk
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
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17
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Isaacs T, Lehloenya R. HIV-associated photodermatitis in African populations. FRONTIERS IN ALLERGY 2023; 4:1159387. [PMID: 37216149 PMCID: PMC10192905 DOI: 10.3389/falgy.2023.1159387] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 04/14/2023] [Indexed: 05/24/2023] Open
Abstract
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.
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18
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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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19
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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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20
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Singh R, Jawade S, Madke B. Actinic Lichen Planus: Significance of Dermoscopic Assessment. Cureus 2023; 15:e35716. [PMID: 37025742 PMCID: PMC10072168 DOI: 10.7759/cureus.35716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 03/03/2023] [Indexed: 03/06/2023] Open
Abstract
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.
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21
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Silva WR, de Lima-Souza RA, Silva LP, Filho LG, Montenegro LT, Iglesias DP. Mucocutaneous diseases with manifestations in the head and neck region: 24 years of experience in a Dermatology service. Med Oral Patol Oral Cir Bucal 2023; 28:e126-e130. [PMID: 36641747 PMCID: PMC9985936 DOI: 10.4317/medoral.25549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 12/16/2022] [Indexed: 01/16/2023] Open
Abstract
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.
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Affiliation(s)
- W-R Silva
- Department of Intensive Care Unit Real Hospital Português (RHP) Av. Gov. Agamenon Magalhães, 4760 52.010-075, Recife, Pernambuco, Brasil
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22
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Meneguzzo A, Mazzetto R, Lazzarotto A, Piaserico S. Painless Plaques Evolving to Bullae and Painful Erosions on the Penis: A Quiz. Acta Derm Venereol 2023; 103:adv00871. [PMID: 36794893 PMCID: PMC9949219 DOI: 10.2340/actadv.v103.4845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/29/2022] [Indexed: 02/17/2023] Open
Abstract
Abstract is missing (Quiz)
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Affiliation(s)
- Alberto Meneguzzo
- Department of Dermatology, University of Padua, Via Vincenzo Gallucci 4, IT-35121, Padova, Italy.
| | - Roberto Mazzetto
- Department of Dermatology, University of Padua, Via Vincenzo Gallucci 4, IT-35121, Padova, Italy
| | - Annalisa Lazzarotto
- Department of Dermatology, University of Padua, Via Vincenzo Gallucci 4, IT-35121, Padova, Italy
| | - Stefano Piaserico
- Department of Dermatology, University of Padua, Via Vincenzo Gallucci 4, IT-35121, Padova, Italy
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23
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Wang Y, Chen L, Wang J, Bian Y, Li Q. Reflectance confocal microscopy-assisted diagnosis of lichen planus pigmentosus distributed along multiple unilateral Blaschko's lines in a child: A case report. Australas J Dermatol 2023; 64:e160-e161. [PMID: 36716215 DOI: 10.1111/ajd.13988] [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: 12/23/2022] [Accepted: 01/14/2023] [Indexed: 01/31/2023]
Abstract
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.
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Affiliation(s)
- Ying Wang
- Department of Dermatology, Tianjin Children's Hospital, Tianjin, China
| | - Lixin Chen
- Department of Dermatology, Tianjin Children's Hospital, Tianjin, China
| | - Ji Wang
- Department of Dermatology, Tianjin Children's Hospital, Tianjin, China
| | - Yawei Bian
- Department of Dermatology, Tianjin Children's Hospital, Tianjin, China
| | - Qinfeng Li
- Department of Dermatology, Tianjin Children's Hospital, Tianjin, China
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Young MK, Holder KG, Baker TE, Kauffman RP. Vulvovaginal erosive lichen planus refractory to topical therapies: What's next? A case report. Case Rep Womens Health 2023; 37:e00478. [PMID: 36636108 PMCID: PMC9829706 DOI: 10.1016/j.crwh.2023.e00478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 12/30/2022] [Accepted: 01/02/2023] [Indexed: 01/04/2023] Open
Abstract
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.
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25
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Zhao P, Remington C, Flowers RH. Autosomal dominant albopapuloid epidermolysis bullosa pruriginosa. Int J Dermatol 2022. [DOI: 10.1111/ijd.16536] [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: 09/19/2022] [Revised: 10/31/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Patricia Zhao
- University of Virginia School of Medicine Charlottesville VA USA
| | - Courtney Remington
- Department of Dermatology University of Virginia Medical Center Charlottesville VA USA
| | - R. Hal Flowers
- Department of Dermatology University of Virginia Medical Center Charlottesville VA USA
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26
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Fernández-Parrado M, Arostegui-Aguilar J, Perandones-González H, Hiltun I, de Dot-Gómara T, Larra-García M, Yanguas-Bayona JI. Photodynamic therapy in uncommon forms of lichen planus. Dermatol Ther 2022; 35:e15914. [PMID: 36209380 DOI: 10.1111/dth.15914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/20/2022] [Accepted: 10/06/2022] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | - Ingrid Hiltun
- Department of Dermatology, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
| | - Teresa de Dot-Gómara
- Department of Pathology, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
| | - Mónica Larra-García
- Department of Dermatology, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
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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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Abstract
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.
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Motamed-Sanaye A, Khazaee YF, Shokrgozar M, Alishahi M, Ahramiyanpour N, Amani M. JAK inhibitors in lichen planus: A review of pathogenesis and treatments. J DERMATOL TREAT 2022; 33:3098-3103. [PMID: 35997540 DOI: 10.1080/09546634.2022.2116926] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
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.
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Affiliation(s)
- Ali Motamed-Sanaye
- Infectious Diseases research center, student research committee, Faculty of Medicine, Gonabad university of medical sciences, Gonabad, Iran.,Clinical Research Development Unit, Bohlool Hospital, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Yasaman Fatemeh Khazaee
- Assistant professor of pediatrics Department, School of Medicine, Gonabad University of Medical Sciences
| | | | - Maryam Alishahi
- Faculty of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Najmeh Ahramiyanpour
- Department of Dermatology, Afzalipour Hospital, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Maliheh Amani
- Department of Dermatology, Faculty of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
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Ahmed WA, Badirah SB, Abdulwahab RA, Al Hawsawi K. Acquired Dermal Macular Hyperpigmentation Mimicking Dowling Degos Disease: A Case Report. Cureus 2022; 14:e28150. [PMID: 36148207 PMCID: PMC9482672 DOI: 10.7759/cureus.28150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2022] [Indexed: 11/07/2022] Open
Abstract
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.
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Mozafari N, Bidari‐Zerehpoosh F, Movahedi M, Dadkhahfar S. Hypertrophic lichen planus on lip mimicking
SCC. Clin Case Rep 2022; 10:e6191. [PMID: 35957792 PMCID: PMC9360339 DOI: 10.1002/ccr3.6191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/13/2022] [Accepted: 07/13/2022] [Indexed: 11/10/2022] Open
Abstract
The lichen planus (LP) is an inflammatory and immune‐mediated disorder that can affect the hair, mucous membranes, nails, and skin. Lichen planus rarely affects the lips. In cases of lip involvement, it presents as radiated streaks, lace‐like papules, and erosions. There is no report of lip LP presenting as hypertrophic plaque. Here, we report interesting and rare clinical presentations of LP in a 45‐year‐old male patient that presented with a verrucous hyperkeratotic plaque on the lower lip mimicking squamous cell carcinoma. However, oral examination revealed, reticulated white patches on the bilateral buccal mucosa, and a biopsy of the lip lesion revealed lichenoid dermatitis which led to the diagnosis of hypertrophic lichen planus. Familiarity with the different clinical presentations of LP and its variants is essential for prompt diagnosis and effective treatment.
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Affiliation(s)
- Nikoo Mozafari
- Skin Research Center Shahid Beheshti University of Medical Sciences Tehran Iran
- Department of Dermatology, Loghman Hakim Hospital Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Farahnaz Bidari‐Zerehpoosh
- Department of Pathology, Loghman Teaching Center, School of Medicine Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Mahdiyeh Movahedi
- School of Medicine Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Sahar Dadkhahfar
- Skin Research Center Shahid Beheshti University of Medical Sciences Tehran Iran
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Elwan NM, Abd-Elsalam S, Fawzy MM, Gamal Alsakaan NA. Efficacy and Safety of Oral Methotrexate versus Oral Mini Pulse Betamethasone Therapy in the Treatment of Lichen Planus: A Comparative Study. J DERMATOL TREAT 2022; 33:3039-3046. [PMID: 35856817 DOI: 10.1080/09546634.2022.2104446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
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 good alternative. Also, Methotrexate (MTX) can be used as alternative and safe modality in LP. OBJECTIVES To compare the efficacy and safety of oral MTX versus OMP betamethasone in 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 maximum 12 weeks. Basic laboratory investigations were done to both groups. Follow up investigations were done at 2nd, 4th, 8th and 12th week. Percentage of improvement in each patient was calculated on a scale according to appearance of new lesions, degree of pruritus/pain, subsidence of cutaneous lesions and clearance of oral lesion. RESULTS In MTX group, 55% of patients showed excellent improvement, 25% showed good improvement and 20% showed partial improvement. In 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 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.
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Affiliation(s)
- Nagwa Mohammad Elwan
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Sherief Abd-Elsalam
- Tropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed M Fawzy
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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Sciuca AM, Toader MP, Stelea CG, Maftei GA, Ciurcanu OE, Stefanescu OM, Onofrei BA, Popa C. Desquamative Gingivitis in the Context of Autoimmune Bullous Dermatoses and Lichen Planus-Challenges in the Diagnosis and Treatment. Diagnostics (Basel) 2022; 12:1754. [PMID: 35885656 PMCID: PMC9322493 DOI: 10.3390/diagnostics12071754] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/01/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022] Open
Abstract
Desquamative gingivitis (DG) is a clinical term that describes erythema, desquamation and erosions of the gingiva, of various etiologies. Although the clinical aspect is not specific for a certain disease, an accurate diagnosis of the underlying disorder is necessary because the disease course, prognosis and treatment vary according to the cause. DG may inflict significant oral discomfort, which is why patients typically present to the dentist for a first consultation, rendering it important for these specialists to be informed about this condition. Our paper aims to review the ethiopatogenesis and diagnostic approach of DG, focusing on the most common underlying disorders (autoimmune bullous dermatoses and lichen planus) and on the management of these patients. Potential etiological agents leading to an inflammatory immune response in the oral mucosa and DG appearance include genetic predisposition, metabolic, neuropsychiatric, infectious factors, medication, dental materials, graft-versus-host reaction and autoimmunity. A thorough anamnesis, a careful clinical examination, paraclinical explorations including histopathological exam and direct immunofluorescence are necessary to formulate an appropriate diagnosis. Proper and prompt management of these patients lead to a better prognosis and improved quality of life, and must include management in the dental office with sanitizing the oral cavity, instructing the patient for rigorous oral hygiene, periodic follow-up for bacterial plaque detection and removal, as well as topical and systemic therapy depending on the underlying disorder, based on treatment algorithms. A multidisciplinary approach for the diagnosis and follow-up of DG in the context of pemphigus vulgaris, bullous pemphigoid, cicatricial pemhigoid or lichen planus is necessary, including consultations with dermatologists, oral medicine specialists and dentists.
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Affiliation(s)
- Ana Maria Sciuca
- Discipline of Oral Medicine, Oral Dermatology, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania; (A.M.S.); (G.A.M.); (B.-A.O.); (C.P.)
| | - Mihaela Paula Toader
- Discipline of Oral Medicine, Oral Dermatology, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania; (A.M.S.); (G.A.M.); (B.-A.O.); (C.P.)
| | - Carmen Gabriela Stelea
- Discipline of Oral Surgery, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania; (O.E.C.); (O.M.S.)
| | - George Alexandru Maftei
- Discipline of Oral Medicine, Oral Dermatology, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania; (A.M.S.); (G.A.M.); (B.-A.O.); (C.P.)
| | - Oana Elena Ciurcanu
- Discipline of Oral Surgery, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania; (O.E.C.); (O.M.S.)
| | - Ovidiu Mihail Stefanescu
- Discipline of Oral Surgery, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania; (O.E.C.); (O.M.S.)
| | - Bianca-Andreea Onofrei
- Discipline of Oral Medicine, Oral Dermatology, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania; (A.M.S.); (G.A.M.); (B.-A.O.); (C.P.)
| | - Cristina Popa
- Discipline of Oral Medicine, Oral Dermatology, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania; (A.M.S.); (G.A.M.); (B.-A.O.); (C.P.)
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Al Khabbaz FA, Ali MM, Al Awadhi A. A Rare Case Report: Five Variants of Lichen Planus in a Young Male Patient. Cureus 2022; 14:e27080. [PMID: 36000123 PMCID: PMC9391065 DOI: 10.7759/cureus.27080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/05/2022] Open
Abstract
Lichen planus is a common dermatological condition. It is described as a chronic inflammatory mucocutaneous disease that has characteristic clinical and histopathological findings. Classical lichen planus lesions occur as purple, pruritic polygonal papules or plaques with a lace-like pattern of whitish markings on the surface. Despite the large number of variants that exist with different clinical manifestations from the classic form, histopathology features are fairly similar among the subtypes and can aid in the diagnosis. Although most cases of lichen planus are often self-limiting with spontaneous resolution expected within one to two years, early diagnosis and treatment are encouraged to control severe pruritus and painful mucosal erosion, but most importantly to minimize the potential for malignant transformation in long-standing lesions. The main objective of this paper is to report the first case of five cutaneous variants of lichen planus occurring simultaneously in a young male patient.
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35
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[Lichen planus: A case report, literature review and its influence on quality of life]. Aten Primaria 2022; 54:102317. [PMID: 35325791 PMCID: PMC8938873 DOI: 10.1016/j.aprim.2022.102317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 11/21/2022] Open
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36
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Grover C, Kharghoria G, Baran R. Nail lichen planus: A review of clinical presentation, diagnosis and therapy. Ann Dermatol Venereol 2022; 149:150-164. [PMID: 35272870 DOI: 10.1016/j.annder.2022.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/08/2021] [Accepted: 01/21/2022] [Indexed: 11/29/2022]
Abstract
Lichen planus is a multifaceted disease of complex etiopathogenesis. Nails are involved in up to 10% of patients with lichen planus. Although most cases are mild, serious consequences may occur due to rapid progression of the disease, the high risk of scarring, and the resulting irreversible damage to the nail structure. Permanent damage of at least one nail occurs in approximately 4-12% of patients with nail lichen planus. In this narrative review, we emphasize the pathophysiology of nail lichen planus, the emergent nature of the disease, and the spectrum of different clinical manifestations. Diagnosis of nail disease in general, and of nail lichen planus in particular, is rapidly evolving. This review provides a comprehensive account of the non-invasive and invasive diagnostic techniques and treatment options reported in the literature, with emphasis on the efficacy and safety of the drugs used, the associated evidence, and the factors to be taken into account in planning and providing adequate treatment. The role of aesthetic and camouflage options is also summarized.
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Affiliation(s)
- C Grover
- Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital, 110091 Delhi, India.
| | - G Kharghoria
- Department of Dermatology and STD, All India Institute of Medical Sciences, 110029 Delhi, India
| | - R Baran
- Nail Disease Centre-42, Rue de Serbes, 06400 Cannes, France
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37
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Andijani F. Zosteriform Lichen Planus on the Trunk: A Case Report of a Rare Clinical Entity. Cureus 2022; 14:e22867. [PMID: 35399446 PMCID: PMC8982484 DOI: 10.7759/cureus.22867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 11/05/2022] Open
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38
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Rasul TF, Anderson J, Bergholz DR, Faiz A, Prasad RR. Gold Dental Implant-Induced Oral Lichen Planus. Cureus 2022; 14:e21852. [PMID: 35273836 PMCID: PMC8901106 DOI: 10.7759/cureus.21852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 02/02/2023] Open
Abstract
Lichen planus is a chronic inflammatory cutaneous and mucosal disease mostly affecting middle-aged individuals. The etiology of lichen planus is unknown, but current literature suggests that it is an altered immune response characterized by dysregulated T-cell activation and subsequent inflammation which can be associated with conditions like allergic contact dermatitis and hepatitis C. Additionally, heavy metals like lead, tin, arsenic, and bismuth can create inflammatory and allergic reactions that can predispose to the formation of lichen planus. This report examines the case of a 64-year-old female with longstanding oral lichenoid lesions with superimposed Wickham's striae, allergic skin reactions to several medications, and a history of receiving gold-containing dental implants. As a result of her history and subsequent allergy testing, she was found to have a gold allergy. The constant mucosal irritation from her dental implants likely was associated with the development of her oral lesions, which were confirmed to be oral lichen planus. She was recommended to apply triamcinolone 0.1% ointment to her oral lesions and to follow up with her dentist for evaluation of her filings. Further, it was recommended she replaces the dental crowns with compounds lacking gold to decrease the persistent irritation. This case represents the first such instance of gold dental fillings directly having an appreciable role in the development of oral lichen planus.
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Affiliation(s)
- Taha F Rasul
- Infectious Diseases, University of Miami Miller School of Medicine, Miami, USA
| | - Jackson Anderson
- Internal Medicine, University of Miami Miller School of Medicine, Miami, USA
| | - Daniel R Bergholz
- Allergy and Immunology, University of Miami Miller School of Medicine, Miami, USA
| | - Arfa Faiz
- Allergy and Immunology, Sutter Medical Center, Sacramento, USA
| | - Rishi R Prasad
- Medical Education, University of Miami Miller School of Medicine, Miami, USA
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Khodaei B, Seyedpour S, Gholami B, Garmarudi G, Nasimi M. Seasonal and gender variation in skin disease: A cross-sectional study of 3120 patients at Razi hospital. Int J Womens Dermatol 2022; 7:799-802. [PMID: 35028385 PMCID: PMC8714557 DOI: 10.1016/j.ijwd.2021.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 11/29/2022] Open
Abstract
Objective: We aimed to determine the prevalence of different skin diseases and their seasonal variations at the Razi dermatology hospital from 2019 to 2020. Methods: In this cross-sectional study, we obtained data from the medical records of 3120 patients visiting the dermatology clinic of Razi hospital. The prevalence of skin diseases was evaluated using meteorologically defined seasons. We looked for significant equally distributed results during each season. Results: During all seasons, women were referred to our clinic more frequently than men. Some diseases demonstrated significant seasonality with a peak during the winter, including acne, eczema, wart, seborrheic dermatitis, nevus, vitiligo, lentigo, and dermatophytosis. Atopic dermatitis was more frequent during the spring and winter compared with other seasons (p < .05). Actinic keratosis and lichen planus showed a significant seasonal trend with a peak during the summer (p < .05). Infections, including viral, bacterial, and fungal skin diseases, were more frequent during the winter than the summer (p = .001). Conclusion: This study provides an overview of the seasonal distribution of dermatology visits at our referral hospital, which will aid in developing better policies to prevent and manage skin disorders in outpatient visits.
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Affiliation(s)
- Behzad Khodaei
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Nanomedicine Research Association, Universal Scientific Education and Research Network, Tehran, Iran
| | - Simin Seyedpour
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Nanomedicine Research Association, Universal Scientific Education and Research Network, Tehran, Iran
| | - Bahare Gholami
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Garmarudi
- Health Promotion and Education Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Nasimi
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
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40
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The Immunogenetics of Lichen Planus. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1367:119-135. [DOI: 10.1007/978-3-030-92616-8_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lichen Planus Activity and Damage Index (LiPADI)–Creation of the Questionnaire. J Clin Med 2021; 11:jcm11010023. [PMID: 35011764 PMCID: PMC8745608 DOI: 10.3390/jcm11010023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 12/21/2021] [Accepted: 12/21/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: Lichen planus (LP) is a chronic autoimmune disease that affects skin, oral and genital mucosa, and other sites. Basic difficulties in assessment of LP are multitude of disease forms and diverse locations of lesions. Moreover, there is lack of objective and consolidated tool for assessment of disease severity and LP progression. Objective: The aim of the study was to develop a valid evaluation tool of LP severity, which will enable disease assessment in a repetitive way. Materials and methods: A combined tool called Lichen Planus Activity and Damage Index (LiPADI) was developed to assess the severity of LP skin, mucosal, and nail lesions as well as hair loss/scaring alopecia to provide an integrative scoring for LP activity and damage caused by the disease. Skin lesions were assessed in nine locations: scalp, face, chest, abdomen, back and buttocks, arms, hands, legs, and feet. The assessment of lesion activity included erythema, hypertrophy, and scaling, while the damage was reflected by the assessment of hyperpigmentation and scaring/atrophy. In addition, mucosal lesions, nail abnormalities, hair loss, and scarring alopecia were evaluated as well. LiPADI scoring was compared with quality of life assessed with the Dermatology Life Quality Index, EQ-5D calculator, pain and pruritus intensity assessed with the Numerical Rating Scale as well as with the patient and physician global assessment. Results: Our results show that LiPADI well reflects the LP patient’s clinical condition. The obtained results were in line with other indicators assessed. In addition, it was possible to evaluate patients with various forms and locations of LP, what indicates its versatility. Conclusions: LiPADI seems to be a useful tool for measurement the severity of the LP and its progress over time, which could help to monitor the effectiveness of the patients’ treatment.
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Rehman F, Krishan K, Latif I, Sudan E, Sultan J, Hassan I. Intra-individual Right-Left Comparative Study of Combined Therapy of Intramatricial Triamcinolone and Platelet-Rich Plasma vs. Intramatricial Triamcinolone Only in Lichen Planus-Associated Nail Dystrophy. J Cutan Aesthet Surg 2021; 14:311-317. [PMID: 34908773 PMCID: PMC8611714 DOI: 10.4103/jcas.jcas_156_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background While intramatricial triamcinolone is the most commonly used treatment option for onychodystrophy due to lichen planus, the role of platelet-rich plasma (PRP) in the treatment of onychodystrophy is not established. So we combined the two treatment modalities to assess the synergistic action on nail dystrophy. Aims and Objectives The aim of this article is to compare the effect of combination of intramatricial triamcinolone and PRP vs. intramatricial triamcinolone alone in the treatment of onychodystrophy. Materials and Methods This study was done in 26 and 25 pairs of symmetrical dystrophic nails in hands and feet, respectively. The patients received intramatricial injection of triamcinolone and PRP on one side of finger and toe nails and triamcinolone on the contralateral side. Results Statistically significant improvements in grades of dystrophy according to the Nail Dystrophy Grading System (NDGS) in the finger and toe nails treated with combined therapy were obtained (P < 0.001 and = 0.002, respectively). According to the physician global assessment, response to combination therapy was statistically significant between the two comparison groups of finger and toe nails (P = 0.001 and = 0.004, respectively). Similarly, according to the patient satisfaction score, statistically significant difference was found between the comparison groups of combination therapy and single therapy (P < 0.001). Conclusion Addition of PRP significantly improved the nail quality. Intramatricial PRP is a safe and effective therapeutic modality in refractory nail dystrophies.
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Affiliation(s)
- Fozia Rehman
- Department of Dermatology, Venereology, and Leprosy, Government Medical College Srinagar, Karan Nagar, Jammu and Kashmir, India
| | - Kewal Krishan
- Department of Dermatology, Venereology, and Leprosy, Government Medical College Srinagar, Karan Nagar, Jammu and Kashmir, India
| | - Insha Latif
- Department of Dermatology, Venereology, and Leprosy, Government Medical College Srinagar, Karan Nagar, Jammu and Kashmir, India
| | - Ekta Sudan
- Department of Dermatology, Venereology, and Leprosy, Government Medical College Srinagar, Karan Nagar, Jammu and Kashmir, India
| | - Javeed Sultan
- Department of Dermatology, Venereology, and Leprosy, Government Medical College Srinagar, Karan Nagar, Jammu and Kashmir, India
| | - Iffat Hassan
- Department of Dermatology, Venereology, and Leprosy, Government Medical College Srinagar, Karan Nagar, Jammu and Kashmir, India
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Sharma P. An Unusual Presentation of Lichen Planus. Cureus 2021; 13:e19304. [PMID: 34900481 PMCID: PMC8649974 DOI: 10.7759/cureus.19304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2021] [Indexed: 11/27/2022] Open
Abstract
Lichen planus is a chronic papulosquamous eruption of the skin, scalp, nails, and mucous membranes. "Pruritic, purple, polygonal, planar, papules, plaques" are the traditional six "P's" of lichen planus. We describe an unusual case of lichen planus presenting as cellulitis. A 64-year-old lady with a past medical history of pyoderma gangrenosum, inclusion body myositis, and chronic kidney disease presented with a two-week history of swelling, erythema, tenderness, hyperkeratotic plaques, and blisters on the medial aspect of both thighs. She had a previous history of pyoderma gangrenosum exacerbations with similar presentations; however, current lesions were different from prior presentations. We considered the differential diagnoses of bacterial cellulitis versus pyoderma gangrenosum exacerbation. Due to the difference in these lesions from previous episodes, the patient was empirically treated for bacterial cellulitis with intravenous cefepime and linezolid. The infectious diseases team was consulted and valacyclovir was added to cover for possible herpes infection, with no improvement in symptomatology. Dermatology was then consulted, and a clinical diagnosis of psoriasiform dermatitis was made. A skin biopsy was obtained and the patient was started on prednisone. There was an immediate improvement in the papules within 24 hours. The papules cleared, leaving behind violaceous flat plaques, clinically diagnosed as lichen planus. The affected area was shrinking as compared to previous examinations. The skin biopsy was reported as chronic psoriasiform dermatitis with the main differential of lichen planus. The patient was discharged home on a tapering dose of oral prednisone, topical clobetasol, and oral moxifloxacin. This case demonstrates the importance of familiarity with rare clinical subtypes as a suspicion for lichen planus. The vesiculobullous subtype of lichen planus, as seen in this patient, tends to present as blisters and cellulitis from infection of the bullae. Treatment of the infection alone is not enough and steroids are essential. This knowledge helps change management, allows for earlier improvement and better patient outcomes.
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Liu Y, Liang X, Wu H, Zhuo F. Case Report: The First Reported Case of Bullous Lichen Planus-Systemic Lupus Erythematosus Overlap Syndrome. Front Med (Lausanne) 2021; 8:744592. [PMID: 34805210 PMCID: PMC8599928 DOI: 10.3389/fmed.2021.744592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/04/2021] [Indexed: 11/14/2022] Open
Abstract
Introduction: Lichen planus/lupus erythematosus overlap syndrome is rarely seen in the clinic and has the characteristic clinical manifestations, histopathology, and immunopathology of lichen planus (LP) and lupus erythematosus (LE). This is the first reported case of bullous lichen planus (BLP)/systemic lupus erythematosus (SLE) overlap syndrome with hair loss as the first symptom. Case Presentation: A 48-year-old female presented with alopecia for half a year, and skin lesions accompanied by itching on her face, trunk, and limbs for 3 months. She had a history suggestive of photosensitivity. Laboratory tests and histopathology were performed for diagnosis. Histopathologic features of the upper arm and back of the hand were consistent with BLP, whereas the scalp lesion indicated LE. Laboratory examination indicated positive for antinuclear antibody (ANA) (1:160), leukopenia, increased urinary protein, decreased C3/C4, and normal BP180. The patient was given glucocorticoid combined with acitretin and immunosuppressive therapy after a definite diagnosis of BLP/SLE overlap syndrome. The lesions of the patient disappeared and some hair had regrown during the two years of follow-up. Conclusion: This is the first reported case of BLP/SLE overlap syndrome which responded well to glucocorticoids, retinoids, and immunosuppressive drugs. Multiple biopsies from characteristic lesions will guide doctors to avoid misdiagnoses and delayed treatment.
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Affiliation(s)
- Yi Liu
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xuelei Liang
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Haixuan Wu
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Fenglin Zhuo
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Cho SK, Chong BF. SnapshotDx Quiz: October 2021. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ruiz-Lozano RE, Hernández-Camarena JC, Valdez-Garcia JE, Roman-Zamudio M, Herrera-Rodriguez MI, Andrade-Carrillo D, Garza-Garza LA, Cardenas-de la Garza JA. Ocular involvement and complications of lichen planus, lichen planus pigmentosus, and lichen planopilaris: A comprehensive review. Dermatol Ther 2021; 34:e15137. [PMID: 34541780 DOI: 10.1111/dth.15137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 09/16/2021] [Indexed: 11/28/2022]
Abstract
Ocular involvement of lichenoid dermatoses, such as lichen planus (LP), lichen planus pigmentosus (LPP), and lichen planopilaris (LPL), although uncommon, is associated with skin manifestations. Isolated ocular involvement is very rare. When lesions are confined to the skin, the dermatologist inquires and evaluates for oral and genital symptoms and lesions, respectively; hence, eye manifestations are commonly neglected by the non-ophthalmologist. Ocular involvement in LP, LPP, and LPL may result in significant morbidity. An ophthalmic interrogatory and a gross ophthalmic evaluation performed by the dermatologist may unravel ocular signs and symptoms that require evaluation by an eye specialist. Ocular surface inflammation and scarring, when untreated, results in serious complications such as corneal perforation and permanent vision loss. This review aims to present an up-to-date overview for the dermatologist of the ocular involvement and complications of LP, LPP, and LPL, and when to refer to the ophthalmologist to prevent blinding complications.
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Affiliation(s)
- Raul E Ruiz-Lozano
- Tecnológico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | - Julio C Hernández-Camarena
- Tecnológico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | - Jorge E Valdez-Garcia
- Tecnológico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | - Mariana Roman-Zamudio
- Tecnológico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | - Monica I Herrera-Rodriguez
- Tecnológico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | - Daniela Andrade-Carrillo
- Tecnológico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | - Lucas A Garza-Garza
- Tecnológico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | - Jesus A Cardenas-de la Garza
- Universidad Autónoma de Nuevo León, Rheumatology Service, University Hospital "Dr. José Eleuterio González, Monterrey, Mexico
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Sánchez-Cárdenas CD, Vega-Memije ME, Flores-Gavilán P, Romero M, Arenas R, Sánchez RL. Disseminated and recurrent infundibulofolliculitis in children in Mexico. Pediatr Dermatol 2021; 38:1233-1236. [PMID: 34515382 DOI: 10.1111/pde.14803] [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: 12/01/2022]
Abstract
Disseminated and recurrent infundibulofolliculitis is an uncommon non-infectious skin eruption characterized by recurrent, sometimes pruritic, follicular papules commonly seen on the trunk and proximal extremities. We describe the clinical, dermoscopic, and histopathologic characteristics of disseminated and recurrent infundibulofolliculitis in three young pediatric patients from the tropical regions of Mexico, Guerrero, and Chiapas.
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Affiliation(s)
- Carlos Daniel Sánchez-Cárdenas
- Departamento de Dermatología, Intituto Mexicano del Seguro Social, Centro Médico Nacional "La Raza", Ciudad de Mexico, Mexico
| | - María Elisa Vega-Memije
- Sección de Dermatopatología, Hospital General "Dr. Manuel Gea González", Ciudad de Mexico, Mexico
| | - Paola Flores-Gavilán
- Sección de Dermatopatología, Hospital General "Dr. Manuel Gea González", Ciudad de Mexico, Mexico
| | - Marina Romero
- Sección de Micología, Hospital General "Dr. Manuel Gea González", Ciudad de Mexico, Mexico
| | - Roberto Arenas
- Sección de Micología, Hospital General "Dr. Manuel Gea González", Ciudad de Mexico, Mexico
| | - Ramon L Sánchez
- Dermopath.Laboratories LLC, Galveston Dermatology, PA, Galveston, TX, USA
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Sears S, Daftary K, Burch A, Todd P. A case of annular atrophic lichen planus in a child and review of the literature. Pediatr Dermatol 2021; 38:1283-1287. [PMID: 34561910 DOI: 10.1111/pde.14812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Lichen planus (LP) is an inflammatory disease affecting both adults and children that may present with numerous rare morphologies. LP and its many subtypes can prove difficult to treat and often leave patients with dyspigmentation. Additionally, pruritus associated with LP can be distressing to patients. The aim of this report is to highlight an uncommon subtype, annular atrophic lichen planus, which uniquely presented in a child, to emphasize the importance of early disease recognition and finally, to demonstrate successful treatment with topical monotherapy with clobetasol propionate ointment.
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Affiliation(s)
- Samantha Sears
- Division of Dermatology, Department of Internal Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Karishma Daftary
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Andrea Burch
- Division of Dermatology, Department of Internal Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Patricia Todd
- Division of Pediatric Dermatology, Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA
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Aquino TM, Calvarido MG, North JP. Interleukin 36 expression in psoriasis variants and other dermatologic diseases with psoriasis-like histopathologic features. J Cutan Pathol 2021; 49:123-132. [PMID: 34346097 DOI: 10.1111/cup.14115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/30/2021] [Accepted: 07/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Elevated epidermal interleukin (IL)-36 expression distinguishes psoriasis from eczematous dermatitis, but other psoriasiform dermatitides (PDs) have not been thoroughly investigated for IL-36 expression. In this study, we assess the IL-36 staining pattern (IL36-SP) in psoriasis variants and other PDs including lichen simplex chronicus (LSC), prurigo nodularis (PN), lichen planus (LP), tinea, pityriasis rubra pilaris (PRP), mycosis fungoides (MF), pemphigus foliaceus (PF), acute generalized exanthematous pustulosis (AGEP), impetigo (IMP), and syphilis (SY). METHODS IL-36 immunostaining was performed on 307 cases of psoriasis and various PDs. IL36-SP in the upper epidermis was graded on a scale of 0-4. RESULTS High IL36-SP occurred in all variants of psoriasis, as well as in AGEP, PRP, PN, tinea, IMP, and LP (P > 0.05). SY, PF, LSC, and MF showed a lower IL36-SP (P ≤ 0.05) compared with psoriasis. CONCLUSION All variants of psoriasis exhibit high IL36-SP. IL-36 staining can assist in differentiating MF, PF, SY, and LSC from psoriasis, particularly MF and LSC, which have consistent low IL-36 expression. AGEP, PRP, tinea, IMP, PN, and LP exhibit high IL-36 expression similar to psoriasis, indicating Th17 activation in these diseases.
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Georgescu SR, Mitran CI, Mitran MI, Nicolae I, Matei C, Ene CD, Popa GL, Tampa M. Oxidative Stress in Cutaneous Lichen Planus-A Narrative Review. J Clin Med 2021; 10:2692. [PMID: 34207416 PMCID: PMC8234860 DOI: 10.3390/jcm10122692] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/13/2021] [Accepted: 06/17/2021] [Indexed: 12/14/2022] Open
Abstract
Lichen planus (LP) is a chronic, immune-mediated inflammatory skin condition that mainly affects the skin (cutaneous LP, CLP) and oral mucosa (oral LP, OLP). However, the mechanisms involved in the pathogenesis of the disease are not fully elucidated. Over time, several theories that could explain the appearance of LP lesions have been postulated. The key players in LP pathogenesis are the inflammatory infiltrate consisting of T cells and the proinflammatory cytokines. The cytokines stimulate the production of reactive oxygen species that induce cell apoptosis, a defining element encountered in LP. The lead inquiry triggered by this revolves around the role of oxidative stress in LP development. There are currently numerous studies showing the involvement of oxidative stress in OLP, but in terms of CLP, data are scarce. In this review, we analyze for the first time the currently existing studies on oxidative stress in CLP and summarize the results in order to assess the role of oxidative stress in skin lesions offering a fresher updated perspective.
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Affiliation(s)
- Simona Roxana Georgescu
- Department of Dermatology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (S.R.G.); (C.M.); (M.T.)
- Department of Dermatology, Victor Babes Clinical Hospital for Infectious Diseases, 030303 Bucharest, Romania;
| | - Cristina Iulia Mitran
- Department of Microbiology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Cantacuzino National Medico-Military Institute for Research and Development, 011233 Bucharest, Romania
| | - Madalina Irina Mitran
- Department of Microbiology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Cantacuzino National Medico-Military Institute for Research and Development, 011233 Bucharest, Romania
| | - Ilinca Nicolae
- Department of Dermatology, Victor Babes Clinical Hospital for Infectious Diseases, 030303 Bucharest, Romania;
| | - Clara Matei
- Department of Dermatology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (S.R.G.); (C.M.); (M.T.)
| | - Corina Daniela Ene
- Department of Nephrology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Nephrology, Carol Davila Clinical Hospital of Nephrology, 010731 Bucharest, Romania
| | - Gabriela Loredana Popa
- Department of Microbiology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Mircea Tampa
- Department of Dermatology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (S.R.G.); (C.M.); (M.T.)
- Department of Dermatology, Victor Babes Clinical Hospital for Infectious Diseases, 030303 Bucharest, Romania;
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