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AlEid NM, Ilesanmi ON, Alshehri MA, Alhumidi AA, AlShihry H. Lichen Planus of the Eyelids: Case Report of a Rare Presentation of a Common Dermatosis. Cureus 2024; 16:e57299. [PMID: 38690479 PMCID: PMC11059109 DOI: 10.7759/cureus.57299] [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: 03/30/2024] [Indexed: 05/02/2024] Open
Abstract
Lichen planus (LP) is a common T-cell-mediated autoimmune skin disease, and its exact etiology is unknown. Typically, it affects the trunk, flexural surfaces, and the mucosa.We report a rare finding of LP involving both eyelids in a 67-year-old female. A 67-year-old Saudi female with a medical history of diabetes mellitus, hypothyroidism and rheumatoid arthritis presented with a three-month history of pruritic skin eruptions in both eyelids. She had no associated musculoskeletal symptoms or fatigue and no medical or family history of atopy. The patient had violaceous, thin, scaly plaques confined to both eyelids. Oral mucosa, genitalia, scalp, and nails were not affected. Histopathology from the right lower eyelid confirmed the diagnosis of LP. Hepatitis C virus serology was negative. Patient was examined by ophthalmology to rule out conjunctival involvement of LP. She had dry eyes only. She was initially managed by topical tacrolimus 0.1% ointment and didn't tolerate it due to severe reaction. She tolerated mometasone propionate 0.1% cream, which relieved the itch and partially improved the lesions. Although rare, LP of the eyelids must be considered among differential diagnoses of eyelid dermatitis. It can be confined, or it may concomitantly involve other parts of the body. LP of the eyelid may also extend to the conjunctiva, so it's important to screen patients by ophthalmology to rule out possible ocular involvement. This is the first case report of a Saudi patient with LP confined to the eyelid. The management of LP involving the eyelids is challenging. Treatment options include topical steroids, tacrolimus ointment, phototherapy and oral retinoids (etretinate).
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Affiliation(s)
- Nouf M AlEid
- Dermatology and Dermatologic Surgery, Prince Sultan Military Medical City, Riyadh, SAU
| | | | - Mona A Alshehri
- Dermatology and Dermatologic Surgery, Prince Sultan Military Medical City, Riyadh, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | | | - Hind AlShihry
- Dermatology and Dermatologic Surgery, Prince Sultan Military Medical City, Riyadh, SAU
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2
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Reekie IR, Simpson A, Erikitola O, Lyall D, Roberts F. Ocular Lichen Planus: A clinicopathologic review. Eur J Ophthalmol 2024:11206721241229128. [PMID: 38304934 DOI: 10.1177/11206721241229128] [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: 02/03/2024]
Abstract
Lichen planus is a chronic inflammatory dermatosis that can affect the skin, mucous membranes and nails. Cutaneous lichen planus lesions are best described by the "six Ps" - purple pruritic polygonal planar papules and plaques. Mucous membrane lesions are commonly associated with cutaneous lichen planus. Ocular involvement with lichen planus is rare and conjunctival involvement usually predominates, it can however be visually devastating. Ocular lichen planus often progresses to extensive conjunctival scarring which can be impossible to distinguish clinically from other cicatrising conjunctivitis, requiring histopathological confirmation. Here we review the ocular pathology of this condition.
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Affiliation(s)
- Ian R Reekie
- Department of Ophthalmology, Hairmyres Hospital, NHS Lanarkshire, East Kilbride, UK
| | - Alasdair Simpson
- Department of Ophthalmology, Hairmyres Hospital, NHS Lanarkshire, East Kilbride, UK
| | - Ore Erikitola
- Department of Ophthalmology, Hairmyres Hospital, NHS Lanarkshire, East Kilbride, UK
| | - Douglas Lyall
- Department of Ophthalmology, Hairmyres Hospital, NHS Lanarkshire, East Kilbride, UK
| | - Fiona Roberts
- Department of Histopathology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
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3
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Liu A, Hefley B, Escandon P, Nicholas SE, Karamichos D. Salivary Exosomes in Health and Disease: Future Prospects in the Eye. Int J Mol Sci 2023; 24:ijms24076363. [PMID: 37047335 PMCID: PMC10094317 DOI: 10.3390/ijms24076363] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 03/30/2023] Open
Abstract
Exosomes are a group of vesicles that package and transport DNA, RNA, proteins, and lipids to recipient cells. They can be derived from blood, saliva, urine, and/or other biological tissues. Their impact on several diseases, such as neurodegenerative, autoimmune, and ocular diseases, have been reported, but not fully unraveled. The exosomes that are derived from saliva are less studied, but offer significant advantages over exosomes from other sources, due to their accessibility and ease of collection. Thus, their role in the pathophysiology of diseases is largely unknown. In the context of ocular diseases, salivary exosomes have been under-utilized, thus creating an enormous gap in the literature. The current review discusses the state of exosomes research on systemic and ocular diseases and highlights the role and potential of salivary exosomes as future ocular therapeutic vehicles.
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Affiliation(s)
- Angela Liu
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX 76107, USA
- North Texas Eye Research Institute, University of North Texas Health Science Center, 3430 Camp Bowie Blvd., Fort Worth, TX 76107, USA
| | - Brenna Hefley
- North Texas Eye Research Institute, University of North Texas Health Science Center, 3430 Camp Bowie Blvd., Fort Worth, TX 76107, USA
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX 76107, USA
| | - Paulina Escandon
- North Texas Eye Research Institute, University of North Texas Health Science Center, 3430 Camp Bowie Blvd., Fort Worth, TX 76107, USA
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX 76107, USA
| | - Sarah E. Nicholas
- North Texas Eye Research Institute, University of North Texas Health Science Center, 3430 Camp Bowie Blvd., Fort Worth, TX 76107, USA
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX 76107, USA
| | - Dimitrios Karamichos
- North Texas Eye Research Institute, University of North Texas Health Science Center, 3430 Camp Bowie Blvd., Fort Worth, TX 76107, USA
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX 76107, USA
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX 76107, USA
- Correspondence: ; Tel.: +1-817-735-2101
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4
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Boch K, Langan EA, Kridin K, Zillikens D, Ludwig RJ, Bieber K. Lichen Planus. Front Med (Lausanne) 2021; 8:737813. [PMID: 34790675 PMCID: PMC8591129 DOI: 10.3389/fmed.2021.737813] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/11/2021] [Indexed: 12/17/2022] Open
Abstract
Lichen planus (LP) is a T cell-mediated disease affecting the stratified squamous epithelia of the skin and/or mucus membrane. Histologically, the disease is characterized by a lichenoid inflammatory infiltrate and vacuolar degeneration of the basal layer of the epidermis. LP has three major subtypes: Cutaneous, mucosal and appendageal LP. Rarely, it may affect the nails in the absence of skin and/or mucosal changes. LP may also be induced by several drugs, typically anti-hypertensive medication or be associated with infections, particularly viral hepatitis. The diagnosis is based on the clinical presentation and characteristic histological findings. Although the disease is often self-limiting, the intractable pruritus and painful mucosal erosions result in significant morbidity. The current first-line treatment are topical and/or systemic corticosteroids. In addition, immunosuppressants may be used as corticosteroid-sparing agents. These, however are often not sufficient to control disease. Janus kinase inhibitors and biologics (anti-IL-12/23, anti-IL17) have emerged as novel future treatment options. Thus, one may expect a dramatic change of the treatment landscape of LP in the near future.
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Affiliation(s)
- Katharina Boch
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Ewan A Langan
- Department of Dermatology, University of Lübeck, Lübeck, Germany.,Dermatological Sciences, University of Manchester, Manchester, United Kingdom
| | - Khalaf Kridin
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Detlef Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Ralf J Ludwig
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Katja Bieber
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
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5
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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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6
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Solimani F, Forchhammer S, Schloegl A, Ghoreschi K, Meier K. Lichen planus – ein Klinikleitfaden. J Dtsch Dermatol Ges 2021; 19:864-883. [PMID: 34139075 DOI: 10.1111/ddg.14565_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/05/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Farzan Solimani
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin
| | | | | | - Kamran Ghoreschi
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin
| | - Katharina Meier
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin
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7
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Solimani F, Forchhammer S, Schloegl A, Ghoreschi K, Meier K. Lichen planus - a clinical guide. J Dtsch Dermatol Ges 2021; 19:864-882. [PMID: 34096678 DOI: 10.1111/ddg.14565] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/05/2021] [Indexed: 12/15/2022]
Abstract
Lichen planus (LP) is a chronic lichenoid inflammatory disorder of the skin, mucosa and of the appendages. LP is classically characterized by the presence of a rich infiltration of inflammatory T cells, which migrate in the upper part of the dermis, arranged in a band-like pattern. Different sub types of the disease have been so far described. Albeit LP is clinically well defined, the disease still represents a therapeutic enigma. Especially with regard to mucosal or scalp affecting LP types, which often present a recalcitrant and treatment unresponsive course, efficacious therapeutic options are still lacking. Thus, LP represents a disease with a high psychosocial burden. Yet, development in the deciphering of LP pathogenesis reveals possible new druggable targets, thus paving the way for future therapeutic options. In this clinical guide, we summarize the current clinical knowledge and therapeutic standards and discuss the future perspective for the management of LP.
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Affiliation(s)
- Farzan Solimani
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Stephan Forchhammer
- Department of Dermatology, University Medical Center, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Alexandra Schloegl
- Department of Dermatology, University Medical Center, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Kamran Ghoreschi
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Meier
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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8
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Altunisik N, Koc A, Toplu Y, Sener S, Turkmen D, Sarac G, Durmaz I. Evaluation of hearing function in patients with lichen planus. Med Hypotheses 2020; 143:109867. [DOI: 10.1016/j.mehy.2020.109867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/07/2020] [Accepted: 05/21/2020] [Indexed: 10/24/2022]
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9
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Lee EY, Arzeno J, Ni C, Holland V. Ocular lichen planus treated with lifitegrast. Int J Dermatol 2020; 60:e231-e233. [PMID: 32989726 DOI: 10.1111/ijd.15230] [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: 02/23/2020] [Revised: 07/22/2020] [Accepted: 09/03/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Ernest Y Lee
- Department of Bioengineering, UCLA, Los Angeles, CA, USA.,Division of Dermatology, Department of Medicine, UCLA, Los Angeles, CA, USA.,UCLA-Caltech Medical Scientist Training Program, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Julia Arzeno
- Division of Dermatology, Department of Medicine, UCLA, Los Angeles, CA, USA
| | - Catherine Ni
- Division of Dermatology, Department of Medicine, UCLA, Los Angeles, CA, USA
| | - Vanessa Holland
- Division of Dermatology, Department of Medicine, UCLA, Los Angeles, CA, USA
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10
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Shteiner M, Kleinman S, Shuster A, Raiser V, Ianculovici C, Rachima H, Kaplan I. Submucosal Fibrotic Bands in Oral Lichen Planus: A Clinico-Pathological Investigation of a Newly Described Phenomenon. Head Neck Pathol 2020; 15:395-401. [PMID: 32705486 PMCID: PMC8134795 DOI: 10.1007/s12105-020-01203-6] [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] [Received: 05/12/2020] [Accepted: 07/04/2020] [Indexed: 12/19/2022]
Abstract
Fibrosis is a recognized complication of chronic inflammatory conditions, which has not yet been described in oral lichen planus. To describe characteristics of submucosal fibrotic bands in oral lichen planus. Prospective study. Patients with biopsy confirmed lichen planus were included. Clinical examination recorded fibrotic bands, mouth opening, vestibular depth loss, gingival recessions adjacent to band, lichen subtypes, areas of affected mucosa, extra-oral manifestations. Patients completed the Chronic Oral Mucosal Disease Questionnaire, with additional questions regarding stiffness, restricted opening, symptom frequency, time from diagnosis of lichen, co-existing medical conditions. 73 patients were included, 14 M, 59 F, age 28-84 (mean 61) years. Buccal fibrous bands were palpated in 22 (30.1%), 13 (59%) were bilateral. Self-reported restricted opening/stiffness were significantly associated with fibrous bands (36% Vs. 11% in controls, p = 0.02). Mouth opening less than 40 mm was recorded in only 2 (9%) with bands, none in controls. Reduced vestibular depth was significantly associated with bands (11 (50%) Vs 3 (6%) in controls, p = 0.0001).Gingival recessions adjacent to bands were recorded in 3 (13.6%). No association was demonstrated between fibrous bands and erosive lesions, extra oral involvement, smoking, age, visual analogue scale, quality of life questionaire and disease duration. Histological evaluation of one case each with and without band and control showed increased mean width of connective tissue. Submucous fibrous band is first described in the present study. It is common in oral lichen planus, may lead to feeling restricted mouth opening, stiffness, loss of vestibular depth and adjacent gingival recession.
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Affiliation(s)
- M. Shteiner
- Unit of Oral Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - S. Kleinman
- Unit of Oral Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - A. Shuster
- Unit of Oral Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel ,Goldschleger School of Dental Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - V. Raiser
- Unit of Oral Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - C. Ianculovici
- Unit of Oral Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - H. Rachima
- Unit of Oral Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - I. Kaplan
- Goldschleger School of Dental Medicine, Tel-Aviv University, Tel Aviv, Israel ,Institute of Pathology, Tel-Aviv Sourasky Medical Center, 5 Daphna St, Tel Aviv, Israel ,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
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11
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Ioannides D, Vakirlis E, Kemeny L, Marinovic B, Massone C, Murphy R, Nast A, Ronnevig J, Ruzicka T, Cooper S, Trüeb R, Pujol Vallverdú R, Wolf R, Neumann M. European S1 guidelines on the management of lichen planus: a cooperation of the European Dermatology Forum with the European Academy of Dermatology and Venereology. J Eur Acad Dermatol Venereol 2020; 34:1403-1414. [DOI: 10.1111/jdv.16464] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 03/31/2020] [Indexed: 12/15/2022]
Affiliation(s)
- D. Ioannides
- Department of Dermatology and Venereology Aristotle University of Thessaloniki Medical School Thessaloniki Greece
| | - E. Vakirlis
- Department of Dermatology and Venereology Aristotle University of Thessaloniki Medical School Thessaloniki Greece
| | - L. Kemeny
- Department of Dermatology and Allergology University of Szeged Szeged Hungary
| | - B. Marinovic
- Department of Dermatology and Venereology University Hospital Center and School of Medicine Zagreb Zagreb Croatia
| | - C. Massone
- Department of Dermatology Medical University of Graz Graz Austria
| | - R. Murphy
- Department of Dermatology Nottingham University Hospital Nottingham UK
| | - A. Nast
- Department of Dermatology, Venereology and Allergy Division of Evidence‐Based Medicine Charité ‐ Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Humboldt‐Universität zu Berlin and Berlin Institute of Health Berlin Germany
| | | | - T. Ruzicka
- Department of Dermatology and Allergology LMU Munich Germany
| | - S.M. Cooper
- Department of Dermatology Oxford University Hospitals NHS Trust and University of Oxford Oxford UK
| | - R.M. Trüeb
- Center for Dermatology and Hair Diseases Wallisellen Switzerland
| | | | - R. Wolf
- Department of Dermatology and Allergology LMU Munich Germany
| | - M. Neumann
- Department of Dermatology Erasmus MC Rotterdam The Netherlands
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12
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Mohebbi M, Mirghorbani M, Banafshe Afshan A, Towfighi M. Lichen Planus in Ocular Surface: Major Presentations and Treatments. Ocul Immunol Inflamm 2018; 27:987-994. [DOI: 10.1080/09273948.2018.1485955] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Masoomeh Mohebbi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Mirghorbani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Banafshe Afshan
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Towfighi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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13
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Evaluation of ocular findings in patients with lichen planus. Postepy Dermatol Alergol 2018; 36:267-271. [PMID: 31333342 PMCID: PMC6640026 DOI: 10.5114/ada.2018.74464] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 02/22/2018] [Indexed: 12/30/2022] Open
Abstract
Introduction Lichen planus (LP) is a chronic, inflammatory disease of unknown etiology. Aim To evaluate the tear functions and the retinal and choroidal thickness (CT) in patients with LP. Material and methods In total, 33 patients and 30 healthy controls were enrolled. All participants were evaluated using the Ocular Surface Disease Index (OSDI) questionnaire, Schirmer 1 test (with anesthesia), tear break-up time (TBUT) test, intraocular pressure (IOP), axial length (AL), and central corneal thickness (CCT). The measurements of retinal thickness (RT) and CT were obtained by spectral domain optical coherence tomography. Results No significant difference was observed between the groups in IOP, AL, CCT, or RT (p > 0.05 in each group). There was a significant difference in the Schirmer 1 test, TBUT, and OSDI questionnaire (p < 0.05 in each group). Choroidal thickness in LP patients was thinner than that in the controls (p = 0.001 in each location). There was a moderate negative correlation between the disease duration and Schirmer 1 test, TBUT, and subfoveal CT (r = –0.426, r = –0.555, r = –0.637; p = 0.001, p = 0.001, p = 0.001, respectively). There was a moderate negative correlation between the oral mucosal involvement and Schirmer 1 test, TBUT, and subfoveal CT (r = –0.345, r = –0.392, r = –0.467; p = 0.006, p = 0.001, p = 0.001, respectively). There was a positive correlation between disease duration, oral mucosal involvement and OSDI score (r = 0.717, r = 0.345; p = 0.001, p = 0.006, respectively). Conclusions Lichen planus may influence tear function tests and may cause dry eye. Patients with LP had lower CT values than healthy controls. Further studies are needed to clarify the effect of LP on the eyes.
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14
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Diagnosis, Treatment, and Surgical Repair in a Case of Isolated Conjunctival Lichen Planus Causing Cicatricial Entropion. Ophthalmic Plast Reconstr Surg 2017; 33:e162-e163. [PMID: 28538610 DOI: 10.1097/iop.0000000000000933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A 50-year-old male presented with bilateral cicatricial entropion with subepithelial fibrosis and fornix foreshortening. Conjunctival biopsy showed lymphocytic infiltrate along the interface of the epithelium and lamina propria with linear, shaggy fibrinogen deposition along the epithelial basement membrane zone, supporting a diagnosis of lichen planus. The patient was treated with commercially available topical cyclosporine for 5 months after which bilateral lower eyelid splitting procedure with recession of the anterior lamella and complete excision of the lower eyelid lashes was performed.
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15
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Reddy AK, Baker MS, Maltry AC, Syed NA, Allen RC. Immunopathology and histopathology of conjunctival biopsies in patients with presumed idiopathic punctal stenosis. Br J Ophthalmol 2016; 101:213-217. [PMID: 27073206 DOI: 10.1136/bjophthalmol-2015-308291] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 03/08/2016] [Accepted: 03/24/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS Numerous processes have been implicated as causes of punctal stenosis. Recent studies have highlighted inflammation in punctoplasty specimens in patients with punctal stenosis. Conjunctival biopsy has been suggested as a means to determine underlying aetiologies, although little is known regarding what conjunctival pathologies are associated with punctal stenosis. Our objective is to examine the pathological and immunological findings in conjunctival biopsy specimens in patients with presumed idiopathic punctal stenosis. METHODS A retrospective chart review was performed at a single institution over a 5 year period of patients with presumed idiopathic punctal stenosis who underwent conjunctival biopsy for histopathological and/or direct immunofluorescence (DIF) examination. Patients with known aetiologies of punctal stenosis were excluded. RESULTS 23 patients met inclusion criteria. Conjunctival biopsies (n=36) from all 23 patients underwent histological examination. 35 specimens (97.2%) showed lymphocytic infiltrates. Two patients (8.7%) had findings suggestive of sarcoidosis. Conjunctival biopsies from 18 of the 23 patients were also evaluated by DIF. Nine patients (50.0%) had fibrinogen characteristics suggestive of lichen planus. There were no complications related to the conjunctival biopsy procedures. CONCLUSIONS Conjunctiva appears to be an excellent proxy in evaluating patients with presumed idiopathic punctal stenosis. The biopsy is safe and provides ample tissue. Clinically, abnormal tissue should be targeted, if available. 11 of the 23 patients in this study demonstrated findings consistent with underlying immunological disorders, suggesting that conjunctival biopsy may play a role in identifying underlying aetiologies of punctal stenosis. Knowledge of these underlying conditions impacted treatments for several patients.
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Affiliation(s)
- Amit K Reddy
- Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Meredith S Baker
- Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Amanda C Maltry
- Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Nasreen A Syed
- Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.,Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Richard C Allen
- Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.,Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Abstract
Lichen planus is an inflammatory mucocutaneous disease that can affect the skin, hair, nails, and mucosal surfaces. Mucosal sites of involvement include oral, genital, ocular, otic, esophageal, and, less commonly, bladder, nasal, laryngeal, and anal surfaces. Oral lichen planus is a mucosal variant of lichen planus, which tends to affect women more often than men, with a typically more chronic course and potential for significant morbidity. Treatment can be challenging, and there is potentially a low risk of malignant transformation; however, therapeutic benefits can be obtained with various topical and systemic medications. Clinical monitoring is recommended to ensure symptomatic control. Increasing awareness and recognition of this entity have continued to fuel advances in therapy and in our understanding of the disease.
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Affiliation(s)
| | - Roy S Rogers
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ
| | - Alison J Bruce
- Department of Dermatology, Mayo Clinic, Jacksonville, FL.
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Huang S, Channa P. Cicatricial keratoconjunctivitis associated with lichen planus. GMS OPHTHALMOLOGY CASES 2015; 5:Doc08. [PMID: 27625952 PMCID: PMC5015628 DOI: 10.3205/oc000030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE To describe a case of cicatricial keratoconjunctivitis associated with lichen planus. METHODS Case report. RESULTS To our knowledge, this is the sixth reported case of cicatricial keratoconjunctivitis associated with lichen planus. A 73-year-old woman had persistent cicatricial keratoconjunctivitis. Histopathologic studies of the buccal mucosa biopsy specimen revealed lichen planus. CONCLUSION Lichen planus is a possible cause of cicatricial keratoconjunctivitis. Topical cyclosporine may stabilize the ocular surface, and additional systemic immunosuppression may be needed in severe cases. A correct diagnosis through biopsy is essential to start aggressive anti-inflammatory treatment to avoid vision loss.
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Affiliation(s)
- Susan Huang
- Department of Ophthalmology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA,*To whom correspondence should be addressed: Susan Huang, Montefiore Medical Center, Department of Ophthalmology, 3332 Rochambeau Avenue, 3rd floor, Room 306, Bronx, NY 10467, USA, Phone: (510) 828-6562, E-mail:
| | - Prabjot Channa
- Department of Ophthalmology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
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Abstract
Lichen planus (LP) is an autoimmune inflammatory condition of the skin and mucous membranes, of unknown aetiology, that infrequently involves the eye. Ocular LP has not been described in children. We present the case of an 8-year-old girl with severe, filamentous dry eyes and persistent conjunctival hyperemia with bilateral progressive conjunctival symblepharon. Her conjunctival biopsy showed heavy linear fibrinogen deposits along the basement membrane without IgG, IgA, IgM, or C3 deposition, consistent with LP. No skin or other mucosal lesions were present, suggesting a diagnosis of isolated conjunctival LP. Oral and topical cyclosporine combined with methotrexate and low-dose oral steroids led to sustained disease remission. To our knowledge, this is the first case of isolated ocular LP in a child.
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Affiliation(s)
- Estera Igras
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland.
| | - Susan Kennedy
- Department of Ophthalmic Pathology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - Emma Jane MacDermott
- National Centre for Paediatric Rheumatology, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
| | - Conor C Murphy
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland; Department of Ophthalmology, Royal College of Surgeons in Ireland, Dublin, Ireland
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Şanli B, Çetin EN, Bir F, Taşli L, Yaldizkaya F, Yaylali V. Conjunctival impression cytology, ocular surface and tear-film changes in patients with lichen planus. Clin Exp Dermatol 2012; 37:341-5. [DOI: 10.1111/j.1365-2230.2011.04274.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Transient liver hypoxia after liver hilus dearterialization. ScientificWorldJournal 1979; 2014:742826. [PMID: 24672362 PMCID: PMC3929580 DOI: 10.1155/2014/742826] [Citation(s) in RCA: 203] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 10/20/2013] [Indexed: 02/06/2023] Open
Abstract
Lichen planus (LP) is a chronic inflammatory disorder that most often affects middle-aged adults. LP can involve the skin or mucous membranes including the oral, vulvovaginal, esophageal, laryngeal, and conjunctival mucosa. It has different variants based on the morphology of the lesions and the site of involvement. The literature suggests that certain presentations of the disease such as esophageal or ophthalmological involvement are underdiagnosed. The burden of the disease is higher in some variants including hypertrophic LP and erosive oral LP, which may have a more chronic pattern. LP can significantly affect the quality of life of patients as well. Drugs or contact allergens can cause lichenoid reactions as the main differential diagnosis of LP. LP is a T-cell mediated immunologic disease but the responsible antigen remains unidentified. In this paper, we review the history, epidemiology, and clinical subtypes of LP. We also review the histopathologic aspects of the disease, differential diagnoses, immunopathogenesis, and the clinical and genetic correlations.
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