Hyperkeratotic Palmoplantar Lichen Planus in a child

Dermatoscopy of Cutaneous Lichen Planus - Attempt to Translate Metaphoric Terminology Into Descriptive Terminology

INTRODUCTION

Dermatoscopy is gaining appreciation in assisting the diagnosis of inflammatory dermatoses (inflammoscopy). Lichen planus (LP) is a common inflammatory skin disease with characteristic dermatoscopic features. Over the last few years, numerous articles were published on the dermatoscopy of LP and a high number of terms have been used to describe the dermatoscopic features of this disease.

OBJECTIVES

The objective of this study was to review the literature on the dermatoscopy of LP and to re-evaluate the published descriptions in the light of the 2019 expert consensus on the terminology of dermatoscopy for non-neoplastic skin diseases.

METHODS

We searched the PubMed database using the keywords 'lichen planus and dermatoscopy', 'lichen planus and dermoscopy', 'lichen planus and epiluminescence microscopy', and 'lichen planus and inflammoscopy'.

RESULTS

Of 408 articles retrieved, we selected 67 articles for full-text review, and finally included 58 articles, mostly case reports or small case series, comprising 572 patients with LP. We identified 118 different terms or short descriptions that were used to characterize the dermatoscopy of LP and redescribed them according to International Dermoscopy Society consensus paper. Frequently, authors applied various terms or descriptions to variants of the same feature. Although reported under different designations, Wickham striae were the most consistent dermatoscopic feature of LP. Other characteristics of LP, such as vascular patterns, pigmented structures and follicular findings were less consistent or depended on skin type, anatomic site, disease stage and applied treatment.

CONCLUSIONS

While Wickham striae are the single most important clue for the diagnosis, other dermatoscopic characteristics of LP are less consistent. Based on the descriptions published in the literature we established a dictionary of useful terms for the description of LP that is consistent with the terminology suggested by the recent consensus conference.

Oral lichen planus in childhood: a case series

BACKGROUND

Although the exact incidence of pediatric oral lichen planus (OLP) is unknown, the oral mucosa seems to be less commonly involved, and the clinical presentation is often atypical. The aim of the study is to present a case series of OLP in childhood.

METHODS

From our database, we retrospectively selected and analyzed the clinical data of OLP patients under the age of 18 where the diagnosis had been confirmed by histopathological analysis.

RESULTS

The case series from our database shows eight patients, four males and four females. The mean (±SD) age at the time of diagnosis of the disease was 13.5 (±2.73) years, ranging in age from 9 to 17. Clinically, a reticular pattern was present in six patients (75%), and the tongue was the most commonly involved oral site (six cases, 75%). We also report the first case of OLP in a 9-year-old girl affected by autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy.

CONCLUSIONS

We report the largest case series of pediatric OLP published in literature thus far. Differences in the disease between adults and pediatric patients have been detected, but further investigation and a larger case series are needed to establish any detailed differences in clinical outcomes.

Treatment modalities of palmoplantar lichen planus: a brief review

Palmoplantar lichen planus is a localized and uncommon variant of lichen planus which is mostly resistant to treatment. Our purpose was to discuss all treatment modalities proposed and tested for palmoplantar lichen planus in the literature. A systematic review of the literature was conducted to evaluate evidence regarding all treatment modalities proposed and tested for palmoplantar lichen planus in the literature. Two major databases (PubMed, Google scholar) were searched. The review included all case reports, letters and original articles reporting any treatment for palmoplantar lichen planus but not treatment used in the other type of lichen planus, generalized lichen planus or other type of palmoplantar dermatoses. We have gone over more than 50 articles. There are many drugs that have been used in the treatment of lichen planus and generalized lichen planus but the palmoplantar type is a rare variety of lichen planus. That is why we could not find any clinical trial on the subject and just case reports have been described in this manuscript. In spite of plentiful investigations carried out on lichen planus, there is no treatment modality that has proved to be utterly satisfactory in treatment of palmoplantar lichen planus.

Comparing The Efficacy of Hematoxylin and Eosin, Periodic Acid Schiff and Fluorescent Periodic Acid Schiff-Acriflavine Techniques for Demonstration of Basement Membrane in Oral Lichen Planus: A Histochemical Study

BACKGROUND

Basement membrane (BM) is a thick sheet of extracellular matrix molecules, upon which epithelial cells attach. Various immunohistochemical studies in the past have been carried out but these advanced staining techniques are expensive and not feasible in routine laboratories. Although hematoxylin and eosin (H-E) is very popular among pathologists for looking at biopsies, the method has some limitations. This is where special stains come handy.

AIMS AND OBJECTIVES

The aim of the present study was to demonstrate and compare the efficacy of H-E, periodic acid Schiff (PAS) and fluorescent periodic acid-acriflavine staining techniques for the basement membrane and to establish a histochemical stain which could be cost effective, less time consuming, and unambiguous for observation of the basement membrane zone.

MATERIALS AND METHODS

A total number of 40 paraffin-embedded tissue sections of known basement membrane containing tissues including 10 - Normal oral mucosa (NOM) and 30 - oral lichen planus (OLP) were considered in the study. Four-micron-thick sections of each block were cut and stained with H-E stain, PAS and fluorescent periodic acid-acriflavine stain. Sections were evaluated by three oral pathologists independently for continuity, contrast and pattern.

RESULTS

Though all the three stains showed favorable features at different levels, acriflavine stain was better than the other stains in demonstrating BM continuity, contrast and also the pattern followed by PAS stain. Acriflavine stain was the better in demonstrating a fibrillar pattern of a BM. Acriflavine stains a BM distinctly and is less time consuming and easy to carry out using readily available dyes as compared to other stains.

CONCLUSION

The continuity and contrast along with the homogenous pattern and the afibrillar pattern of the BM was better demonstrated by acriflavine followed by the PAS stain.

A rare presentation of palmoplantar lichen planus

Lichen planus is a disease characterized by a large variety of clinical forms and morphological patterns. Localized rash on the palms and soles is considered rare and may create certain problems in diagnosis if it is present as an isolated finding in the absence of typical papular rash on the skin and mucous membranes, and such problems may be solved by histological examination. We report a case of a 41-year-old male with palmoplantar lichen planus. The disease was characterized by pruritic erythematous well-defined plaques dotted wit h multiple, punctate brown keratotic plugs on the palms and soles, which were difficult to separate when scraping. Histological examination revealed changes in the excretory ducts of eccrine sweat glands. We suggest that the presented case is a unique clinicopathologic variant of palmoplantar lichen planus that may be designated by the term “lichen planoporitis.”