乳腺癌放疗后扁平苔藓一例

患者女,51岁,因左胸部丘疹伴痒2个月就诊。患者1年前行左乳腺癌改良切除术,术后间断辅以放射治疗25次,照射范围为左胸部、左锁骨上区及左腋窝％,累积剂量50 Gy……     

Impairment of myocardial functions and arterial stiffness in patients with lichen planus

BackgroundLichen planus is a chronic inflammatory mucocutaneous disease. Recent studies have suggested that it is associated with an increased risk of cardiovascular comorbidities.ObjectiveThe purpose of this study was to assess and compare arterial stiffness and cardiovascular hemodynamics in patients with lichen planus and a healthy control group.MethodsFifty-five patients with lichen planus and 42 healthy controls were enrolled. All patients underwent echocardiographic examination, and arterial stiffness was measured using applanation tonometry.ResultsNo statistically significant difference was determined between the patient and control groups in terms of arterial stiffness, but stiffness was markedly higher in patients with erosive lichen planus compared to the control group and other patients (p = 0.006, and p = 0.023, respectively). Moderate positive correlation was determined between duration of disease and arterial stiffness. Impairment of systolic and diastolic functions was also determined in patients with lichen planus compared to the control group (p < 0.001, and p = 0.005, respectively).Study limitationsRelatively low number of patients.ConclusionThe positive correlation observed between duration of disease and arterial stiffness in patients with lichen planus suggests that these patients should be followed-up in terms of cardiovascular risk in the presence of resistant and long-term disease, particularly in case of erosive lichen planus.     

扁平苔藓的皮肤镜学表现

扁平苔藓的主要皮肤镜学表现包括具有诊断意义的叶脉状、网状Wickham纹,和非特异性点状或线状血管及点状、球状或线状色素沉着;偶尔可见其他一些变异表现。使用皮肤镜可以更清楚观察到肉眼能辨认的Wickham纹和肉眼看不到Wickham纹、血管和色素表现,因此皮肤镜有助于扁平苔藓的诊断及与银屑病、皮炎湿疹、红斑狼疮等相似疾病的鉴别诊断。     

Bcl-2、p53在扁平苔藓病变组织中的表达

为了探讨扁平苔藓的发病机理,采用标记抗链菌卵蛋白生物素（ＬＳＡＢ）的方法,检测了３５例扁平苔藓Ｂｃｌ２和ｐ５３蛋白的表达。结果发现,在扁平苔藓组织中Ｂｃｌ２和ｐ５３蛋白有广泛的表达（分别为８５７１％和６０％）,Ｂｃｌ２阳性表达率和强度均高于ｐ５３（两者Ｐ＜００５）,并呈平行关系（Ｐ＜００５）。提示Ｂｃｌ２和ｐ５３可能是协同参与扁平苔藓病变的重要因素。     

Oral lichen planus: case series and experience in a tertiary dermatology service in Brazil

BackgroundLichen planus is an inflammatory disease that can affect both the skin and mucous membranes, including the oral mucosa. There is very little original Brazilian dermatology literature about oral lichen planus.ObjectiveTo describe the clinical, pathological, and treatment data of 201 patients diagnosed with oral lichen planus followed at the Stomatology Outpatient Clinic of Hospital das Clínicas, Universidade de São Paulo, from 2003 to 2021.MethodThe patients demographic profile, the morpho-topographic features of the lesions, the treatment employed, and the possible presence of squamous cell carcinoma were analyzed.ResultsThe disease was more common in women over 50 years of age, tending to be chronic, with a large number of cases showing cicatricial sequelae in the mucosa. Topical treatment with potent corticosteroids was shown to be effective in the vast majority of cases. Squamous cell carcinoma in oral lichen planus cicatricial sequelae was observed in eight cases.Study limitationsRetrospective study of medical records, with gaps regarding the filling out of data; unequal observation time among the studied cases.ConclusionsThis is the largest Brazilian dermatology series on oral lichen planus. The response to topical corticoid therapy was excellent in the vast majority of cases. The high prevalence of atrophic lesions, demonstrating the chronicity and tissue destruction potential of this disease, may explain the large number of cases of squamous cell carcinoma.     

Male genital lichen planus: A retrospective study of 89 cases

BackgroundUnlike other types of lichen planus (LP), there are no series concerning male genital LP.ObjectiveTo describe the clinical characteristics, diagnosis, and response to treatment of male genital LP.Patients and methodsA retrospective study of male patients with genital LP consulting a dermatologist specialized in anogenital diseases between January 2010 and 2019. Demographic data, history, functional signs, clinical characteristics, pathology, complications, and treatment efficacy were collected.ResultsEighty-nine patients were included at four centers. The median age was 51 years. Most patients were uncircumcised and asymptomatic. In 88.8% of cases, only the genital mucosa was involved. Erythema (71%), papules (21.3%), lacy network (15.7%), atrophic lesions (15.7%), erosions (14.6%), and post-inflammatory hyperpigmentation (2.2%) were less frequently observed. Biopsy results confirmed LP in 61.3% of cases but could not rule out other inflammatory genital dermatoses in other cases. Anatomic complications were observed in 30.3% of patients. Topical corticosteroids (TCS) induced remission in most cases. Tacrolimus efficacy was comparable to that of TCS.ConclusionMale genital LP is a rare inflammatory disorder chiefly affecting uncircumcised men. It is found predominantly on the mucosal component of the penis and presents as non-erosive inflammatory balanitis in most cases, with frequent partial or complete remission on treatment with TCS.     

20甲扁平苔藓11例临床分析

目的：了解11例20甲扁平苔癣的临床特点，以提高对该病的认识。方法：对11例20甲扁平苔癣患者的临床资料、真菌学和组织病理检查进行分析，并对相关文献进行复习。结果：11例患者中男6例，女5例，平均年龄27．9岁，均表现为20指趾甲全部受累，真菌镜检、培养均阴性，经组织病理检查明确诊断为甲扁平苔癣。结论：甲扁平苔癣好发年龄为青少年和40～60岁，无性别差异。单独发生于甲部，特别是20甲受累的扁平苔癣十分少见，容易误诊，确诊需要组织病理活检。     

Delayed type hypersensitivity is abnormal in patients with lichen planus

Summary Lichen planus is characterized by the histological features of a cell-mediated attack on the epidermis. To see whether there is any defect in cutaneous immunity in non-lesional skin, we measured the response to a contact sensitizer in 17 patients with lichen planus and 27 control subjects. Sensitization was induced with 30 g dinitrochlorobenzene applied to the thigh. The subjects were challenged 4 weeks later with three doses of dinitrochlorobenzene (8.8, 12.5 and 17.7 g), and responses were quantified with calipers as the change in skinfold thickness at 48 h. Patients with lichen planus were significantly less responsive with smaller reactions at all challenge doses. These abnormalities suggest that the skin is abnormal in areas unaffected by the rash, and raise the possibility that there may be a primary defect in the cutaneous immune system in lichen planus.     

Macrophage — T-lymphocyte interaction in lichen planus

Summary Papular lichen planus lesions from 12 patients were studied by a double-step immunocyto-chemical method to detect T-lymphocytes. Semithin sections were studied by light microscopy and ultrathin sections examined by electron microscopy. In the dermal infiltrate, many T-lymphocytes appeared closely juxtaposed to macrophages or Langerhans cells, frequently arranged in a rosette-like pattern. In the epidermis, T-lymphocytes were juxtaposed to macrophages or Langerhans cells and to degenerated keratinocytes. The close relationship between T-lymphocytes, macrophages or Langerhans cells and degenerated keratinocytes supports the hypothesis that lichen planus is immunological in nature: T-lymphocytes, after interacting with macrophages or Langerhans cells, become cytotoxic for keratinocytes.Supported in part by the Consiglio Nazionale delle Ricerche; Roma, Italia, grant no 790181604The ultrastructural findings have been presented by prof. Giannotti in occasion of the VII European Meeting of the SCUR Vienna, 8–10 May 1980     

Multiple keratoacanthomas in hypertrophic lichen planus: treatment with systemic retinoids (etretinate)

A 75-year-old woman was referred for treatment of multiple keratoacanthomas and hypertrophic lichen planus. Surgical excision was considered but was not possible given the multiplicity of the lesions. Etretinate, potent topical corticosteroids and gradient support stockings were initiated. Complete resolution was achieved in four months and oral and topical therapy was discontinued. Four months after discontinuation of all therapy there has been no recurrence.     

Oral lichen planus: study of 21 cases

BACKGROUND:

Lichen planus is considered to be the most common dermatological disease involving the oral mucosa.

OBJECTIVE:

To investigate the profile, clinical features, and the presence of dysplasia and candidiasis in patients with oral lichen planus.

METHODS:

A total of 21 patients were selected from 258 patients at risk for oral cancer development.

RESULTS:

Most of the patients were white (76,2%), female (66,6%), with mean age of 58.8 years. Eight were smokers and seven were alcohol consumers. The buccal mucosa was the most affected site, followed by the tongue and the gingiva. The reticular pattern was the most common appearance. Histopathology depicted dysplasia in nine cases and cytopathology was positive for Candida in eight cases in the first appointment.

CONCLUSION:

Our data are similar to the literature. Cytopathology was important for the diagnosis of candidiasis. Although the presence of dysplasia was verified, further studies are necessary to clarify the importance of this finding.     

经典和色素性扁平苔藓常见皮肤镜特征的比较

目的：比较经典扁平苔藓与色素性扁平苔藓常见皮肤镜的特征。方法：选取13例经典扁平苔藓和6例色素性扁平苔藓患者共99处皮损进行皮肤镜检查并对其特征进行比较。结果：经典扁平苔藓常见的皮肤镜特征有Wickham纹,以片状模式为主的黄棕色色素结构和点状、线状及球状等血管;色素性扁平苔藓常见的皮肤镜特征有以点状、球状模式为主的蓝灰色、黄棕色色素结构和毛囊角栓。结论：皮肤镜可用于经典扁平苔癣和色素性扁平苔藓的辅助诊断。     

The role of perforin-mediated apoptosis in lichen planus lesions

Lichen planus is recognized as a T-cell-mediated disease. Histologically, it is characterized by the formation of colloid bodies representing apoptotic keratinocytes. The apoptotic process mediated by CD8⁺ cytotoxic T lymphocytes (CTLs) and NK cells mainly involves two distinct pathways: the perforin/granzyme pathway and the Fas/FasL pathway. So far, little is known regarding the role of perforin-mediated apoptosis in lichen planus. In the present study, the expression and distribution of perforin, T and NK cell subsets in the epidermis and dermis of lesional and nonlesional lichen planus skin were studied. Skin biopsy specimens from lesional and nonlesional skin of ten patients with lichen planus and eight healthy persons were analysed by immunohistochemistry. Significant accumulation of T cells, particularly of CD4⁺ and CD8⁺ subsets, was found in both epidermis and dermis of lichen planus lesions compared with nonlesional and healthy skin. There were no significant differences in the incidence of NK cells (CD16⁺ and CD56⁺) between lesional, nonlesional and healthy skin. Perforin expression was significantly upregulated in the epidermis of lichen planus lesions. In conclusion, accumulation of perforin⁺ cells in the epidermis of lichen planus lesions suggest a potential role of perforin in the apoptosis of basal keratinocytes.     

蕈样肉芽肿与扁平苔藓、银屑病浸润细胞的免疫组化比较

目的 探讨免疫表型对蕈样肉芽肿与扁平苔藓、银屑病鉴别诊断的意义.方法 应用ABC免疫组化技术检测15例蕈样肉芽肿,17例银屑病和17例扁平苔藓,6例正常人皮肤的CD1a、CD4、CD8、ICAM-1、LFA-1、HLA-DR(树枝状细胞)、CD30和CD7的表达情况.结果 蕈样肉芽肿表皮CD1a,CD30,ICAM-1(单一核细胞P<0.001,树枝状细胞P<0.01)的阳性细胞密度明显高于扁平苔藓、银屑病、正常人皮肤.蕈样肉芽肿表皮CD4,CD8,HLA-DR的阳性细胞密度明显高于扁平苔藓.蕈样肉芽肿真皮中CD1a阳性细胞的线性密度(P<0.01),真皮内ICAM-1和LFA-1阳性细胞百分比亦较扁平苔藓增多(P<0.05).蕈样肉芽肿表皮CD7阳性细胞与扁平苔藓、银屑病比较差异无统计学意义.银屑病和扁平苔鲜真皮内CD7阳性细胞百分比高于蕈样肉芽肿和正常人皮肤.结论 蕈样肉芽肿和扁平苔藓、银屑病皮损CD1a、CD4、CD8、ICAM-1、LFA-1、HLA-DR、CD30和CD7免疫表型有差异,其结果可为探讨发病机制提供线索.     

扁平苔藓皮损中钙激活蛋白酶Ⅰ和半胱氨酸天冬氨酸蛋白酶3的表达及其与细胞凋亡的关系

目的 探讨凋亡相关蛋白钙激活蛋白酶Ⅰ（Calpain Ⅰ）和半胱氨酸天冬氨酸蛋白酶3（Caspase-3）在扁平苔藓皮损中的表达及其与细胞凋亡的关系。方法 分别采用脱氧核糖核苷酸末端转移酶介导的原位缺口末端标记（TUNEL）法和免疫组化法对20例扁平苔藓患者皮损组织和10例健康人皮肤组织中细胞凋亡和Calpain Ⅰ、Caspase-3表达进行检测。采用SPSS 13. 0软件,两组凋亡指数比较采用t检验,两组Calpain Ⅰ和Caspase-3表达量比较采用秩和检验,Calpain Ⅰ和Caspase-3表达量与凋亡指数相关性分析采用 Spearman 等级相关分析。结果 扁平苔藓组表皮层角质形成细胞的凋亡指数（67.59 ± 13.50）显著高于健康对照组（28.26 ± 7.56）,两组比较,差异有统计学意义（t = 8.52,P < 0.01）;Calpain Ⅰ和Caspase-3表达均高于健康对照组（T = 78.00 和77.00,P < 0.01）。扁平苔藓皮损中Calpain Ⅰ和Caspase-3阳性表达强度均与其自身角质形成细胞的凋亡指数呈正相关（r = 0.71和0.74,P < 0.01）。结论 扁平苔藓皮损中Calpain Ⅰ和Caspase-3表达上调,且与角质形成细胞凋亡亢进关系密切。     

Prevalence of vulval lichen planus in a cohort of women with oral lichen planus: an interdisciplinary study

BACKGROUND: Lichen planus (LP) is a mucocutaneous inflammatory dermatosis that frequently involves the oral and genital mucosae. Patients with LP affecting these sites are often seen by oral medicine specialists or gynaecologists who work in isolation and depend heavily on histopathologists to help them in confirming the diagnosis. There are few studies in the literature combining the experiences of these specialists who share the care of patients with both oral and genital LP. OBJECTIVES: To estimate the prevalence of vulval LP (VLP) in a cohort of patients with histologically confirmed oral LP (OLP). METHODS: The study group consisted of 42 women histologically diagnosed with OLP. The mean age was 60.5 years (range 27-81). They underwent genital examination, colposcopy and vulvoscopy. For the histological confirmation of clinical VLP biopsies were performed whenever a clinical lesion was found. Oral and genital biopsy specimens were processed through histological and immunohistochemical staining. Histological diagnoses of LP were made according to the modified World Health Organization histopathological criteria proposed by van der Meij and van der Waal for the diagnosis of OLP, and extended to VLP. Patients with clinical evidence, but without the histological confirmation of OLP and VLP, were excluded from the study group. RESULTS: Thirty-two vulval and one vaginal biopsy specimens were obtained. Histological diagnoses were confirmed in 24 of 32 (75%) patients who underwent a vulval biopsy: these represent 57% (24 of 42) of the study group. Of the 12 patients free of symptoms such as itching, burning and dyspareunia, but with clinical vulval lesions, 11 (92%) had histological confirmation of VLP. Vulval lichen sclerosus was ascertained in five of 32 (16%) cases. CONCLUSIONS: This study showed a 57% prevalence of VLP in selected patients with OLP. The high prevalence of VLP of 92% in the women who were free of vulval symptoms confirmed the usefulness of this careful integrated approach.