Annular atrophic lichen planus

A 30-year-old woman presented with a 1-year history of a pruritic eruption on the extremities, characterized by several annular plaques. The patient had been treated unsuccessfully with medium-potency topical steroids. The lesions had an erythematous papular border with an atrophic center (width, 1-4 cm) (Fig. 1). No oral, genital, or nail lesions were observed. A skin biopsy from one of the plaques was performed. Histopathologic examination of the raised border showed hyperkeratosis of the stratum corneum, focal thickening of the granular layer, basal liquefaction degeneration of the epidermis, and a band-like subepidermal infiltration with numerous Civatte bodies. In the center of the lesion, the epidermis became thinner (Fig. 2). Elastic fibers were reduced or absent in the papillary dermis. The patient was treated with high-potency topical steroids for 2 months with clinical improvement.     

Annular follicular lichen planus

Annular lesions can be found in cases of lichen planus (LP). We present a case with follicular (histopathologic) and annular (clinical) features. To our knowledge, this is the first case of annular follicular LP reported in the literature.     

Annular atrophic lichen planus

We describe a new case of annular atrophic lichen planus. Annular atrophic lichen planus is a rare variant of lichen planus that is clinically characterized by violaceous plaques of annular morphology with central atrophy and histopathologic findings of annular and atrophic lichen planus, respectively. There have been 4 cases of this entity reported previously.     

生殖器环状扁平苔藓

<正>患者男,30岁。主诉:龟头、包皮环状排列丘疹伴轻度瘙痒1年。现病史:1年前患者无明显诱因包皮龟头处出现数个细小淡红色丘疹,偶伴轻度瘙痒。后数目增多,皮疹融合,近环状排列。曾予以口服反应停、复方甘草酸苷片,外用卤米松软膏、苯扎氯铵溶液等治疗效果欠佳。     

生殖器环状扁平苔藓

患者男,30岁.主诉:龟头、包皮环状排列丘疹伴轻度瘙痒1年.现病史:1年前患者无明显诱因包皮龟头处出现数个细小淡红色丘疹,偶伴轻度瘙痒.后数目增多,皮疹融合,近环状排列.曾予以口服反应停、复方甘草酸苷片,外用卤米松软膏、苯扎氯铵溶液等治疗效果欠佳.     

Annular lichen planus: a case series of 20 patients

BACKGROUND: Annular lichen planus (ALP) is a long-recognized clinical variant of lichen planus, but is often considered uncommon in occurrence. The typical distribution and presentation of this variant have not been well described. OBJECTIVE: We sought to better define the sites affected and clinical characteristics of the annular variant of lichen planus, along with the age and race of patients affected with this disorder. METHODS: We conducted a retrospective review of 20 patients given a diagnosis of ALP during an 18-year period. The diagnosis was confirmed histologically in all but 3 cases of classic ALP that presented on the glans penis. RESULTS: Patients ranged in age from 24 to 76 years. There were 18 men and 2 women; 15 were Caucasian and 5 were African American. Sites of involvement in order of decreasing frequency included: axilla (35%); penis (25%); extremities (25%); groin (including the inguinal creases and scrotum) (20%); back (15%); buttocks (10%); flanks (5%); neck (5%); and eyelids (5%). None of the patients had oral mucosal, vulval, scalp, or nail lesions. A total of 18 patients had purely annular lesions, whereas 2 of the 20 had a few purple polygonal papules in the vicinity of the annular forms. Some eruptions were macular, whereas the majority had a slightly raised edge with central clearing. In all, 6 patients had solitary lesions whereas only 4 had 10 or greater lesions. None exhibited a linear Koebnerized response or generalized lesions. Most patients were asymptomatic. CONCLUSIONS: ALP commonly involves the male genitalia but also has a predilection for intertriginous areas such as the axilla and groin folds. Eruptions typically consist of a few lesions localized to one or a few sites. Distal aspects of the extremities, and less commonly the trunk, may also be involved. ALP is a subtype of lichen planus that may be more common than is reflected in the literature.     

Letter:Annular atrophic lichen planus of the lip

Annular atrophic lichen planus is a rare form of lichen planus, clinically characterized by a circumscribed annular configuration. We report herein a 32-year-old female who developed depressed plaques on the lips. Physical examination showed well-circumscribed, erythematous plaques on the lower lip. The border was slightly elevated and the inner portion was depressed and atrophic. Also, a bean-sized well-circumscribed plaque with slightly elevated border was found on the upper lip. A biopsy specimen revealed that the epithelium of the mucous membrane was reduced in thickness and a mononuclear cell infiltration invaded the basement membrane of the epithelium. This is the first case of annular atrophic lichen planus involving the lip. She was treated with 0.1 percent tacrolimus ointment once daily, which resulted in a beneficial effect.     

Annular lichen planus: study of the cellular mechanisms of annularity

Annular lichen planus is a rare, unique subtype of lichen planus. We report a 34-year-old Japanese male who had multiple, dark red to purple, annular macules with slightly raised borders. Histopathological examination of a skin biopsy specimen from the peripheral region of the macule showed the typical features of lichen planus. Immunohistochemical stainings revealed that a number of CD1a-positive, S-100-protein-positive Langerhans cells were present at the border zone of the annular lesion and most of the infiltrating cells were CD4-positive, CD8-negative lymphocytes. Conversely, inside the annular lesion, the number of Langerhans cells was decreased, and an equal number of CD4-positive cells and CD8-positive cells was present in the sparse infiltration. These results suggest that activation of Langerhans cells initiated a lichenoid tissue reaction but a subsequent depletion of Langerhans cells suppressed the lymphocyte infiltration. These sequential events might be involved in the formation of the unique annular structure in this condition.     

Annular lichen planus showing a change in metallothionein expression on immunohistochemistry

The immunohistochemical localization of metallothioneins (MTs), low-molecular-weight metal-binding proteins, was investigated in a case of annular lichen planus (LP) that enlarged centrifugally with healing in the centre after a month. The annular lesion was found to exhibit the early, developed and late stages of LP, as judged by the clinical and histopathological findings. Immunostaining for MTs was increased around the lesion, discontinuous around the rim of the erythema and undetectable in the centre of the lesion. MT expression was examined in eight specimens of idiopathic LP. Discontinuous immunostaining for MTs was observed in six specimens and increased staining around the lesion was observed in two specimens. These results suggest that MT expression changes depending on the inflammatory stage of LP. Although the role of MTs in dermatological disease is still unknown, their expression might be related to the pathological process of LP.     

Unilateral Blaschkoid lichen planus involving the entire half of the body, a unique presentation

A large number of congenital as well as acquired skin disorders assume a characteristic morphological pattern following the Blaschko lines. Lichen planus (LP) is an acquired inflammatory disorder that can come with different faces. Linear lesions are frequently seen but cases of zonal (zosteriform) or whorled appearance have rarely been described in the literature. We describe an even rarer presentation in a 30-years-old man who had unilateral pruritic violaceous lesions over right half of body characteristically following lines of Blaschko with clinical and histological morphology typical of LP.     

大疱性扁平苔藓

报告1例大疱性扁平苔藓.患者男,60岁.躯干、四肢出现角化性丘疹伴瘙痒5年,躯干起水疱3年.皮损组织病理检查显示典型扁平苔藓的组织病理改变.水疱直接免疫荧光检查阴性,有别于类天疱疮样扁平苔藓.     

Erosive lichen planus: a therapeutic challenge

Erosive lichen planus is an uncommon variant of lichen planus. Chronic erosionsof the soles, accompanied by intense and disabling pain, are some of its mostcharacteristic manifestations. We present the case of a woman who developed oraland plantar erosive lichen planus associated with lichen planus pigmentosus andungueal lichen planus that were diagnosed after several years. The patientfailed to respond to multiple therapies requiring longstanding medication butremained refractory. Knowledge of the treatment options for erosive lichenplanus is insufficient. Further research is required to clarify theireffectiveness, ideally adopting an evidence-based methodology.