Intraepithelial mast cells in gingival lichen planus: an ultrastructural study.

Intraepithelial mast cells, identified by ultrastructural criteria, were seen in lesions of gingival lichen planus. The mast cells were found either singly, interspersed among keratinocytes, or in combination with other mononuclear cell types, especially lymphocytes. The mast cells were seen in regions with relatively normal intercellular spaces, as well as in regions of more severely disrupted keratinocytes. They had cytologic features indicative of active synthesis and release of granules. Moreover, the finding of centrioles in several intraepithelial mast cells, in combination with certain other cytologic features, suggested that these cells might be in an early stage of differentiation. It is speculated that intraepithelial mast cells have a role in the pathogenesis of gingival lichen planus.     

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.     

Childhood lichen planus: a study of 87 cases

AIMS: We undertook this study to analyze the clinical profile of childhood lichen planus (LP) prevailing in north India, and to highlight differences from and similarities with adult LP. METHODS: Clinical records of children with LP, who attended the Pediatric Dermatology Clinic, Nehru Hospital, Postgraduate Institute of Medical Education and Research, Chandigarh, India, from July 1988 to December 2000, were analyzed. RESULTS: Eighty-seven patients with LP were examined during a 12.5-year period of observation. These patients formed 2.5% of the total number of pediatric dermatology patients and 0.6% of the total number of new dermatology outpatients. The male : female ratio was 1.1 : 1. The age at onset was between 8 months and 12 years (mean, 7.1 years). Classical LP was observed in 53 (60.9%) patients, followed by actinic LP in 10 (11.5%), and lichen planus hypertrophicus (LPH) and linear LP in eight (9.2%) each. Other forms seen were eruptive, follicular, lichen planopilaris, atrophic, and bullous LP. The involvement of skin alone was observed in 75 (86.2%) children and mucosa alone only in one (1.1%) child. Concomitant skin and mucosal involvement was seen at the time of presentation in four patients, while mucosal involvement occurred later during the course of the disease in seven patients. Lesions appeared earlier in boys than in girls. CONCLUSIONS: The natural history of LP in children was essentially similar to that in adults. Unusual features, such as involvement of the palms and soles and upper eyelids, were observed. Actinic LP, mimicking melasma, as reported in adult women, also seems to occur in children.     

Extracorporeal photopheresis as an alternative therapy for drug-resistant graft versus host disease: three cases

BACKGROUND: Graft versus host reaction is a life-threatening complication of allogenic bone marrow transplantation. Extracorporeal photopheresis has been used for some years in the treatment of graft versus host reaction. We report on three children treated with extracorporeal photopheresis for a graft versus host reaction resistant to immunosuppresive drugs. MATERIAL AND METHODS: Three children with a graft versus host reaction were submitted to 18, 30 and 46 extracorporeal photopheresis courses respectively. In the same time, the other immunosuppressive treatments were tapered or definitively stopped (ciclosporin). RESULTS: A dramatic improvement of cutaneous status and biological data was observed after the first courses. However, the extracorporeal photopheresis treatment did not improve the mucous lesions. No serious adverse effect was encountered. COMMENTS: As published elsewhere, extracorporeal photopheresis was effective on the graft versus host reaction lichenoid cutaneous lesions and in case of visceral involvement. In all of our cases, the immunosuppressive drug could have been tapered. No adverse event was observed. Thus, extracorporeal photopheresis should be indicated in case of resistance to immunosuppressive drugs.     

The epidermal disorder in lichen planus: an in vitro study

The epidermal component of lichen planus seems to result from a continuous process of erosion of the basal zone, and repopulation of the ‘wounded’ area by cells from nearby uninvolved epidermis. In order to investigate these migrating cells further, we have studied tissue slices from forty papules of lichen planus derived from twenty-nine patients. The tissue slices were cultured for periods of 24 or 48 h. Marked migration of fusiform and spindle-shaped cells into the eroded dermo-epidermal zone appeared to have taken place. In general, the changes represented an exaggeration of those usually present in vivo. Cytochalasin B, in concentrations of 5 μg/ml or greater in the culture medium, prevented cell migration. This effect, and the fact that autoradiographic studies showed few cells to be synthesizing DNA, suggested that cell migration took place by movement rather than by mitotic activity. Lichen planus (LP) seems unusual in that, although there is destruction in the basal generative layer, there is at the same time epidermal thickening. A recent study by Marks, Black & Wilson Jones (1973) has produced evidence suggesting that kcratinocytes migrate into the LP lesion from nearby uninvolved epidermis, and then repopulate the damaged basal zone in an attempt at healing the ‘microwound’ due to the erosive LP process. We have tried to learn more about these epidermal changes, by studying in vitro tissue slices from LP papules. During this study we have made observations that we believe support the concept that the epidermal changes in LP are a mixture of continuous damage and of attempts at repopulation by migrating epidermal cells.     

Superficial mucoceles and lichenoid graft versus host disease: report of three cases

Superficial mucoceles are subepithelial extravasations of sialomucin that occur at the epithelial-connective tissue interface and are directly related to minor salivary glands. They have been described in association with oral lichen planus and, exceptionally, with chronic graft versus host disease. Three patients who underwent an allogeneic bone marrow transplantation for a chronic myelogenous leukaemia presented multiple superficial mucoceles and an oral lichenoid graft versus host disease.     

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.     

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.     

Circumscribed lenticular anetoderma in an HIV-infected man with a history of syphilis and lichen planus

Anetoderma is an uncommon dermatosis that manifests as discrete foci of well-circumscribed, atrophic skin. The condition can be idiopathic or can be secondary to a number of associated cutaneous diseases. Whereas the pathophysiologic mechanisms remain unknown, anetoderma results from diminished elastic fibers in the dermis. We present an unusual case of localized, lenticular anetoderma in a man with HIV, a history of syphilis, and lichen planus. Both of these infections have been associated with anetoderma. Although his lesions are vaguely reminiscent of a variant of syphilitic anetoderma described in the 1930s, they are confined to a smaller anatomic distribution, differ in size, and have a papular appearance. As anetoderma can develop in the context of infectious disease, a diagnosis of anetoderma should trigger a thorough examination and evaluation for treatable concomitant illnesses.     

Phototherapy for the treatment of cutaneous graft versus host disease

Graft versus host disease (GvHD) occurs in half the patients who receive allogenic haematopoietic stem cell transplantation and is a major contributor for the morbidity and mortality in these patients. Immunosuppressant therapy cannot suppress all the manifestations of GvHD and new ways of treating the condition are needed. The focus of this review is the treatment of cutaneous GvHD through phototherapy. Of the six acute and ten chronic cutaneous GvHD case series examined the overall trend was that phototherapy was able to reduce the presence of cutaneous lesions of GvHD and, as a consequence, steroid use could be reduced. This provides a positive outlook for phototherapy as a treatment for cutaneous GvHD but there is a need for future studies to include larger numbers of patients in order to obtain more data.     

Hepatocellular carcinoma and lichen planus: report of two cases.

A patient with lichen planus (LP) who developed a hepatocellular carcinoma as a consequence of a postviral chronic hepatitis is described. Its possible noncoincidental association with LP is discussed on the basis of a recent large case-control study in which the association of LP with chronic, possibly postviral, liver disorders has been confirmed. In the same study 1 case out of 577 LP patients was found to have hepatocellular carcinoma versus none of the 1,031 controls, a prevalence which is higher than expected in a western population.     

Comparative immunological and histopathological study in fifty cases of mucosal/nonmucosal lichen planus

Lichen planus is a common disorder and 40-50% of LP patients also reveal mucosal lesions. It is well known that mucosal LP lesions take very long to heal in comparison to cutaneous lesions. Rarely erosive mucosal LP can turn malignant. Both CMI and humoral immunity may play role in aetiopathogenesis of LP. Present study was conducted to study and compare CMI, Humoral Immunity, histopathology in mucosal and nonmucosal LP.     

Actinic lichen planus in a Japanese man: first case in the East Asian population

Actinic lichen planus (ALP) is a rare variant of lichen planus in which lichen planus develops on the light-exposed areas of the skin. ALP is reported to occur in the African, Middle Eastern,and Indian populations, with very few cases reported in Caucasians. Here, we report a case of ALP in a Japanese man; to the best of our knowledge, this is the first reported occurrence of ALP in the East Asian population. A 52-year-old Japanese man developed recurrent painful annular erythema on the face and hands. Histopathological examination of his skin biopsy revealed lichenoid-type infiltrates of lymphocytes and histiocytes. We established a diagnosis of ALP on the basis of the distribution of eruptions only on the sunlight-exposed areas and histological findings. Oral administration of systemic steroids proved effective in improving his condition. Lichen planus is known to be induced by an irritant (Koebner phenomenon);we believe that our patient is genetically susceptible to sunlight exposure and that sunlight acted as an irritant stimulating the development of ALP.     

Corticosteroid injection in treatment of persistent oral lichen planus: Three cases

Oral lichen planus (OLP) is a chronic inflammatory disease with unknown etiology. There are many clinical types of OLP. OLP cases are often asymptomatic; however, atrophic or erosive forms may cause sensitivity, burning, and discomfort. The best model of the OLP treatment modality is to evaluate the restorations that may lead to oral mucosa hypersensitivity as the first step. Local corticosteroid injection therapy may be preferred to eliminate the possible systemic side effects of systemic corticosteroid medication in patients with OLP. The aim of this case series is to evaluate treatment alternatives in OLP.