Carcinoma verrucoso de pene desarrollado sobre un liquen plano. ¿una auténtica lesión preneoplásica?

Introductionup to 30% of squamous cell carcinomas of the penis arise from a lichen sclerosus, but very few reports in which lichen planus was the preexisting lesion have been published. We report a male with verrucous carcinoma of penis that developed in an area of lichen planus.Clinical casea 53-year-old male presented with an exophytic tumor on the glans penis that had been present for about 6 months. The lesion developed in a previously biopsied area of lichen planus hypertrophicus. After excision, histological diagnosis was verrucous carcinoma.Commentthe development of any subtype of squamous cell carcinoma of penis in a lichen planus can be coincidental, or a neoplastic transformation of lichen planus can take place.     

Oral erosive lichen planus regression after thymoma resection

Thymomas are neoplasms known to be frequently associated with autoimmune disorders. Oral lichen planus is an immunologically based, chronic inflammatory oral mucosal disease of undetermined cause. We describe a 79-year-old patient with a 6-month history of generalized oral erosive lichen planus in whom a chest roentgenogram led to the discovery of an anterior mediastinal mass consistent with thymoma. Transsternal complete thymoma resection achieved erosive oral lichen planus regression. The clinical correlations between erosive oral lichen planus and thymoma are presented.     

Dermatoscopy of Nail Lichen Planus: A Boon for Early Diagnosis

BackgroundLichen planus is an immune-mediated disorder affecting the skin, mucous membranes, scalp, and nails.ObjectiveWe sought to evaluate dermatoscopic nail patterns in patients with lichen planus.MethodsThis was a cross-sectional, observational study performed in the outpatient dermatology department of a tertiary care hospital. Thirty-one patients with skin biopsy-proven lichen planus with nail changes were included. An evaluation of clinical nail patterns and dermoscopic assessment of nail patterns were performed.ResultsLongitudinal ridging with splitting, longitudinal melanonychia and splinter hemorrhages were the most commonly found nail patterns in patients with lichen planus. Pterygium has been found to be most pathognomic feature of nail lichen planus.ConclusionDermatoscopy has been demonstrated to be a valuable, noninvasive tool to identify subsurface nail bed changes and subclinical surface findings to facilitate early diagnosis and timely management of lichen planus to avoid long-term sequelae.     

Evaluation of Botulinum Toxin Type A Injection in the Treatment of Localized Chronic Pruritus

BACKGROUND: Botulinum toxin is a neurotoxin produced by the bacterium Clostridium botulinum that causes a flaccid muscle paralysis. It is currently used for aesthetic procedures and to treat focal hyperhidrosis. The botulinum toxin has also been used experimentally in many other dermatological conditions with positive results. OBJECTIVE: We sought to evaluate the efficacy and safety of intradermal injection of botulinum toxin A in the treatment of localized recalcitrant chronic pruritus in lichen simplex, inverse psoriasis, post-burn itching, lichen planus (hypertrophic), and postherpetic neuralgia. METHODS: This was a clinical trial study of 32 patients (12 with lichen simplex chronicus [LSC], 4 with inverse psoriasis, 4 with post-burning itch, 4 with lichen planus, 4 with hypertrophic lichen planus, and 4 with post-herpetic neuralgia). We used 2 to 3mL of unpreserved saline to dilute each vial (50 units) of botulinum toxin A. This led to a final concentration of 2 to 2.5U/0.1cc; injections were typically made into the dermis. RESULTS: The ages of patients in the group studied ranged from 13 to 85 years, with a mean of 37.38 years, and 59.4 percent were female. There were statistical reductions in visual analog scale in all the studied cases. CONCLUSION: Botulinum toxin A appears to be a safe and effective therapy for the improvement of localized recalcitrant itching in LSC, inverse psoriasis, burns, hypertrophic lichen planus, lichen planus, and symptoms of postherpetic neuralgia.     

Oral lichen planus part II: therapy and malignant transformation

Oral lichen planus lesions can cause discomfort, pain, and a burning sensation. Therefore, all professionals who deal with the oral cavity must be aware of all the therapeutic options for it. This article presents a review of the literature on oral lichen planus, focusing on its treatment, and also discusses the important and controversial potential for the evolution of oral lichen planus into epidermoid carcinoma.     

Minimally invasive repair of a late stricture in a reversed gastric tube

Ingestion of caustic agents may result in severe scarring and stricture formation of the esophagus. Reversed gastric tube esophagoplasty is an option for definitive surgical management of severe esophageal stricture refractory to medical treatment. Delayed complications from this procedure have rarely been reported. We present a case involving a patient who developed a delayed gastric stricture three decades after receiving a reversed gastric tube esophagoplasty. A historical review of the reversed gastroplasty is presented as well.     

Full thickness,split thickness and culture epithelium as a treatment for ulcerative lichen planus

Summary Ulcerative lichen planus is a rare and chronic form of lichen planus. The disease affects mainly the feet and the oral cavity. This form is not only extremely painful and disabling, but carries the hazards of malignant transformation. Only nine patients described in the literature had excision and skin grafting of their lesions, with good short and long-term results. We present a case report of a patient with 27 years history of ulcerative lichen planus and multiple skin grafting and recurrencies. We present an alternative method of treatment with culture epithelium allograft as a temporary measure.     

Surgical treatment of painful lichen planus of the hand and foot

Lichen planus of the hands and feet, although uncommon, can be very disabling with painful hypertrophic areas or ulcers, mainly of palmar and plantar surfaces. These lesions may not respond to conventional medical treatment. A case of surgical treatment with excision and split skin grafting of ulcerative lichen planus of the soles, with a fourteen year follow up, is reported. Only three other reported cases with a longer review period could be found. A second patient is described in which excision and grafting of painful, hypertrophic, ulcerative lichen planus of the hands achieved a satisfactory long term outcome. No other examples could be found in the English literature. It is suggested that surgical treatment should be considered more often and sooner in painful lichen planus of the hands and feet.     

Efficacy of Intralesional Bacillus Calmette-Guérin Polysaccharide Nucleic Acid and Vitamin D Injections in the Treatment of Lichen Planus

BACKGROUND: Lichen planus is a multifactorial chronic inflammatory disease with diverse clinical manifestations involving the skin, hair, nails, and mucous membranes. OBJECTIVE: We evaluated the clinical efficacy and adverse effects of Bacillus Calmette-Guérin polysaccharide nucleic acid (BCG-PSN) injection, vitamin D injection, and the combination of both in the treatment of different types of lichen planus. METHODS: Thirty patients ranging in age from 12 to 70 years with clinically diagnosed lichen planus were enrolled in this study and divided into three groups according to treatment regimen. RESULTS: A partial therapeutic response in three patients and no improvement in seven patients were achieved in the intramuscular vitamin D injection group. Meanwhile, the intralesional injection of BCG-PSN was associated with complete response in three patients, partial response in three patients, and no response in four patients. The combination of both intralesional injection of BCG-PSN and intramuscular injection of vitamin D was associated with complete response in two patients, partial response in four patients, and no response in four patients. CONCLUSION: BCG-PSN alone appears to be efficacious in the treatment of lichen planus, and vitamin D in combination with BCG-PSN had no effect on cutaneous lichen planus.     

Penile carcinoma originating from lichen planus on glans penis

A 53-year-old man presented to the urologic department with a small tumor on the glans penis. He had been receiving dermatologic treatment of lichen planus on the glans penis for 10 years. On physical examination, the tumor displayed an irregular surface. Because of a suspicion for malignancy, a biopsy was performed. The pathologic diagnosis was squamous cell carcinoma; therefore, partial penectomy was performed. The detailed pathologic findings revealed that the white raised areas adjacent to the tumor consisted of lichen planus with mild cytologic atypia. The final pathologic diagnosis was squamous cell carcinoma (pT1N0M0) originating from lichen planus. No recurrence had been seen as of 4 years postoperatively.     

Secondary esophageal surgery following repair of esophageal atresia with distal tracheoesophageal fistula

During the period 1948 through 1988, 498 patients with esophageal atresia and distal tracheoesophageal fistula were admitted to the Royal Children's Hospital, Melbourne. Fifty patients had a second operative procedure on the esophagus, for anastomotic stricture (30), recurrent fistula (15), both (4), and a postmyotomy diverticulum (1). During the same period, nine patients underwent esophageal replacement and 33 patients a Nissen fundoplication. Improvements in the technique of esophageal anastomosis, and in recent years the use of fundoplication to correct gastroesophageal reflux have led to a marked reduction in the need for secondary surgery to the esophagus after repair of esophageal atresia. Esophageal replacement is rarely required in esophageal atresia and distal tracheoesophageal fistula. One-layer end-to-end esophageal anastomosis using interrupted sutures resulted in the lowest rate of recurrent fistula and anastomotic stricture.     

Validation of instruments to measure the symptoms and signs of oral lichen planus.

OBJECTIVE: The aim of this study was to validate the visual analog scale (VAS), numeric rating scale (NRS), and change in symptoms scale (CSS) in measuring symptoms of oral lichen planus, and the modified oral mucositis index (MOMI) in measuring the signs of oral lichen planus. STUDY DESIGN: Criterion validity, construct validity, and internal consistency reliability were evaluated using data from a randomized, double blind, placebo-controlled clinical trial of curcuminoids in oral lichen planus. RESULTS: Moderate to high correlations were found between VAS, NRS, and CSS. Correlations of symptom scores with clinical signs ranged from minimal to high. Correlation of NRS with clinical signs was stronger than that of VAS with clinical signs. Significant changes from baseline at each follow-up in NRS, VAS, and MOMI scores were seen. The Cronbach alpha for erythema and ulceration scores from the MOMI were 0.66. CONCLUSIONS: This study gives some evidence of the validity of NRS, VAS, CSS, and MOMI for use in oral lichen planus. The NRS has better construct validity than VAS, based on higher correlations with clinical signs. Erythema plus ulceration is a better measure than ulceration alone.     

Pharyngoesophageal caustic stricture: Treatment by pharyngogastrostomy compared to colon interposition combined with free bowel graft

Four cases of combined hypopharyngeal and cervical esophageal stricture secondary to caustic ingestion are presented. Although gastropharyngostomy has rarely been used for treatment of patients with caustic stricture of the pharynx and cervical esophagus, we believe that it is a useful procedure and has several advantages over use of the colon. We prefer total esophagectomy and posterior mediastinal transposition of the stomach to the neck followed by gastropharyngostomy in those patients who have minimal stomach involvement.     

Malignant transformation of a potentially low risk lichenoid reaction

Lichenoid reaction represents a family of oral lesions identical, both clinically and histologically to oral lichen planus. The triggering factor for this lesion varies from medicines to dental materials, usually demonstrating a cause-effect relationship unlike lichen planus. We present a typical case of lichenoid reaction on the buccal mucosa that appeared in response to betel quid which progressed to carcinoma during a follow-up period of 6 months. Lichenoid reactions occurring in response to known carcinogens and that occurring in risk group population has to be observed more cautiously.     

Submucosal Fibrotic Bands in Oral Lichen Planus: A Clinico-Pathological Investigation of a Newly Described Phenomenon

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.     

Oral lichen planus part I: epidemiology, clinics, etiology, immunopathogeny, and diagnosis

This article presents a review of the literature on oral lichen planus, focusing on important aspects of its epidemiology, etiopathogeny, and clinical manifestations. The oral form is an important clinical presentation of lichen planus. It may precede or accompany the skin lesions, or it may be the only manifestation of the disease. Dermatologists, dentists, otorhinolaryngologists, and other specialists who deal with the oral cavity must be aware of this disease so they can diagnose, treat, and keep these patients under observation.     

Thymoma accompanied by lichen planus

Thymomas are associated at a high frequency with paraneoplastic autoimmune diseases. We treated a 64-year-old male with a thymoma, who also had lichen planus. The tumor was resected and diagnosed as thymoma, however, the symptoms associated with lichen planus did not subside and persisted. A preoperative examination showed an elevated serum level of squamous cell carcinoma antigen, which gradually decreased to normal after surgery. The findings of this case are interesting for understanding the correlation between a thymoma and autoimmune abnormalities.     

Hypertrophic bullous lichen planus

Lichen planus is usually characterized by distinctive morphologic features and consequently does not create dilemmas in diagnosis. At times, variations in the clinical presentation can make diagnosis difficult. The author describes a variant form of lichen planus in a black female with the primary lesions beginning on the foot.     

口腔扁平苔藓的临床治疗分析

目的采用中西医结合方法调节患者免疫功能,探讨口腔扁平苔藓的治疗效果。方法根据患者临床表现,辨证施治,并结合西医方法联合治疗。结果治疗2年后,69例患者中,治愈23例,好转27例,总有效率达72.4%。结论口腔扁平苔藓是一种病因复杂且不确定的疾病,与患者免疫失衡有关,利用中药对机体免疫功能的双向调节作用,免疫平衡得以恢复,并取得较好的临床疗效。     

Assessment of the peripheral immunocompetent cells in patients with reticular and atrophic-erosive lichen planus.

OBJECTIVE: To assess the cellular and humoral immunity in patients with reticular and atrophic-erosive oral lichen planus (OLP). STUDY DESIGN: Lymphocyte phenotype analysis of 50 patients with OLP and 16 control subjects was performed by means of flow cytometry. The results were analyzed by the Mann-Whitney U test. RESULTS: In the patient group the percentage of na?ve helper T cells was significantly decreased, while that of memory cells was increased, resulting in a significantly higher ratio of memory to na?ve cells in the OLP group than in the control group. In the group of patients with atrophic-erosive OLP, the percentages of cytotoxic/suppressor T cells and cytotoxic/suppressor na?ve T cells were found to be slightly decreased. CONCLUSIONS: The results indicate that the relative ratio of immunocompetent cells in the peripheral blood is altered in patients with lichen planus and that the exact character of these disturbances depends on OLP form. Some of the alterations observed in these patients are typical to autoimmune diseases, thus promoting the concept of autoimmune etiopathogenesis of lichen planus.