Sulfhydryl drug-induced eruption: a clinical and histological study

Sulfhydryl drug-induced skin eruptions were studied clinically and histologically in 23 patients. In this study, tiopronin, D-penicillamine, captopril and gold sodium thiomalate were considered to be sulfhydryl drugs, because they have a thiol group or release sulfhydryl compounds. The clinical features included skin eruptions that were maculopapular, erythema multiforme-like, eczematous, psoriasis-like, seborrheic dermatitis-like, Gibert-like, lichen planus-like, and pemphigus-like. These clinical findings were reminiscent of the wide variety of eruptions seen in cutaneous graft-versus-host reactions (GVHR). Histologically, areas of vacuolation and eosinophilic necrosis with a satellite infiltrate of lymphoid cells were seen in the epidermis, and perivascular infiltrates were noted in the dermis. These findings were similar to the histological picture of cutaneous GVHR. In skin tests with sulfhydryl compounds, 19 out of 20 subjects showed positive reactions, and autoantibodies were found in 8 out of 12 subjects tested. Sulfhydryl drugs seem likely to induce immunologic changes in the host and to produce a distinctive reaction similar to that of cutaneous GVHR.     

Lichen planus annularis: an immunohistochemical study.

Lichen planus annularis is a relatively rare skin manifestation of lichen planus. The mechanisms in the formation of annular lesions are not fully understood. We reported here a 57-year-old female with this disease. The eruption initially occurred as lichen-papules, then enlarged (bean-sized, umbilicated small plaques), and finally developed annular manifestations. We performed immunohistochemical examinations of specimens taken from different types of eruptions. In all specimens, HLA-DR was expressed in the focal keratinocytes adjacent to the dermal HLA-DR positive cell infiltration. Both in the initial papule and in the final annular lesion, expression of ICAM-1 was present only in the keratinocytes above the dermal cell infiltration, similar to HLA-DR. It is of interest that, in the umbilicated small plaques, the peripheral epidermis other than the central site extensively reacted to ICAM-1. LFA-1 expression was most prominent in the mononuclear cells impinging on the dermo-epidermal junction in all specimens. In addition, in the periphery of the umbilicated small plaques, which showed no bandlike dense cell infiltration nor degeneration of basement membrane, TNF-alpha, but not LFA-1, was positive in the infiltrated cells of the upper dermis. These results suggest that expressions of ICAM-1 and TNF-alpha in the peripheral keratinocytes and dermal infiltrated cells are important molecular events in the mechanisms of formation of the annular lesions.     

Lichen planus and lichenoid reactions of the oral mucosa

Oral lichenoid reactions represent a common end point in response to extrinsic agents (drugs, allergens), altered self‐antigens, or superantigens. Oral lichen planus, a common and under‐recognized inflammatory disorder, shares many clinical and histopathological features with oral lichenoid drug reaction and oral lichenoid contact reaction. Clinical presentation can vary from asymptomatic white reticular striae to painful erythema and erosions. Cutaneous and additional mucosal involvement is common. Delay in diagnosis of extraoral mucocutaneous lichen planus (LP) results in conjunctival scarring; vaginal stenosis; vulvar destruction; and stricture of the esophagus, urethra, and external auditory meatus. Although the etiology of LP is idiopathic, oral lichenoid reactions may be caused by medications or exogenous agents such as cinnamates and other flavorings. The clinical features, evaluation, and management of these oral lichenoid reactions are discussed.     

Lichen planus: a clinical and epidemiological study

Clinical and epidemiological data from 232 patients with lichen planus is presented. Lichen planus constituted 0.38% of the total dermatology, outpatients diagnosed. The patient ages ranged from 8 to 76 years, most being in the age range from 20 to 49 years. Duration of disease varied from 1 month to 7 years. Both sexes were equally affected. The majority of the patients (47.4%) had classical lesions followed by hypertrophic and actinic lichen planus next in frequency. Itching was the predominant symptom in 79.3%. Limbs were the most frequent initial site of onset (55.6%). Mucosal involvement along with cutaneous lesions were observed in 16.8% and genital involvement in only 5.2%. Nail changes were observed in 15.1% of patients. A history of recurrence of the disease was obtained from 10.3% of patients. Liver disease was found to be associated in 2.2% of patients. No malignant changes were observed in any of the lesions of lichen planus.     

Histopathological discriminant criteria between lichenoid drug eruption and idiopathic lichen planus: retrospective study on selected samples

The lesions observed in 15 idiopathic lichen planus (ILP) skin biopsies were compared with those occurring in 15 clinically relevant lichenoid drug eruptions (LDE). Various histopathological features were taken into account. Statistical analysis of results showed that none of these can be considered as a significant criterium allowing a pathognomonic differential diagnosis between ILP and LDE. Nevertheless, a strong suggestion of drug etiology can be inferred when the following histopathological signs ('LDE-related criteria') are present: focal parakeratosis, focal interruption of the granular layer, cytoid bodies in the cornified and granular layers, present in more than 50% of LDE and never in ILP.     

Lichen planus and Hepatitis C: a case-control study

Background

The association of lichen planus with hepatitis C (HCV) has been widely reported in the literature. However, there are wide geographical variations in the reported prevalence of HCV infection in patients with lichen planus. This study was conducted to determine the frequency of hepatitis C in Iranian patients with lichen planus at Razi hospital, Tehran.

Methods

During the years 1997 and 1998, 146 cases of lichen planus, 78 (53.1%) women and 69 (46.9%) men were diagnosed. They were diagnosed on the basis of the usual clinical features and, if necessary, typical histological findings. The patients were screened for the presence of anti-HCV antibodies by third generation ELISA and liver function tests. We used the results from screening of blood donors for anti HCV (carried out by Iranian Blood Transfusion Organization) for comparison as the control group.

Results

Anti-HCV antibodies were detected in seven cases (4.8%). This was significantly higher than that of the blood donors' antibodies (p < 0.001). The odds ratio was 50.37(21.45–112.24). A statistically significant association was demonstrated between erosive lichen planus and HCV infection. Liver function tests were not significantly different between HCV infected and non-infected patients.

Conclusion

HCV apears to have an etiologic role for lichen planus in Iranian patients. On the other hand, liver function tests are not good screening means for HCV infection.     

Lichen planus and dyslipidaemia: a case–control study

Background  Previous reports have demonstrated an association between psoriasis and dyslipidaemia.
Objectives  As lichen planus (LP) is also a chronic inflammatory disorder, we investigated the association between LP and dyslipidaemia in Israel.
Methods  A case–control study was performed utilizing the database of Clalit Health Services, a large healthcare provider organization in Israel. Patients aged 20–79 years who were diagnosed as having LP were compared with a sample of enrollees without LP regarding the prevalence of dyslipidaemia. Data on other health-related lifestyle factors and comorbidities were collected.
Results  The study included 1477 patients with LP and 2856 controls without LP. The prevalence of dyslipidaemia was significantly higher in patients with LP (42·5% vs. 37·8%, P  =   0·003; odds ratio, OR 1·21, 95% confidence interval, [CI]: 1·06–1·38). A multivariate logistic regression model demonstrated that LP was significantly associated with dyslipidaemia even after controlling for confounders, including age, sex, smoking, hypothyroidism, diabetes, hypertension, socioeconomic status and obesity (multivariate OR 1·34, 95% CI: 1·14–1·57, P  <   0·001).
Conclusions  In the present study, LP was found to be associated with dyslipidaemia.     

Hidradenocarcinoma: a histological and immunohistochemical study

The diagnosis of hidradenocarcinoma is difficult due to a combination of factors including inconsistent nomenclature/ classification, rarity of the neoplasm, and variable morphology of cells composing the neoplasm. Immunohistochemistry has not been previously performed on a series of hidradenocarcinomas. We evaluated six cases of hidradenocarcinoma histologically and immunohistochemically using antibodies to gross cystic disease fluid protein-15 (GCDFP-15), carcino-embryonic antigen (CEA), epithelial membrane antigen (EMA), S-100 protein, keratin AE1/3, cytokeratin 5/6, p53, bcl-1, bcl-2, and Ki67. Histology suggested concurrent eccrine and apocrine differentiation of the cases. Ki67 and p53 staining was strongly positive in five of six tumors. The neoplasms stained with antibodies to CEA, S-100 protein, GCDFP-15, EMA, bcl-1, and bcl-2 in no consistent pattern. All tumors studied stained positively for keratin AE1/3 and cytokeratin 5/6. In making the diagnosis of hidradenocarcinoma, it may be unnecessary to separate hidradenocarcinoma into eccrine and apocrine categories, and although Ki67 and p53 may be helpful, histological parameters remain paramount.     

Lichen planus: an ultrastructural study.

Ultrastructural features of skin lesions are described in 11 patients with lichen planus. Keratinocytes and melanocytes in the basal layer show loss of nuclear membrane, disappearance of nucleoli, homogenization of nuclear material, and aggregation of tonofilaments around the nucleus to resemble cells in the late prophase of the mitotic cycle except that there is no clumping of chromosomes. These cells undergo fibrillar transformation to form densely packed fibrillar bodies (colloid bodies) which are the size and shape of normal cells and frequently have cytoplasmic organelles. Ten per cent of the mainly lympho-histiocytic cells in the dermal infiltrate show changes such as multiple cell membrane discontinuities, disintegration of cytoplasm, and breaks in the nuclear membrane with spilling of nuclear substance either into the cytoplasm or the extracellular space. The shape, size and occasional fibrillar changes in the nuclei and cytoplasm of these cells resemble colloid bodies. Contact sites frequently occurred between cells in the dermal infiltrate, especially between lymphocytes and macrophages. It appears that primary injury to the basal layer cells occurs during the early phase of the mitotic cycle and antigen from this primary site may evoke a cell-mediated type of hypersensitivity reaction. Colloid bodies evolve from cells which have injured nuclei and undergo fibrillar transformation. Dermal as well as epidermal cells may contribute to colloid body formation.     

Lichen sclerosus et atrophicus. A histological,immunohistochemical and electron microscopic study

We studied three cases of genital lichen sclerosus et atrophicus (LSA) using histological, immunohistochemical and ultrastructural techniques to elucidate the characteristics of the collagen fibres, the elastic fibres and the interfilamentous matrix in the upper dermal homogeneous zone. In the early stages of LSA, the homogeneous zone caused elaunin fibres to push downwards and partially disappear, the collagen fibres were presumably phagocytosed by fibroblasts, and there were peculiar cells containing numerous vacuoles in the cytoplasm. In the advanced stages of LSA, the homogeneous zones showed newly formed collagen fibres and amorphous, dispersed, medium electron-dense substances that were probably composed of elastin or elastin-like substances and microfilaments originating from the collagen fibres. Immunohistochemically, there were numerous anti-aortic alpha-elastin-positive substances, but there was no positivity for anti-amyloid P component. These findings suggest that in advanced LSA a hybrid substance (elastocollagenous mass) between collagen fibres and elastic fibres may be formed in the homogeneous zone.This paper was presented in part at the 44th Annual Meeting of the West Japan Dermatological Association, Takamatsu, Japan, 28. November 1992     

Lichen planus pemphigoides: an immuno-electron microscopic study

We report a case of lichen planus pemphigoides. Immuno-electron localization of G-immunoglobulin and C3 showed that in the peribullous zone these were in the lamina lucida, as in typical bullous pemphigoid, but in the bulla itself they were along the floor, and not along the roof as in bullous pemphigoid. We conclude that bullous pemphigoid antigen and lichen planus pemphigoides antigen have different localizations.     

色素性扁平苔藓

报告1例色素性扁平苔藓。患者男,20岁。躯干及四肢出现褐色斑疹半年余,无自觉症状。皮肤科检查见躯干及四肢散在大小不一、边界清楚的褐色斑疹和斑片,部分呈条索状,部分皮损肥厚、浸润。皮损组织病理改变符合色素性扁平苔藓。     

扁平苔藓类天疱疮1例

报告1例扁平苔藓类天疱疮.患者男,36岁.因四肢紫红色扁平丘疹2个月,起水疱半个月就诊.皮肤科检查:四肢广泛分布紫红色扁平丘疹,上覆少许鳞屑;在红斑基础上及正常皮肤上散在分布米粒至黄豆粒大水疱,疱壁紧张,疱液清,尼氏征(-).皮损组织病理检查:兼具扁平苔藓及类天疱疮组织学改变.直接免疫荧光示表皮基膜C3强阳性;IgM、IgA、IgG弱阳性呈线状沉积.结合临床和组织病理检查符合扁平苔藓类天疱疮诊断.该病应与大疱性扁平苔藓及大疱性类天疱疮等鉴别.     

色素性扁平苔藓1例

报告1例色素性扁平苔藓。患者女68岁。胸背部、腋下起黑褐色斑疹半年余,无自觉症状。皮肤科检查见躯干及腑下米粒至蚕豆大黑褐色斑,呈圆形或椭圆形,躯干部皮损主要是向心性分布。组织病理改变符合色素性扁平苔藓。     

Lichen planus in African children: a study of 13 patients

Abstract  Lichen planus is an uncommonly encountered dermatosis in children, reported worldwide, however in sub-Saharan Africa there is paucity of data on Lichen planus among children. The aim of this study was to document the clinical types of Lichen planus observed in children in South East Nigeria from 1998 to 2001; and to highlight any differences and similarities with adult disease. In all, 13 patients (eight boys and five girls) aged between 3 and 15 years were diagnosed with Lichen planus. The limbs were the most common sites of involvement for nine (69.2%) children. Classic Lichen planus was the commonest clinical variant in eight (61.5%), while extensive hypertrophic plaques were observed in three (23.1%), linear lesions in two (15.4%) and eruptive generalized Lichen planus in two (15.4%). Koebner phenomenon was documented in five (38.5%); mucosal involvement, which is very uncommon in children affected by this disease, occurred in three (23.1%). Only one child had pterygium formation in all 20 nails (total nail dystrophy). No child had scalp or palmoplantar involvement. Despite the endemicity of hepatitis B surface antigen in our environment, this study also revealed that liver function tests were not significantly different between children with Lichen planus and hepatitis B surface antigen and those who were negative for this antigen; while anti-hepatitis C virus seropositivity was not recorded in any of these children.