Oral lichen planus in children: An Italian case series

Oral lichen planus usually occurs in adults; there are no clear data regarding the incidence and the clinical features of oral lichen planus in children. This paper reports clinical findings, treatments, and outcomes of 13 Italian patients with oral lichen planus in childhood diagnosed between 2001 and 2021. The most common finding was keratotic lesions with reticular or papular/plaque-like patterns, confined to the tongue in seven patients. Although oral lichen planus in childhood is rare and the malignant transformation index is unknown, specialists must be aware of its characteristics and oral mucosal lesions must be correctly diagnosed and managed.     

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.     

Oral lichen planus: hypersensitivity to dental restoration material

67 patients with oral lichen planus of the atrophic-erosive or reticular plaque type were examined. Dental amalgam in contact with mucosal lesions was present in 64 patients, and gold fillings in 33. Patch testing with a standard procedure was performed with components of dental fillings. 11 patients (16%) reacted to at least one of the mercury compounds compared to 8% in a reference group. Most positive reactions were caused by elemental mercury and ammoniated mercury. No patient reacted to gold or capper. Readings at days 10–14 did not increase the number of responders. 13 patients were patch tested with palladium; all were negative. It is not clear whether in the mercury-positive patients allergy to dental amalgam is a causative or aggravating factor, or merely on epiphenomenon.     

Wolf's isotopic response: a case of zosteriform lichen planus

Lichen planus is a lichenoid disorder characterized by shiny, flat papules. In addition to the classical appearance, there are several variants. Zonal or zosteriform lesions have been described. A 25-year-old male with a complaint of increasing numbers of erythematous swellings on his left groin for twenty days was admitted to our out-patient clinic. He had a history of herpes zoster in the same localization which had been treated with topical acyclovir two weeks prior to his admission. Dermatological examination revealed multiple, shiny, erythematous, umblicated papules localized to the left inguinal region in a linear pattern. A biopsy was taken from the lesions. According to the clinical and pathological findings the diagnosis was zosteriform lichen planus. Zosteriform lichen planus is a rare variant of lichen planus; its differentiation from zona zoster and other linear dermatoses is difficult. We presented our case because of its rarity as a variant of lichen planus and its appearance in the area of healed herpes zoster as an isotopic response.     

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.     

沿静脉分布的色素性扁平苔藓

报告1例沿静脉分布的色素性扁平苔藓.患者男,39岁.双上臂与静脉走向一致的紫色斑5个月.皮肤科检查:双前臂数条紫色或褐色色素沉着带,与浅表静脉走向大致相同.自身抗体及乙肝、丙肝抗体榆查均阴性.组织病理检查示正性角化过度,基底层液化变性,表、真皮交界处可见到Civatte小体,真皮血管周围淋巴细胞浸润明显,并可见噬黑素细胞.诊断为色素性扁平苔藓.     

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。     

色素性扁平苔藓1例

患者男，58岁。面部、颈、躯干、四肢散在分布直径0．1－3．0cm黑褐色班或斑片，无瘙痒。颈及双腋下皮损类似固定性药疹，右颊黏膜可见白色细纹和糜烂。组织病理显示色素性扁平苔藓的改变。     

Topical pimecrolimus in the treatment of genital lichen planus: a prospective case series

BACKGROUND: A potent topical steroid is the conventional therapy for genital lichen planus (GLP). Side-effects or steroid resistance can be encountered and second-line therapy such as topical tacrolimus may be required. In our experience tacrolimus may be poorly tolerated in genital skin because of a burning sensation. In addition, there is impairment of Langerhans cell function, raising concerns about its long-term use. These adverse effects may not be as marked with pimecrolimus. To our knowledge, pimecrolimus has not been used in the treatment of GLP. OBJECTIVES: To assess the efficacy and tolerability of topical pimecrolimus in the treatment of GLP. METHODS: Eleven women with GLP were recruited: 10 had erosive vulval disease and one had classical lichen planus of perianal skin. Ten patients had poor disease control, and despite using topical steroids appropriately, two of these also had steroid-related side-effects in adjacent unaffected skin. The eleventh patient had adequate disease control but marked steroid atrophy. Topical pimecrolimus 1% cream (Elidel cream; Novartis, Camberley, U.K.) was applied twice daily to affected areas. Patients were followed up between 4 and 6 weeks later. They remain under regular review and at the time of writing mean follow-up is 5.2 months (range 2-10). RESULTS: Nine patients (82%) tolerated pimecrolimus, including three patients previously intolerant of tacrolimus. These nine patients showed a clinical response at 4-6 weeks: two showed a complete response with no residual disease activity visible and seven had a partial response. With longer follow-up, six (55%) of the women had a complete response and three (27%) were considered to have a partial response. Eight patients noted symptomatic improvement and one felt that her symptoms were the same as with steroid use. Two patients (18%) with erosive lichen planus were unable to tolerate pimecrolimus due to local irritation. CONCLUSIONS: We have found that topical pimecrolimus 1% cream is an effective treatment for GLP. Local irritation can limit its use, but it may be better tolerated than topical tacrolimus: three of our complete responders had previously been intolerant of tacrolimus. Topical pimecrolimus may be a valuable second-line treatment for patients with steroid-related side-effects or steroid-resistant GLP.     

光化性扁平苔藓1例

报告1例光化性扁平苔藓。患者女，80岁。右耳前皮肤棕褐色斑疹伴做痒1年余。皮肤组织病理检查显示角化过度、表皮萎缩，基底细胞液化变性伴明显的色素失禁．真皮浅层中等量淋巴细胞带状浸润或片状分布于毛细血管周围，未见异形细胞。     

发疹型扁平苔藓1例

  报告1例发疹型扁平苔藓。患者男,69岁。全身暗红斑、丘疹伴瘙痒5个月。血糖升高9年余。皮肤专科检查：头面部、躯干及四肢可见暗红斑,部分融合成片,部分苔藓样肥厚明显,伴扁平丘疹及斑块,上覆细薄鳞屑,头部皮肤脱屑明显,未见束状发。口腔颊黏膜可见Wickham纹,生殖器黏膜见白色斑疹。皮损组织病理：表皮缺损,真皮浅层见带状的淋巴组织浸润,见色素失禁。PAS染色阴性。诊断:发疹型扁平苔藓;2型糖尿病。予小剂量激素联合羟氯喹治疗1个月后,遗留色素沉着斑,无新发皮疹。     

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……     

Heterogeneous disease: a child case of lichen planus pemphigoides triggered by varicella

Lichen planus pemphigoides (LPP) is a rare and controversial disease. It is characterized clinically by tense bullae arising both on lichen planus papules and on uninvolved skin, histologically by the demonstration of subepidermal bullae and by linear deposits of immunoglobulin G and C3 along the basement membrane zone on immunofluorescence of peribullous skin. Some authors consider LPP as the combination of lichen planus and bullous pemphigoid. Others think that it most likely encompasses a heterogeneous group of subepidermal autoimmune blistering disorders occurring in association with lichen planus. We present a child case that supports the heterogeneous condition of this disease triggered by varicella.     

Vulval lichen sclerosus and lichen planus

Lichen sclerosus (LS) and lichen planus (LP) are both immunologically mediated diseases with a preference for the genitalia. The basic principles of management of vulval LS and vulvovaginal LP are the same and involve explanation of the disease, emphasizing the chronic nature of the condition and outlining treatment options. The main difference between the two conditions is that LP has a propensity to involve the mucous membranes including the mouth and vagina which are rarely affected in LS. First‐line treatment for LS is a super‐potent topical corticosteroid ointment which has a high response rate. Erosive vulvovaginal LP is more challenging to treat. Second‐line therapies include topical calcineurin inhibitors and systemic agents. There is limited evidence for systemic treatments for both conditions. The risk of vulval squamous cell carcinoma (SCC) is increased in both LP and LS, and it is not known how treatment affects this risk. We recommend teaching self‐examination and longitudinal evaluation.     

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.     

硬化性苔藓合并扁平苔藓、硬斑病一例并文献复习

硬化性苔藓(LS),扁平苔藓(LP)和硬斑病是三种病因不明的皮肤病,已有多篇任意两种疾病合并的报道,但患者同患LS、LP和硬斑病少见,目前未见国内有相关报道。本文报道1例LS合并LP和硬斑病,并对国外已报道的7例病例进行回顾性分析。结果示8例患者中男2例,女6例,平均年龄(60.3±15.1)岁。8例患者的LS与硬斑病同时发生或硬斑病发病早于LS,同一皮损的病理切片同时具有LS与硬斑病的特征,LP发病可早于或晚于LS和硬斑病;8例患者皮损主要表现为生殖器外LS、泛发型硬斑病、经典或糜烂型LP;6例有免疫相关异常指标,4例合并其他自身免疫性疾病。     

A case of linear lichen planus

Linear lichen planus (LLP) is a very rare form of lichen planus (LP) characterized by a linear distribution of the lichenoid lesions. It usually follows the lines of Blaschko with unilateral involvement. We report such a case of LLP. A 50-year-old man presented with slightly pruritic, linear, violaceous, papular lesions on the right side of his jaw. A biopsy specimen demonstrated the typical histology of LP. Based on the clinical and pathological findings, the diagnosis was LLP.