泛发性扁平苔藓继发面部巨大鳞状细胞癌1例

报告1例泛发性扁平苔藓并发巨大鳞状细胞癌。患者男，20岁。因全身暗红色斑块10年，面部肿块5个月就诊。腹部皮损组织病理活检显示，符合扁平苔藓病理改变，面部肿块经病理诊断为中分化鳞状细胞癌。     

足跟部扁平苔藓继发鳞状细胞癌一例

皮肤鳞状细胞癌是起源于表皮或附属器角质形成细胞的一种恶性肿瘤,常由各种癌前期疾病演变而来,其中扁平苔藓继发鳞状细胞癌临床上较为少见。本文报道了足跟部扁平苔藓继发鳞状细胞癌1例。     

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.     

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。     

The period prevalence of oral lichen planus in a cohort of patients with vulvar lichen sclerosus

Background Lichen sclerosus and lichen planus are chronic inflammatory mucocutaneous disorders that may coexist. Objective The aim of this study was to estimate the period prevalence of oral lichen planus in a cohort of patients with vulvar lichen sclerosus and to document their clinical characteristics. Methods We report a series of cases of vulvar lichen sclerosus presenting to two dermatologist‐led vulvar clinics in Oxfordshire, England between 1997 and 2007 with coexistent clinical signs of oral lichen planus. Results Thirteen cases with coexistent vulvar lichen sclerosus and oral lichen planus were identified, of which five had oral biopsies. Four oral biopsies showed histological features consistent with lichen planus. One oral biopsy was not diagnostic but compatible with oral lichen planus. No cases of oral lichen sclerosus were identified. The period prevalence of oral lichen planus was 6 per 1000 cases of vulvar lichen sclerosus. Conclusion The period prevalence of oral lichen planus in women with vulvar lichen sclerosus (0.6%) is similar to that reported for oral lichen planus in the general population (1–2%).     

Evaluating and treating patients with oral lichen planus

Lichen planus (LP) is a relatively common disorder with a reported incidence approximating that of psoriasis. Unlike cutaneous lesions, which in the majority of instances are self-limiting, oral lesions are chronic and are a potential source of significant morbidity. Furthermore, compared to cutaneous lesions, oral lesions are more difficult to control and are often refractory to therapy. Patients with oral lichen planus (OLP) frequently have concomitant disease in one or more extraoral sites and therefore require a thorough evaluation to uncover all affected sites of involvement. Genital involvement, which develops in approximately 20% of women patients with OLP, and esophageal involvement may result in scarring if undetected and not treated appropriately. Since no therapy for OLP is curative, the primary goal for symptomatic patients is palliation. Relief can be achieved in the majority of patients with topical corticosteroids alone or in combination with other immunomodulatory topical agents. Infrequently patients require the prolonged use of systemic medications to control the disorder. All treatments are nonspecific and directed at eliminating inflammation, and therefore are only partially successful.     

Antinuclear antibodies in patients with lichen planus

Abstract Lichen planus (LP) is a mucocutaneous syndrome of yet uncertain pathogenesis, and it has usually been considered to be a dermatosis without antinuclear antibodies (ANA) nor other specific auto-antibodies. Over 10 years ago a series of indirect immunofluorescence researches with patients' lesional skin and serum disclosed the presence of lichen planus specific antigens (LPSA). After this, a number of substrates have been submitted for evaluation. In this study we have carried out indirect immunofluorescent test in relation with different substrates, with the aim of verifying whether the negative results previously obtained were due to poor sensitivity of the substrates employed. Subsequently we have compared the results obtained in the erosive forms of LP with those obtained in the non-erosive forms. We have concluded that rat oesophagus is a better substrate for the detection of ANA in patients with LP, as it has proved to have a positivity rate of 40.42%. Monkey oesophagus has provided a rate of 27.6%, and HEP-2 cells and rat liver have proved to be unsuitable. In addition, we have observed that the frequency of ANA is higher in the erosive forms of LP (P= 0.0389). In this article we demonstrate that the presence of ANA in patients with LP depends on the substrate employed, the most suitable substrate being rat oesophagus. Also, we demonstrate that ANA is more frequently observed in patients with erosive LP.     

Hypertrophic lichen planus – successful treatment with acitretin

Lichen planus classifies into different subtypes according to morphology and location. Hypertrophic LP (HLP) manifests a great challenge due to persistent itching, the risk to develop into squamous cell carcinoma and therapeutic resistance. We report two clinical cases exemplary for the successful treatment of dramatic‐resistant HLP with acitretin.     

Ultraviolet-B treatment for cutaneous lichen planus: our experience with 50 patients

Background: Previous small reports suggested the role of ultraviolet (UV)‐B in the management of cutaneous lichen planus. Objective: To summarize our experience with UVB in a relatively large study group looking specifically into predictive factors for complete response and the long‐term relapse rates. Methods: A retrospective analysis of 50 patients with generalized cutaneous lichen planus, treated by broad or narrow band UVB. Results: Seven and 43 patients were treated by broad and narrow band UVB, respectively. Complete response was achieved in 70% and 85% of those were still in remission after a median of 34.7 months. The complete response rate and the need for higher cumulative exposure doses were not influenced by sex, age, skin type, presence of additional diseases, failure of previous treatment or disease duration. Limitations: This is a retrospective non‐randomized analysis of a usually self‐limiting disease. Conclusion: UVB is a safe and efficient treatment option for generalized cutaneous lichen planus.     

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.     

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.     

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。     

Childhood actinic lichen planus: successful treatment with antimalarials

Actinic lichen planus (ALP) is a photosensitive variant of lichen planus, affecting mainly young adults of Middle Eastern descent. We report a case of ALP in a 9-year-old Colombian girl with an excellent response to hydroxychloroquine and photoprotection.     

CD44分子在扁平苔藓中的表达

目的：检测扁平苔藓皮损组织中粘附分子CD44的表达。方法：对30例扁平苔藓患者的皮损组织、10例正常皮肤组织、10例病理上以淋巴细胞浸润为主的皮损组织进行免疫组化染色。结果：在扁平苔藓皮损中,表皮及真皮中CD44分子的表达较正常皮肤及以淋巴细胞浸润为主的皮损组织均明显增强,差异有统计学意义（P<0.01）。结论：CD44分子可能与扁平苔藓发病相关。     

Plantar lichen planus masquerading eumycetoma of dark grains

Lichen planus is a common inflammatory disease but its perforating variety is not so common and it has been described in small number of text and articles. Here we reported a case of plantar lichen planus where there was a history of discharge of dark grains from the sole of foot and diagnosing the disease as eumycetoma of dark grains repeated antifungal therapy could not resolve the lesions and histopathologically it showed the classical pictures of lichen planus. Collaborating the clinical and histological features we have diagnosed the case as perforating lichen planus but Verhoeff-Van Gieson stain could not elucidate the perforating channel which ot difficult to delineate and often missed. So, we have put the diagnosis of plantar lichen planus and treated with intramuscular triamcinolone and the lesions resolved.     

Paraneoplastic pemphigus mimicking erosive mucosal lichen planus associated with primary hepatocellular carcinoma

A 58-year-old Japanese male visited us with painful lesions on the lower lip, oral mucosa and genital region of an 8-month duration. Histological features of the genital lesion were almost consistent with lichenoid tissue reaction. A few intraepidermal acantholytic keratinocytes were also seen in the suprabasal clefts. Direct immunofluorescence exhibited cell surface immunoglobulin (Ig)G deposition and linear deposition of fibrinogen at the dermoepidermal junction. IgG anti-desmoglein (Dsg)3 antibody, but not anti-Dsg1 antibody, was detected in the patient's serum by enzyme-linked immunosorbent assay. Immunoblotting using normal human epidermal extract detected the 210-kD envoplakin, 190-kD periplakin and 130-kD Dsg3. The diagnosis of paraneoplastic pemphigus (PNP) was made. Subsequent investigation revealed a large space-occupying lesion in the liver. Histological findings from liver biopsy specimen were consistent with hepatocellular carcinoma. The patient has been alive 38 months after the diagnosis of PNP was made, although the liver mass has slowly enlarged. Our case is clinically and histologically similar to erosive mucosal lichen planus. Immunological studies confirmed the diagnosis of PNP. The results of negative Dsg1 and positive Dsg3 were consistent with clinical features showing severe mucosal involvement without cutaneous erosion. In PNP, the association with non-hematological solid tumor is extremely rare.     

Pemphigus vulgaris coexisting with generalized lichen planus

A case of coexistence of pemphigus vulgaris and generalized lichen planus is presented. The patient had clinical, histological and immunopathological findings of pemphigus vulgaris in the mouth, lichen planus on the scalp, and glabrous skin over the trunk and the extremities. These facts may suggest that a common immunologic mechanism may cause either disease, depending on the constitutional predisposition of the patient.     

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。