Diagnóstico y manejo de manifestaciones clínicas típicas y variantes del liquen plano

Lichen planus

Blaschkoid lichen planus: Throwing a “curve” in the nomenclature of linear lichen planus

Sir, Lichen planus (LP) is categorized as a chronic inflammatory skin disease of unknown etiology that involves immune reactions. It is characterized by flat-topped, polygonal, violaceous papules and plaques. It has various clinical presentations, such as classical LP, hypertrophic LP, LP pigmentosus, and linear LP (LLP). Primary aldosteronism (PA) is known to pose a higher risk of causing multiple autoimmune diseases [1]. Herein, we report a case with LLP and PA present at the same time. A 72-year-old Japanese female presented herself to our hospital with a three-month history of slightly itchy skin lesions on the lower right leg. A physical examination revealed flat-topped plaques on the lower right limb extending from the middle of the leg to the dorsum of the foot (Fig. 1a). There was no oral or nail involvement. The patient had a history of hypertension from the age of 62 years and was diagnosed with PA afterward. The patient had been treated with an antihypertensive drug since then without change in internal medication. The patient had no history of a preceding trauma, dental metal fillings, hepatitis, metastatic cancer, or any other infections. A histopathological examination of a skin biopsy from a lesion on the right leg revealed hyperkeratosis, a saw-tooth appearance of the epidermis, and severe liquefaction degeneration. A band-like lymphocytic infiltration was present in the upper dermis (Figs. 2a and 2b), as well as lichenoid infiltration into the dermis composed of CD4+ and CD8+ T lymphocytes. Predominantly, CD8+ T lymphocytes infiltrated into the epidermis (Figs. 2c and 2d). Clinical and histological findings confirmed the diagnosis of LPP.

A form of lichen planus (LP) which follows the Blaschkos line pattern known as linear LP, presents with lichenoid eruptions and violaceous papules in a linear distribution. It is a rare form of LP affecting <0.2% population with LP. We present a case of a 52-year-old female with hyperpigmented patches and plaques distributed linearly along the Blaschkos line in her right leg. From a clinical perspective, the lesions on the patient’s right leg resembled those of lichenoid epidermal naevus, which is a type of linear verrucous epidermal nevus but the dermoscopic findings and the presence of oral mucosa LP indicate that the patient has the uncommon variant of LP which is called linear LP. It is thus critical for clinicians to distinguish linear LP from other acquired dermatoses following the lines of Blaschko both clinically and dermoscopically.

Oral lichen planus (OLP) is a common disease whose aetiopathogenesis is linked to psychological disorders. This study aims to determine the influence of anxiety and depression in OLP patients, define the perception of quality of life in these patients and check for potential differences between atrophic/ ulcerative and reticular lesions. A group of 48 OLP patients and a control group of 40 patients were selected. In order to assess anxiety, depression and quality of life, Hospital Anxiety and Depression Scale (HADS) and Oral Health Impact Profile 14 (OHIP-14) tests were completed. OLP patients showed higher scores on HADS (anxiety p<0.01, depression p<0.05) and OHIP-14 (physical pain p<0.05, psychological discomfort p=0.001). Patients with reticular lesions obtained higher scores in HADS (anxiety p=0.001, depression p<0.001), whereas patients with atrophic/ ulcerative lesions obtained higher scores in OHIP-14 (p=0.02). Psychological disorders play an important role as a trigger for OLP and are responsible for many relapses. Psychological support would be advisable in order to improve their mental health, as this would have a positive impact on their quality of life and would lead to a better progression of the disease.

Objective To investigate the impact of diabetes on quality of life in breast cancer patients. Methods A cross-sectional study was conducted among 3 344 community patients suffering from breast cancer during April to July 2013, in Shanghai. Data were collected using a questionnaire, which included socio-demographic situation, diagnosis, and treatment of cancer, as well as diabetes mellitus. European Organization for Research and Treatment of Cancer QOL Questionnaire-C30(EORTC QLQ-C30)Simplified Chinese Version and Functional Assessment of Cancer Therapy(FACT-G)Simplified Chinese Version were used to investigate the quality of life in the patients. The quality of life scores in breast cancer patients with and without diabetes were compared. Results The prevalence of diabetes was 14.38% in the patients with breast cancer. Breast cancer patients without diabetes reported significantly higher EORTC QLQ-C30 scores in physical functioning, role functioning, cognitive functioning, emotional functioning, social functioning, global health, lower EORTC QLQ-C30 scores in fatigue, pain, dyspnoea, insomnia, appetite loss, constipation, diarrhoea, and higher FACT-G scores in physical well-being, social/family well-being, emotional well-being, functional well-being, compared with the patients with diabetes(P<0.05). Conclusions Diabetes mellitus affects the quality of life in patients with breast cancer. Integrated measures for chronic disease management should be taken to improve the quality of life in patients with breast cancer as well as diabetes mellitus. (Chin J Endocrinol Metab, 2015, 31: 43-46) Key words: Diabetes; Breast cancer; Quality of life

Lichenplanus is a chronic inflammatory disorder with remissions and relapses. The pathogenesis is likely to be autoimmune, with T Lymphocytes targeting the basal keratinocytes. The clinical presentation is violaceous papules and plaques in skin, mucous membranes and nails. The aim of this study is to analyse the clinical and pathological profile of Cutaneous Lichen planus of all patients diagnosed with Lichen planus attending our hospital from 2016 to 2019.All cases diagnosed as Lichen planus clinically and confirmed histopathologically are analysed for age, sex, location, duration, associated comorbid conditions, type of Lichen Planus, histopathological features and for malignant transformation.Of the 91 patients diagnosed, 83 (91%) were classical Lichen Planus, 6 (6.5%) hypertrophic Lichen Planus, 2 (2.5%) lichenplanopilaris. The median age was 38 years and the mean age 40 years. Majority were in the age group of 20 to 40 years. Male : Female ratio was 1.1 :1. 10 (10.98%) patients were in paediatric age group. 7 (8%) had skin and oral involvement. 40 patients had violaceous plaques &amp; papules, 46 pigmented and violaceous plaques and papules, 5 hypertrophic pigmented plaques. No nail or genital involvement was seen in any of our patients.The predominant type was classical Lichen planus. Few patients had Hypertension, diabetes Mellitus, diabetes mellitus and hypertension seemed to be age related. No malignant transformation was observed.

Lichen planus (LP) affects between 0.5 and 1% of the population. Linear LP accounts for &lt;0.2% of LP cases. Linear LP of the face is even rarer, with only a handful of cases. Linear facial LP follows Blaschko’s lines, usually along the mandible, has follicular localization and leaves long-standing pigmentation and atrophy. There is a paucity of data for the treatment of LP esthetic sequelae, more so for facial linear LP in darker skin types with atrophy. Most treatments are attempted to stabilize the spreading of the disease and limit its progression but do not successfully address esthetic pigmentation and atrophy. Our case is an Indian woman with isolated facial linear LP clinically who was successfully treated for esthetic sequelae with 1064 nm Q-switched neodymium: Yttrium-aluminiumgarnet laser and microneedling pen without relapse even after 1 year.

Introduction: Lichen planus (LP) is a chronic inflammatory pruritic dermatosis occurring infrequently in children. Very few studies are available on childhood LP from South India. Aim: This study aims to analyze the clinical profile of LP among children. Settings and Design: This was a retrospective study. Materials and Methods: Records of the children Results: Of the 76 children with childhood LP, examined over a period of 5.4 years, 42 were boys and 34 were girls with a male: female ratio of 1.2:1. Childhood LP accounted for 17.7% of total LP cases. The mean age of the children was 10.7 years, and the lesions appeared earlier in boys than girls. Limbs were the common site of onset, and classical LP was observed in 56.6% (43) of cases followed by, linear LP (11, 14.4%), hypertrophic LP (10, 13.2%), eruptive LP, and actinic LP in 5.3% each. Koebner's phenomenon was noted in 37.3% and a positive history of infective foci before the onset was noted in 14.4% of children. Palmoplantar, oral mucosal, and nail involvement were noted in 7.8%, 14.4%, and 15.7% of children, respectively. Multiple morphological types were noted in 14.4% of children. Conclusion: Hence, as per our study, LP in children is relatively common, and it can sometimes be triggered by infection. Apart from classical LP, linear LP, annular LP, and palmoplantar involvement were frequently observed in the present study.

Lichen planus (LP) is a chronic inflammatory disorder that most commonly affects middle-aged individuals. LP involves the skin and/or mucous membranes, including oral, vulvovaginal, esophageal, laryngeal, and conjunctival mucosa. Linear LP, a rare distinct variant of LP, is characterised by pruritic eruption of lichenoid and violaceous papules in a linear distribution. We report an unusual presentation of linear LP in a 14-year-old child that extended from the left anterior nares to upper lip and into the oral mucosa up to the upper gum margin.

Lichen planus (LP) is a condition with many clinical variants that can be quite varied in their presentation. We report a case of a 60-year-old woman who presented with a very unusual palmoplantar eruption characterized by violaceous pustule-like papules that was subsequently diagnosed as LP. The above case is reported, along with biopsy results. The patient was subsequently treated with a combination of topical corticosteroids and oral acitretin, and her clinical course was followed. The eruption responded dramatically to our combination treatment and resolved by the 2-month follow-up. Palmoplantar LP is a rare variant of LP that bears little resemblance to its classic LP. This condition responds well to a combination of potent topical corticosteroids and oral acitretin.

Chronic heart failure is one of the most common and prognostically adverse disease of cardiovascular system. Presence of chronic heart failure is associated with poor quality of life. Quality of life in patients with chronic heart failure is largely determined by the presence of comorbidity. An important role is given to anemic syndrome, which is considered to be a marker of increased risk of death, quality of life disorders in patients with chronic heart failure. Aim of the study - to evaluate the quality of life for patients with anemia varying grade of severity developed on the background of chronic heart failure, depending on the presence or absence of chronic kidney disease, using a questionnaire FACT-An. 140 patients with II-IV functional class of chronic heart failure due to ischemic heart disease were investigated. First group consists of 71 anemic patients with chronic heart failure and chronic kidney disease, second - 69 anemic patients with chronic heart failure without chronic kidney disease. Functional class of chronic heart failure installed according to the classification of the New York Heart Association (NYHA). Diagnosis of chronic kidney disease was determinate according to NKF K/DOQI, 2006. Patients were divided by grades according to WHO classification. Questionnaire FACT-An was used to assess the quality of life in anemic patients with chronic heart failure with or without chronic kidney disease. Results. Study of quality of life in both groups of patients showed a statistically significant reduction in the parameters of physical, emotional, functional, social well-being, scale of weakness, total scale of weakness and anemia with an increase in the severity of anemia. In comparing the parameters of quality of life in patients with the same degree of anemia severity depends on the presence or absence of renal dysfunction observed differences. Thus in anemic patients with chronic heart failure and chronic kidney disease observed a significant reduction in the parameters of physical, emotional, functional well-being, scale of weakness, total scale of weakness and anemia compared with patients with chronic heart failure without chronic kidney disease in the presence of the same degree of anemia severity. In anemic patients with chronic heart failure were found direct correlations between the level of red blood cells and functional well-being (r = 0,20), total scale of weakness and anemia (r = 0,23); hemoglobin level and scale of anemia (r = 0, 17), color index and social well-being (r = 0,27). In anemic patients with chronic heart failure and chronic kidney disease were found direct correlations between hemoglobin and physical well-being (r = 0,37), scale of weakness (r = 0,22), total scale of weakness and anemia (r = 0,23); color index and physical well-being (r = 0, 39), emotional well-being (r = 0,23), functional well-being (r = 0,34), scale of weakness (r = 0,35). Conclusions. Presence of anemic syndrome in patients with chronic heart failure associated with reduced quality of life parameters regardless of the presence or absence of concomitant chronic kidney disease. Low hemoglobin levels were associated with a reduction of the physical state parameters, the total scale of weakness and anemia in both groups of patients. Color level had a significant effect on the physical, functional, and emotional well-being in patients with chronic heart failure, chronic kidney disease and anemia, as well as the level of social and family relationships in patients with anemia, developed on a base of chronic heart failure without chronic kidney disease. Key words: chronic heart failure, chronic kidney disease, anemia, quality of life.

Lichen planus (LP) is an inflammatory skin disorder that can present in various forms across the body, including lesions on the skin (cutaneous LP [CLP]), scalp (lichen planopilaris [LPP]), and mucosal regions (mucosal LP [MLP]). Qualitative exploration of the patient experience of LP, notably symptoms and impacts on health-related quality of life (HRQoL), is limited. A scarcity of research was also identified relating to emotional wellbeing impacts of CLP patients. Two qualitative studies were conducted with LP patients to address these gaps. Study 1 consisted of exit interviews conducted with a subset of adult patients with MLP (n = 5), CLP (n = 4), and LPP (n = 4) enrolled in an LP clinical study in the United States (US) to explore the patient experience. Study 2 consisted of independent qualitative interviews conducted with adult CLP patients (n = 13) from the US and Germany to further explore impacts on emotional wellbeing. Exit interviews found that itch , pain, and skin lesions were most frequently reported as signs/symptoms of LP. Itch and skin lesions were experienced across all LP subtypes, while pain was only reported by CLP and MLP patients. These signs/symptoms impacted HRQoL including emotional wellbeing (frustration, embarrassment), daily activities (oral hygiene, clothing options), social functioning (intimacy, social activities), and physical functioning (chewing/swallowing, opening/moving mouth). Impacts on activities of daily living (ADL) and physical functioning were mostly experienced by MLP patients. Independent qualitative interviews, which further explored impacts of CLP on patients' emotional wellbeing, identified frustration, worry, sadness, embarrassment, and depression as the most frequently experienced. The findings contribute to the literature by providing qualitative insights into signs/symptoms and HRQoL impacts of LP, from the adult patient perspective. The findings also highlight the importance of considering assessment of HRQoL impacts in future clinical LP research, particularly impacts on emotional wellbeing when selecting instruments for assessment of HRQoL in the CLP population. NCT04300296.

Linear lichen planus (LLP) is a rare variant of lichen planus that is characterized by lichenoid, pruritic, violaceous papules, arranging in a linear pattern. When lichen planus is localized in a dermatomal pattern or Blaschcoid lines, incorrect nomenclature has been used and mistakes have been made in terminology. It should be known that there is not a dermatomal arrangement; however, Blaschko lines have been followed in the definition of linear lichen planus. We should avoid the zosteriform term when there is not a previous story of herpes zoster infection. Here we present a case of 40-year-old man that has lesions in two different Blaschko lines and investigate this complexity in terminology. J Clin Exp Invest 2013; 4 (4): 529-531

ObjectiveGiven their unique COVID-19 pandemic experience, it is necessary to evaluate the mental health of youth beyond the initial stages of the pandemic, in relation to the stringency of the social distancing measures. We aimed to describe long-term trends in emotional well-being and self-esteem among youth in Japan during the pandemic.MethodUsing serial cross-sectional data from April 2020 to December 2021, we evaluated the trends in emotional well-being and self-esteem of youth aged 6–17 years using the self-report KINDL questionnaire, weighted to represent the age and gender distributions in the Japanese population. We then tested the associations between emotional well-being and self-esteem and stringency of social distancing policies, measured using the Oxford COVID-19 Stringency Index. Analyses were also stratified by gender and age group.ResultsThe emotional well-being and self-esteem of youth improved transiently in 2020, followed by a slight worsening trend into 2021. While emotional well-being stayed lower compared to initial levels nearly 2 years into the pandemic, self-esteem began to improve by late 2021. 12–17 year-olds had lower emotional well-being and self-esteem compared to 6–11 year-olds throughout the study period. Females had lower emotional well-being than males in May 2020 and lower self-esteem than males in May and September/October 2020. More stringent social distancing measures were associated with lower emotional well-being and self-esteem, especially 6–11 year-olds’ self-esteem and females’ emotional well-being.ConclusionDuring the COVID-19 pandemic, older youth tended to have lower emotional well-being and self-esteem than younger youth. Younger and female youth were especially vulnerable to stringent social distancing measures.