Band-like Infiltrate Research Articles

Identifying diagnostic biomarkers for Erythemato-Squamous diseases using explainable machine learning

Erythemato-squamous diseases (ESD) are a heterogeneous group encompassing six clinically and histopathologically overlapping subtypes, representing a substantial diagnostic challenge within dermatology. The existing body of research reveals a notable void in detailed examinations that deconvolute the distinct features endemic to each ESD variant. To bridge this knowledge gap, our study applied Explainable Artificial Intelligence (XAI) techniques to systematically elucidate the intricate diagnostic biomarker profiles unique to each ESD category. Methodological rigor was fortified through the employment of stratified cross-validation, bolstering the robustness and generalizability of our diagnostic model. The CatBoost classifier emerged as a preeminent algorithm within our analytical framework, manifesting exemplary classification prowess with an accuracy of 99.07%, precision of 99.12%, recall of 98.89%, and an F1 score of 98.97%. Central to our inquiry was the deployment of Shapley Additive exPlanations (SHAP) values, which afforded granular insight into the contributory weight of individual diagnostic biomarkers for each ESD subtype. Our findings delineated pivotal diagnostic biomarkers including saw-tooth appearance of retes (STAR), melanin incontinence (MI), vacuolisation and damage of basal layer (VDBL), polygonal papules (PP), and band-like infiltrate (BLI) as instrumental in the identification of seborrheic dermatitis, while Psoriasis was characterized by fibrosis of the papillary dermis (FPD), thinning of the suprapapillary epidermis (TSE), elongation of the rete ridges (ERR), clubbing of the rete ridges (CRR), and notable psoriatic spongiosis. This integrative approach, leveraging the analytical acumen of Random Forest coupled with the interpretability afforded by SHAP, signifies a significant advancement in the nuanced diagnostic landscape of ESD.

Oral lichen planus – an oral potentially malignant disorder (OPMD) of the oral cavity

Introduction. Oral lichen planus is a chronic inflammatory disease of unknown etiology, characterized by recurrent lesions, presenting as reticular lesions, sometimes accompanied by atrophic, erosive, and/or ulcerative areas. Despite being one of the most common conditions affecting the oral mucosa, oral lichen planus remains an ailment with undefined etiology and unclear pathogenesis, imprecise management, and uncertain premalignant potential. Materials and methods. A narrative literature review study was conducted. A bibliographic search was carried out in databases such as PubMed, Hinari, SpringerLink, the National Center of Biotechnology Information, and Medline. Articles published from 1990 to 2023 were selected using various combinations of keywords: “oral lichen planus,” and “epidemiology,” “etiology,” “pathogenesis,” “symptoms,” “management,” “histopathology,” and “malignant transformation.” After processing the data from these databases, 475 full articles were found. The final bibliography comprised 50 relevant sources, considered representative of the materials published on the topic of this synthesis article. Results. Oral lichen planus is an inflammatory condition associated with T-cell-mediated immune dysfunction. Triggers include autoimmune responses to local antigens, microorganisms, and stress. The disease results from a complex interplay of host factors, lifestyle, and environmental factors leading to T-cell-mediated immune dysregulation. Diagnosis of oral lichen planus is based on clinical features (multiple, bilateral, symmetrically distributed lesions, occurring most commonly on the buccal mucosa, dorsal tongue surface, and gingiva), histopathological findings (predominantly lymphocytic bandlike infiltrate in the lamina propria, presence of apoptotic cells in the basal cell layer, absence of epithelial dysplasia), and immune-related changes (deposition of fibrinogen along the basement membrane zone, presence of granular fluorescent deposits containing IgA, IgG, and IgM in colloid bodies). Conclusions. Oral lichen planus is a chronic inflammatory condition mediated by T-cells in response to various extrinsic antigens, modified autoantigens, or superantigens, with periods of remission and relapse and the potential for malignant transformation. The etiology and pathogenesis of this condition are complex, diagnosis relies on clinical features, histopathological findings, and immunological data, patient treatment is symptomatic, and the potential for malignant transformation varies. Nevertheless, prospective studies with large sample sizes, adequate treatment duration, and long-term follow-up are needed.

Pembrolizumab-Induced Lichen Planus in a Patient with Metastatic Pulmonary Giant Cell Carcinoma: A Case Report and Literature Review

Ιmmune checkpoint inhibitors (ICIs) have revolutionized the management of advanced cancers. Nevertheless, the oncologic response is often achieved at the cost of immune-related adverse events (irAEs). We present a case of an immune-mediated lichen planus (LP) and a literature review of similar cases. A 60-year-old man, who is being treated with pembrolizumab for a pulmonary giant cell carcinoma since April 2022, presented in November 2022 with a pruritic eruption that appeared two weeks ago. Examination showed bright purple confluent scaly papules on wrists, proximity of limbs, back and buttocks and palmar keratoderma made of violaceus papules covered with reticular white striae. Histological examination revealed an epidermal hyperplasia, vacuolization of the basal layer, necrotic keratinocytes and a band-like subepidermal lymphocytic infiltrate with many eosinophils. The diagnosis of an immune-related LP was retained. Pembrolizumab was withheld because of the severity and the extension of the lesions. Superpotent topical steroids were prescribed with a significant improvement of the rash within 3 weeks. Immune-mediated lichenoid euptions represent one of the most frequent dermatologic irAEs. In our patient, the onset seven months after the initiation of ICIs, the infiltrate rich in eosinophils, and the rapidly diffused character are indications of an immuno-mediated LP.

Líquen plano cutâneo extenso de início recente na infância após infecção assintomática por COVID-19: relato de caso

ABSTRACT Objective: The objective of this study was to describe a case of cutaneous lichen planus (LP) that appeared following COVID-19 infection. Case description: We report a case of extensive cutaneous classic familial LP in a 4-year-old male child after an asymptomatic serologically confirmed COVID-19 infection. The patient developed intensely itchy, purple, flat-topped papules and plaques, mainly on the dorsal surface of the hands, feet, forearms, and shins. Histopathological examination of the skin biopsy showed vacuolar and apoptotic degeneration of the basal cell layer with a band-like lymphocyte infiltrate at the dermo-epidermal junction and confirmed the diagnosis of LP. Comments: LP could be considered among the differential diagnoses of pediatric post-COVID inflammatory skin lesions, either in the patients recovering from COVID-19 infection or in the suspicious asymptomatic cases in close contact with COVID-19-infected patients.

Extensive fatal Pyoderma gangrenosum in a dog after drug exposure.

A 4-year-old, spayed female mixed breed dog was presented with large crater-like, well-demarcated, erosive and ulcerative necrotic lesions of the skin, elevated body temperature and lethargy, that began 14 days after vaccination and treatment with fluralaner and milbemycin/praziquantel. Cytology revealed severe pyogranulomatous inflammation with moderate numbers of extracellular microorganisms. Histopathologic examination showed severe multifocal pyogranulomatous dermatitis and panniculitis with severe dermal edema and severe neutrophilic exocytosis with band-like infiltration of the lower portion of the epidermis consistent with pyoderma gangrenosum. Despite intensive immunosuppressive and antimicrobial therapy and intensive inpatient care, the dog was euthanized 16 days after admission due to complications with clinical signs of sepsis, acute dyspnea and thoracic effusion.

Hyperpigmented Mycosis Fungoides Masquerading as Longstanding Lichen Planus Pigmentosus: A Diagnostic Pitfall.

Mycosis fungoides (MF) is a rare primary cutaneous T-cell lymphoma, accounting for 50%-60% of all cutaneous T-cell lymphoma cases. It has a prevalence of approximately 5-6 cases per 1 million people annually and a higher incidence in dark-skinned populations. We report a case of hyperpigmented MF in a 72-year-old dark-skinned man with a 5-year history of progressive, widespread poikilodermatous patches and thin plaques on the back and bilateral legs. The patient had been treated for lichen planus pigmentosus for 5 years without significant response to therapy. Multiple biopsies revealed a band-like lymphoid infiltrate in the dermis, accompanied by intraepidermal lymphocytes, some of which had larger hyperchromatic nuclei. CD4 + T lymphocytes were predominant over CD8 + T-positive cells located along the epidermis, dermoepidermal junction, and in the dermis. A diagnosis of hyperpigmented MF was made based on the clinical, histopathological, and immunohistochemical findings. This case report highlights the importance of considering hyperpigmented MF as a differential diagnosis in patients with longstanding lichen planus pigmentosus, particularly when there is a lack of response to therapy.

CPC02 Delayed widespread lichenoid drug reaction with radioisotopic response in a patient treated with nivolumab

Abstract The introduction of immune checkpoint inhibitors for the treatment of a wide variety of malignancies has led to a rise in cutaneous immune-related adverse events (irAEs), including autoimmune and autoinflammatory skin conditions, which typically present within the first 16 weeks of treatment—on average, 3.6 weeks after drug initiation. Cutaneous irAEs occur in approximately 8.7% of patients receiving antiprogrammed cell death type 1 therapy (PD-1). Nivolumab is an antibody against PD-1 widely used for various cancers. As the application of these therapies expands, understanding of their adverse cutaneous effects is essential. We present a 76-year-old woman with metastatic renal cell carcinoma, who developed a widespread pruritic eruption 18 months after commencing nivolumab. Examination revealed a papular and vesicular rash affecting the arms, legs, anterior chest, face, hands and feet. There was a confluent well-demarcated rectangular area of grouped papules on the right side of her back; this site had been treated with radiotherapy for localized rib metastases 1 month prior to onset of rash. There was no mucosal involvement and no systemic symptoms. Three skin biopsies were taken, which showed vacuolar alteration of the basal layer and a band-like inflammatory cell infiltrate at the dermoepidermal junction, with focal areas of subepidermal separation. Direct immunofluorescence was negative, and skin swabs were negative for bacterial and viral infection. A diagnosis of delayed bullous lichenoid drug reaction secondary to nivolumab was made. The area involving the previous radiotherapy field was considered to be a radioisotopic response rather than a radiation recall response as she was already on nivolumab when it occurred. She discontinued nivolumab and commenced oral prednisolone and her skin settled over 5 weeks. Lichenoid dermatitis is a known adverse reaction associated with PD-1 therapy, with improved survival outcomes noted in patients with lichenoid irAEs on PD-1 therapy. Typically, it occurs within 16 weeks, with a documented range of 1–266 days. This patient developed a delayed lichenoid eruption at approximately 550 days, with concurrent radioisotopic response at a previous radiotherapy site. Radiotherapy-induced lichen planus is rare, with only one case report documenting involvement outside the irradiated field. We found no previous reports of nivolumab causing lichenoid drug eruption after such a protracted period. This case adds to the growing literature around PD-1 inhibitor-associated cutaneous eruptions.

P11 Acrodermatitis chronica atrophicans: a sign of late lyme disease

Abstract Borrelia infection manifests a variety of signs and symptoms, and its insidiousness and heterogeneity mean that its diagnosis can be delayed. We describe two patients from south-east Scotland who presented with unilateral asymptomatic atrophic areas of skin discoloration. The first was a 71-year-old woman, who presented with a 4-month history of a nonprogressive, mottled, erythematous rash involving her right thigh, buttock and calf. Case 2 was a 56-year-old woman with a 2-year history of an erythematous area of atrophic skin involving the medial aspect of her left thigh and shin. Histology from case 1 showed a normal epidermis with a largely ‘top-heavy’ superficial and deep, predominantly interstitial and focally perivascular, lymphohistiocytic infiltrate, with a predominance of mononuclear histiocytes and with focal extension to deep reticular dermis. Scattered plasma cells were identified, but eosinophils were not a prominent feature. Well-formed granulomas were absent, as were interface dermatitic activity and vasculitic changes. On close questioning, each patient remembered ‘insect’ bites in the vicinity of the cutaneous changes, although neither recalled rashes that could have been consistent with erythema chronicum migrans. In both cases, serology confirmed infection with Borrelia burgdorferi (sensu lato) and diagnoses of acrodermatitis chronica atrophicans (ACA) were made. Both patients responded well to oral treatment with doxycycline. ACA is a cutaneous sign of late-stage Lyme disease and is caused by ongoing active skin infection by tick-borne bacteria of the Lyme disease group of Borrelia species. The tick bite has usually occurred months or years before symptom onset. Typically, there is an early, unilateral inflammatory stage with bluish-red discoloration of the skin and an oedematous appearance. This is followed by an atrophic stage where the skin becomes thin and wrinkled (‘cigarette paper’-like), with the loss of epidermal and dermal structures. Histological features usually include marked atrophy of the epidermis and dermis, loss of adnexal structures and an absence of elastic tissue. A band-like lymphocytic infiltration with plasma cells and mast cells is seen in the dermis, especially in the early stage of disease. Laboratory-confirmed cases of Lyme borreliosis in the UK have risen steadily since reporting began in 1986. ACA is likely to be underdiagnosed and, if there is a clinical suspicion, a detailed history, careful skin examination, Borrelia serology and skin biopsy should be undertaken. Early recognition and treatment reduce the risk of irreversible skin changes and systemic symptoms.

Vesicular Lymphomatoid Papulosis With DUSP22-IRF4 Rearrangement on Chromosome 6p25.3: A Case Report.

Lymphomatoid papulosis (LyP) with DUSP22-IRF4 rearrangement on chromosome 6p25.3 is a newly identified subtype of LyP. It is characterized by an older age of onset, localized skin lesions, with good prognosis, and it resembles a hybrid of LyP types B and C in histopathology. A limited number of cases have been reported so far. In this article, we reported a case of a 72-year-old man with recurrent episodes of widespread multiple discrete papular or vesicular eruptions on a region of the head, trunk, and 4 extremities for about 3 years. Histopathological examination of a vesicle revealed a subepidermal blister with abundant atypical lymphocytes in the vesicular space, band-like infiltrates in the papillary dermis, along with epidermotropism and pilosebaceous structure involvement. Fluorescence in situ hybridization analysis further demonstrated DUSP22-IRF4 rearrangement on chromosome 6p25.3. A diagnosis of vesicular LyP with this rare subtype was made according to the clinical and pathological findings.

Coexistence of psoriasiform stratum corneum and underlying lichenoid features in skin biopsies of cutaneous reactions to anti-PD1.

Coexistence of psoriasiform stratum corneum and underlying lichenoid features in skin biopsies of cutaneous reactions to anti-PD1.

Histomorphological study of lichenoid dermatitides – A retrospective study

Background: Lichenoid dermatitis is a very common dermatological condition and is defined by features of basal cell damage and a dense band-like infiltration at the dermo-epidermal junction. There is a wide range of lesions included under this and the prototype lesion is Lichen Planus. Aims and Objectives: The aims of this study were to study the histopathological spectrum of the conditions with lichenoid tissue reaction and to find clinicopathological concordance of the lichenoid lesions. Materials and Methods: A retrospective study was conducted in a tertiary care center, where all the skin biopsy cases diagnosed clinically and/or histologically as lichenoid dermatitis for 2 years (2018–2019) were included in the study. Demographic details, clinical diagnosis, histological diagnosis, and the different histological features were collected from the respective case sheets and biopsy reports and entered in an excel worksheet. Frequency and percentages were used to represent the data. Results: A total of 47 cases were clinically diagnosed as lichenoid dermatitis, of which 38 cases showed concordance between clinical and histopathological diagnosis. Nine cases showed discordance between clinical and histopathological diagnosis and were categorized as lesions without lichenoid features. Seven cases were diagnosed as lichenoid dermatitis only on the histopathological study with an absence of such a differential diagnosis clinically. Out of the total 45 cases diagnosed as lichenoid dermatitis, 27 were lichen planus, five were lichen planus pigmentosus, four were hypertrophic lichen planus, three were lichenoid dermatitis, and two cases each of lichen planopilaris, lichen keratosis, and lichen sclerosis. Lichenoid dermatitis was seen commonly among the 41–50 years age group. Females were more commonly affected than males. Conclusion: Lichen planus is the prototype lesion among the lichenoid dermatitides. Definitive diagnosis of the specific entity among the lichenoid lesions is important as decision-making regarding the treatment modality and prognosis of the patient depends on it. Histopathological examination is vital for the definitive diagnosis, along with clinical correlation which concludes that clinicopathological correlation is the key.

Assessing the Agreement of Light Microscopic Evaluation of Oral Lichen Planus Lesions With Associated Direct Immunofluorescence Evaluation.

Assess agreement between light microscopy and direct immunofluorescence (DIF) for histopathologic evaluation of oral lichen planus (OLP). Records evaluated included 60 OLP, 16 lichenoid mucositis (LM), and 56 non-OLP/non-LM cases. Cases had both light microscopic and DIF evaluations. Histopathologic parameters of OLP included: (1) hydropic degeneration of the basal cell layer, (2) band-like lymphocytic infiltrate immediately subjacent to the epithelium, and (3) presence of Civatte bodies. Two calibrated examiners independently assessed light microscopic features. Examiners reviewed cases with discordant diagnoses to determine a consensus diagnosis. Intra-rater reliability (IRR), sensitivity, specificity, positive, and negative predictive values (PPV and NPV) were determined. Of 132 patients, 72.7% were female, average age 61.9 (SD = 13.8). Most common sites were gingiva (37.9%), buccal mucosa (37.1%), and tongue (7.6%). IRR was 0.74 (95% CI: 0.40, 1.00) for the consensus diagnosis and 0.73 (95% CI: 0.39, 1.00) and 0.34 (95% CI: -0.03, 0.72) for the 2 examiners. Comparing consensus and definitive diagnoses: sensitivity of light microscopy: 0.32 (95% CI: 0.20, 0.45); specificity: 0.88 (95% CI: 0.78, 0.94); PPV: 0.68 (95% CI: 0.48, 0.84), and NPV: 0.61 (95% CI: 0.51, 0.70). Light microscopy alone is not a viable alternative to adjunctive DIF for diagnosis of OLP lesions.

Immunohistochemical and Histopathological Features of Persistent Gingival Enlargement in Relation to Metal Allergic Sensitisation during Orthodontic Treatment.

This study aimed to analyse the immunohistochemical profile of inflammatory infiltrates in the gingival tissue of patients undergoing orthodontic treatment in relation to patients’ titanium and/or nickel allergy status. Patients with gingival enlargement received initial periodontal therapy, followed by external gingivectomy in the case of persistent gingival enlargement. The sample included 44 patients (22 had metal allergic sensitisation). Histopathological changes were assessed, and an immunohistochemical analysis was performed on formalin-fixed and paraffin-embedded gingival samples using antibodies against CD1a, CD3, CD4, CD8, CD20, CD68, and CD138. Computer-assisted image analysis was performed to evaluate the positive cell count in the gingival tissue. The gingiva of the sensitised patients was characterised by the absence of multifocal inflammatory infiltrates (p < 0.05), while pronounced exocytosis and band-like inflammatory infiltrates were more frequently observed in sensitised patients. In addition, there was an increase in Langerhans cells and T-helper lymphocytes and a decrease in naïve T-lymphocytes, cytotoxic T-lymphocytes, macrophages, and plasma cells in the sensitised subjects compared to non-sensitised. However, the differences were only statistically significant for macrophages, with a moderate effect size (82.8 vs. 133.9; p = 0.041; r = 0.308). The absence of multifocal inflammation appears to be the most characteristic histopathological feature of the gingiva of sensitised patients. Although their gingiva presented certain characteristics of late hypersensitivity immune reactions the observed changes imply dominant irritative effect e.

Clone and Contradistinction—Mycosis Fungoides

Mycosis fungoides is a peripheral T cell lymphoma engendered from mature, post-thymic T lymphocytes representing with cutaneous patches, plaques, tumours and erythroderma. Mycosis fungoides demonstrates a ‘bathing trunk’ distribution wherein gluteal region, trunk and proximal limbs appear incriminated. Mycosis fungoides enunciates enhanced expression of Th2 gene along with Th2 associated cytokine production and activation of nuclear factor kappa B (NFkB). Lesions depict a band-like infiltrate of atypical lymphoid cells within papillary dermis with focal fibroplasia and Pautrier’s micro-abscesses. Neoplastic cells display mature T cell phenotype and are immune reactive to CD45RO+, TCRβ+, CD2+, CD3+, CD4+, CD5+or CD7+. Photodynamic therapy, retinoids, targeted therapy, biologic therapy, radiation, chemotherapy or allogenic haematopoietic stem cell transplant may be adopted to treat mycosis fungoides.

Widespread and eruptive comedonal lesions with alopecia

A 68-year-old White man presented with a 2-year history of asymptomatic, widespread comedones associated with patchy alopecia of the scalp and eyebrows and total alopecia of axillary and pubic hairs (Fig 1, A to C). Histopathology of a comedonal area demonstrated a dilated, follicular infundibulum with keratotic plugging and a perifollicular band-like CD4-predominant atypical T-lymphocytic infiltrate leading to the detachment and infiltration of the follicles (Fig 1, D and E). Subsequently, erythematous, erosive plaques started to develop on the trunk and limbs of the patient (Fig 1, F), the histopathology of which showed a more extensive, diffused, epidermotropic infiltrate containing CD4-predominant T lymphocytes with sparse medium- to large-sized lymphocytes (Fig 1, G).

Diltiazem-associated, photo-distributed hyperpigmentation in a patient with Sjögren’s syndrome

Sir, Herein, we report a case of hyperpigmented macules on ultraviolet exposed areas during the intake of diltiazem hydrochloride (DTH) in a patient with Sjögren’s syndrome. A 63-year-old Japanese female with a history of Sjögren’s syndrome and vasospastic angina presented to our hospital with brown, irregular macules on the neck, face, and both hands, which she first noticed one year earlier. The patient had a history of taking DTH for vasospastic angina for the previous fifteen years. A physical examination revealed pale brown macules and plaques irregularly scattered around the corners of the mouth, lower lip, and neck (Figs. 1a and 1b). In addition, there were numerous erythematous papules on the dorsal side of both hands. The oral mucosal membrane, scalp, and nails were not involved. A biopsy specimen taken from the dorsal side of a hand revealed individual cell keratinization in the epidermis, intercellular edema, liquefaction degeneration of the basal layer, and band-like lymphocyte infiltrate with melanophages in the superficial dermis (Fig. 2a). Immunohistochemistry revealed the infiltration of CD3+, CD4+, CD8+, and HLA-DR+ lymphocytes in the superficial dermis (Figs. 2b and 2c). Routine laboratory examinations of the blood cell count, serum, and urine showed no abnormalities. Other tests showed positive antinuclear antibody (1:80, nucleolar) and anti-SS-A antibody (240 U/mL; normal: &lt; 9.9), whereas hepatitis C virus antibody, rheumatoid factor, anti-CCP antibody, and anti-SS-B antibody were negative. DTH was switched to another medicine, and ascorbic acid, calcium pantothenate, and topical steroids were initiated. In addition, we advised the patient to avoid sun exposure. Although no improvement was observed in the rash in the first four months, it disappeared at follow-up several years later (Figs. 3a and 3b).

S2422 A Lichen for the Esophagus: A Rare Case of Esophageal Lichen Planus

Introduction: Lichen planus is an inflammatory condition of the skin and mucosal membranes. Sites of disease are variable and esophageal involvement is uncommon. We highlight a case of esophageal lichen planus masquerading as eosinophilic esophagitis. Case Description/Methods: A 59-year-old female with a past medical history of hypothyroidism status post thyroidectomy presents with progressive dysphagia and odynophagia to solids for 3 years. Symptoms initially began after thyroidectomy. Evaluation by ENT was notable for inflammatory changes of the oropharynx for which PPI trial was given for clinical features of silent reflux. Despite a 2-month course of therapy, symptoms persisted. Videofluoroscopic swallow study was unremarkable without evidence of aspiration or penetration. Subsequent EGD was notable for exudates, linear furrowing, and rings to suggest the diagnosis of eosinophilic esophagitis. Esophageal biopsy pathology features, however, showed band-like lymphocytic infiltration of the lamina propria and civatte bodies within the squamous epithelium consistent with esophageal lichen planus. Unfortunately, the patient was lost to follow up and subsequent treatment was unable to be initiated. Discussion: Esophageal lichen planus is an exceedingly rare entity with less than 100 documented case reports. It is likely underdiagnosed given that it can mimic other esophageal entities, such as eosinophilic esophagitis as seen in our patient. As such, histologic examination is necessary to identify key features of esophageal lichen planus which include lymphocytic infiltrates of the lamina propria as well as civatte bodies, which represent necrotic keratinocytes. Esophageal lichen planus has a tendency to be chronic and require topical or systemic therapy with steroids. Stricture development will typically require dilatation. Clinicians should consider esophageal lichen planus as part of their differential for dysphagia especially given the potential for malignant transformation to squamous cell carcinoma, which has been reported in 1-2% of cases.

Mucosal lichen planus-adiagnostic and therapeutic challenge

Mucosal lichen planus (MLP) is achronic inflammatory disease of the mucosa. This condition can affect the mouth, esophagus, pharynx, genitalia, anus, and conjunctiva. This disease shows atendency to chronicity with phases of relapses for aduration of 3-10years. It presents with varying morphologies including lacy or fern-like, slightly raised striae, erosions, erythema, and atrophy. The pathophysiology is not yet fully understood and is dominated by the classic band-like lymphocytic infiltrate along the dermoepidermal junction. MLP is very challenging to treat, since the clinical course entails frequent relapses and shows resistance to therapy. The most commonly used local treatments are topical corticosteroids or calcineurin inhibitors. In addition to systemic glucocorticosteroids and traditional systemic drugs such as oral retinoids or methotrexate, emerging anti-inflammatory therapies such as Janus kinase inhibitors and biologics may be promising and are currently being evaluated in clinical trials.

The spectrum of fibrosing alopecias

AbstractLichen planopilaris (LPP) is a primary lymphocytic cicatricial alopecia considered the most common cause of scarring hair loss in adults. It has been classified into three clinical variants: classical LPP, frontal fibrosing alopecia (FFA) and Graham Little‐Piccardi‐Lassueur syndrome. Classical LPP usually presents as a circumscribed cicatricial patch on the vertex and FFA as a band‐like scarring alopecia of the frontotemporal hairline. Fibrosing alopecia in a pattern distribution (FAPD) and lichen planopilaris diffuse pattern (LPPDP) are two recently described subtypes of LPP that exhibit a diffuse involvement of the androgen‐dependent region or the whole scalp, respectively. Classical LPP, FFA, FAPD and LPPDP share trichoscopic (cicatricial areas, absence of follicular openings, perifollicular erythema and hyperkeratosis) and histologic features (interface dermatitis involving follicular epithelium and concentric fibrosing around the isthmus and infundibulum). The remarkable clinical and histological overlap between these entities has led to the concept that these diseases exist along a spectrum. In the effort to identify classical LPP, FFA, FAPD and LPPDP with an umbrella term, we suggest to use ‘lichenoid alopecias’, as the distinguishing hallmark of these diseases is the lichenoid bandlike inflammatory infiltrate in the superficial dermis involving the infundibulum and isthmus of the hair follicle.

Solitary pink papule in an elderly man

Solitary pink papule in an elderly man