Case Of Lichen Planus Pemphigoides Research Articles

A rare case of lichen planus pemphigoides induced by metformin

Abstract: Metformin is an oral antidiabetic drug of the class biguanides. It can rarely cause dermatological adverse drug reactions (ADRs), of which, lichen planus pemphigoides is an extremely rare ADR. This case report emphasizes the chance of potential immune reaction with metformin and the importance of early diagnosis and treatment of the ADR.

Lichen planus pemphigoides erupting after COVID‐19 vaccination and infection, successfully treated with methotrexate

AbstractWe report a case of lichen planus pemphigoides (LPP) in a 36‐year‐old woman who presented bullous skin eruptions following both COVID‐19 infection and vaccination. The patient had a history of biopsy‐confirmed lichen planus since 2013 and had been previously investigated for suspected dermatitis herpetiformis since 2014, with inconclusive biopsy results. On two separate occasions, following her COVID‐19 vaccination and infection, she suffered the eruption of similar bullous lesions. A final diagnosis of LPP was established, believed to have been triggered by both the vaccination and the COVID‐19 infection. Treatment with prednisolone offered temporary relief, but sustained remission was achieved with methotrexate. This is, to our knowledge, the first documented case of LPP post‐COVID‐19 vaccination or infection.

Lichen planus pemphigoides: A unique form of bullous and lichenoid eruptions secondary to nivolumab.

The widespread use of PD‐1 inhibitors to treat various solid tumors has brought certain challenges for the clinician, including immune‐related adverse events (irAEs). Cutaneous toxicities are among the most observed irAEs. Bullous and lichenoid dermatoses following PD‐1 inhibitor therapy have been described. Here we report a novel case of lichen planus pemphigoides, featuring characteristics of both bullous pemphigoid and lichen planus, in a patient treated with nivolumab for renal cell carcinoma. We subsequently review all three cutaneous conditions which may arise in the context of PD‐1 inhibitor therapy.

Lichen Planus Pemphigoides: From Lichenoid Inflammation to Autoantibody-Mediated Blistering.

Lichen planus pemphigoides (LPP) is a very rare autoimmune sub-epidermal blistering disease associated with lichenoid skin changes. Initially thought to be a mere variant of more common inflammatory dermatoses, particularly Bullous Pemphigoid (BP) or Lichen Planus (LP), a growing body of evidence suggests that it is a disease entity in its own right. In common with a range of autoimmune blistering diseases, including BP, pemphigoid gestationis (PG), mucous membrane pemphigoid (MMP) and linear IgA dermatosis (LAD), a key feature of the disease is the development of autoantibodies against type XVII collagen (COL17). However, accurately establishing the diagnosis is dependent on a careful correlation between the clinical, histological and immunological features of the disease. Therefore, we present an up to date summary of the epidemiology and etiopathogenesis of LPP, before illustrating the predisposing and precipitating factors implicated in the development of the disease. In addition to a selective literature search, we compare reports of potential drug-induced cases of LPP with pharmacovigilance data available via OpenVigil. We subsequently outline the cardinal clinical features, important differential diagnoses and current treatment options. We conclude by demonstrating that an improved understanding of LPP may not only lead to the development of novel treatment strategies for the disease itself, but may also shed new light on the pathophysiology of more common and treatment-refractory autoimmune blistering diseases.

Lichen planus pemphigoides: four new cases and a review of the literature

Lichen planus pemphigoides (LPP) is a rare autoimmune blistering disease. It appears to be combination of lichen planus and bullous pemphigoid. We describe four new cases of LPP and discuss the epidemiological, clinical, pathological, and therapeutic features of this singular association through a review of the 74 published cases within the English literature. We report four cases of LPP (three women aged respectively 47, 51, and 53 years old, and a 53-year-old man). All patients presented with bullae on lichenoid and normal skin, predominately on the extremities. The diagnosis was confirmed by immunohistological findings. Our patients were treated with oral corticosteroids with a good response. Our review of the literature of 78 cases of LPP (65 adults and 13 children) showed that it involved adults (mean age: 54 years), with a slight female preponderance. A mean lag time between LP and the development of LPP was 8.3 months. LPP is characterized by developing blisters on lichenoid lesions and on uninvolved skin with more acral distribution of bullous lesions. Involvement of palms and soles was more frequent in children. The diagnosis is based on pathological and immunological confrontation. LPP is usually idiopathic, but some cases were reported in association with various drugs. There have also been reports of association with internal malignancy. Most cases of LPP are successfully treated with systemic corticosteroids. In most cases, the prognosis was good.

Lichen Planus Pemphigoides: A Case Report

Lichen planus pemphigoides describe a rare subset of patients who usually have typical lichen planus then develop blistering on their lichen planus lesions and in normal skin. Less commonly the blistering antedates the lichen planus. They clinically appear to be a combination of lichen planus and bullous pemphigoid. Oral disease may occur and resemble either lichen planus or bullous pemphigoid. Lichen planus pemphigoides has been triggered by medication & PUVA. Pruritus may be severe and lesions may evolve to resemble pemphigoid nodularis. Histopathologically lichen planus lesions show lichen planus and bullous lesion shows the features of bullous pemphigoid. DIF is positive in a linear pattern with IgG and C3 along the basement membrane zone, at the roof of saline split skin. The antigen targeted by the autoantibody in Lichen planus pemphigoides is located in the same region as the bullous pemphigoid antigen (at the basal hemidesmosomes). Lichen planus pemphigoides tends to follow a benign and chronic course, even when compared to bullous pemphigoid. We diagnosed a case of Lichen planus pemphigoides on the basis of history, clinical examination, histopathology & DIF. The patient was treated with systemic & topical steroid, Dapsone. After 2 month of treatment steroid was withdrawn, but Dapsone continue with no relapse.To our knowledge this is the first diagnosed and treated case in this hospital. DOI: http://dx.doi.org/10.3329/jssmc.v4i1.12002 J Shaheed Suhrawardy Med Coll, 2012;4(1):35-37

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.

Childhood Lichen Planus Pemphigoides: A Case Report and Review of the Literature

Lichen planus pemphigoides is a rare autoimmune blistering disease that is characterized by evolution of vesico-bullous skin lesions in patients with active lichen planus. We describe a case of lichen planus pemphigoides in a 6-year-old boy and review the clinical and immunopathologic features of all reported cases of pediatric lichen planus pemphigoides. The mean age at onset of childhood lichen planus pemphigoides is 12 years with a male to female ratio of 3:1 and a mean lag-time between lichen planus and the development of lichen planus pemphigoides of 7.9 weeks. Vesiculo-bullous lesions were found on the extremities in all patients and there was palmoplantar involvement in about half of the cases. Direct and indirect immunofluorescence features were similar to those reported in adults. One patient had Western immunoblot data revealing antigens of 180, 230, and 200 kDa. Immunoelectron microscopy in two cases showed localization of immune deposition different from that in bullous pemphigoid. We found that topical corticosteroids or oral dapsone caused resolution of lichen planus pemphigoides without known relapse of blistering in four cases, suggesting that it might be possible to reserve oral corticosteroids as a second line of therapy in children with lichen planus pemphigoides.

Lichenoid eruption with single plantar blisters: a very rare case of lichen planus pemphigoides

Lichenoid eruption with single plantar blisters: a very rare case of lichen planus pemphigoides

Captopril‐induced lichen planus pemphigoides

To report a rare case of lichen planus pemphigoides (LPP) possibly induced by captopril. A 74-year-old woman developed pruriginous and bullous lichenoid eruption after starting captopril for hypertension. Histopathological and immunological features were consistent with the diagnosis of LPP that was managed by discontinuing captopril and corticosteroid therapy. Eight months after the cessation of oral steroid therapy, no relapse had occurred. LPP, a rare skin disorder, has been generally considered to represent a mixture of clinical, histopathological and immunological patterns of lichen planus and bullous pemphigoid. It is predominantly idiopathic. However, in rare cases it has been associated with the administration of drugs. Here we present a typical LPP related to the use of captopril. Clinicians should be aware of the ability of captopril to induce LPP.

Clinical and immunopathologic findings in oral lichen planus pemphigoides

Lichen planus pemphigoides (LPP) is a rare, acquired, immunobullous disorder of skin that occasionally involves oral mucous membranes. Clinical, histologic, and immunopathologic findings of the oral manifestations of LPP are described. Clinical features are lichenoid striae, erosions, and ulcerations involving gingiva and buccal mucosae. Histopathologic features are similar to those of ora lichen planus. Direct immunofluorescence demonstrates linear deposits of immunoglobulin G and complement component C3 along the basement membrane with fibrillar deposits of fibrin at the epithelial/lamina propria junction. Fluorescence overlay antigen mapping and laser scanning confocal microscopy of the biopsy specimen exhibits colocalization of in situ antibodies with beta4 integrin, a marker of the keratinocyte basal plasma membrane and upper lamina lucida, consistent with the location of the bullous pemphigoid antigens. This case report describes a case of LPP that presented exclusively as an oral condition. Lichen planus pemphigoides should be considered in the clinical differential diagnosis of vesiculoerosive oral mucosal diseases.

Ramipril-associated lichen planus pemphigoides

We report the first case of lichen planus pemphigoides (LPP) secondary to ingestion of ramipril, an angiotensin-converting enzyme inhibitor. Clinical, histological and immunofluorescent findings were all consistent with a diagnosis of LPP. Linear basement membrane zone (BMZ) staining with IgG and C3 was only seen at the roof of split-skin preparations and circulating autoantibody to the BMZ was present at a titre of 1/100. Controlled immunoblotting of epidermal extracts detected the bullous pemphigoid antigens of 230 and 180 kDa.

Lichen planus pemphigoides

Lichen planus pemphigoides is a rare condition characterized by blisters arising on normal or erythematous skin in a patient with concurrent lichen planus. It must be distinguished from bullous lichen planus, in which, as a consequence of severe basal cell hydropic degeneration, blisters arise within lichenoid papules or plaques. We present a clinicopathological study of nine cases of lichen planus pemphigoides, and report histological, immunofluorescent, ultrastructural and immuno-electronmicroscopical observations. We distinguish lichen planus pemphigoides from bullous lichen planus and consider the differential diagnosis. We propose that lichen planus pemphigoides does not represent a homogeneous condition: it may represent a number of bullous dermatoses that develop as a consequence of exposure of different basement membrane antigens following severe damage to the epidermal basement membrane as part of the lichenoid inflammatory process.

Deposition of C3, C9 neoantigen and vitronectin (S-protein of complement) in lichen planus pemphigoides

We have compared the distribution of C3, C9 neoantigen (C9n) and vitronectin at the dermoepidermal junction in lichen planus pemphigoides with that in bullous pemphigoid. Eight out of 30 biopsies from patients with lichenoid lesions had linear C3 deposition at the basement membrane zone (BMZ); four of these patients had bullae and fulfilled the criteria for lichen planus pemphigoides. C9n immunoreactivity was detected as a linear or an intermittent linear/granular band at the BMZ only in these four patients, suggesting a role for the membrane attack complex of complement (MAC) in the pathogenesis of blister formation in lichen planus pemphigoides. Faint linear deposition of vitronectin, in addition to C9n, at the BMZ was seen in two of the four cases of lichen planus pemphigoides and three of six cases of bullous pemphigoid. This suggests that vitronectin may be deposited in association with C9n not only as part of the non-lytic SC5b-9 complex, but also as a regulatory step following the lytic action of MAC. A regulatory function for vitronectin in limiting tissue damage following activation of MAC is supported by our finding of a heavy deposition of vitronectin in association with C9n in a lichen planus pemphigoides patient in whom bulla formation had ceased.