Follicular Lichen Planus Research Articles

Successful treatment of recalcitrant follicular lichen planus (lichen planopilaris) with the topical JAK 1/2 inhibitor ruxolitinib

AbstractWe report the successful treatment of a patient with refractory follicular lichen planus (LP) with topical ruxolitinib, a Janus kinase (JAK) 1/2 inhibitor, which resulted in significant improvement of lesional skin within 1 month of daily use.

SEVERE FORM OF CICATRICIAL ALOPECIA AS A RESULT OF A COMBINED COURSE OF SCALP DERMATOSES: A CLINICAL CASE

The article describes a clinical case of a combined course of dermatoses with damage to the scalp, such as psoriasis and follicular lichen planus (LPP), proceeding like pityriasis amiantacea (PA), with the formation of a severe form of cicatricial alopecia. Clinical patterns of damage to the scalp in these diseases are presented, confirming the possibility of developing cicatricial forms of hair loss, the treatment method is described. This clinical case demonstrates the need to conduct a histological examination in patients with scarring hair loss in order to select the most effective treatment method. The variety of forms of cicatricial alopecia and their common clinical manifestations create difficulties in differential terms and require an integrated approach to their diagnosis. Proper control of inflammation can prevent the progression of cicatricial alopecia.

Trichoscopic Features of Scalp Discoid Lupus Erythematosus versus Lichen Planopilaris: A Systematic Review.

Lichen planopilaris (LPP) and discoid lupus erythematosus (DLE) are primary scarring alopecias that pose diagnostic challenges clinically, where trichoscopy features may provide benefit in delineating these two cicatricial alopecia, and also helps in assessing the evolution and therapeutic response. To date, there are few reviews on dermoscopic findings in differentiating these two alopecias. A systematic literature review was conducted using the PubMed and Google Scholar databases. The search terms included for scalp DLE were 'lupus' OR 'discoid lupus' OR "scalp lupus" and for scalp LPP were "lichen planopilaris" OR "scalp follicular lichen planus" OR "lichen planus follicularis" and were combined with "dermoscopy" OR "dermatoscopy" OR "videodermoscopy" OR "video dermatoscopy" OR "trichoscopy". The differences in the prevalence of dermoscopic features in scalp DLE and LPP were calculated using the Chi-square test. Of 52 articles, 36 (17 LPP, 19 DLE) were eligible for quantitative analysis. We found predominant peripilar tubular casts and perifollicular erythema with the presence of arborizing vessels in the vicinity of these changes, indicating early LPP. In contrast, follicular red dots, speckled brown pigmentation, and hair diameter variability indicated active DLE. Shiny white areas were common in both the groups in late stages. The target pattern of distribution of blue-grey dots, milky red areas, and irregular white fibrotic dots were seen in LPP, and pink-white background, follicular plugs, perifollicular and interfollicular scale, rosettes, chrysalides, and red spider on yellow dots were detected in DLE. Features such as yellow dots and blue-grey structureless areas were nonspecific and did not have a major role in differentiating DLE from LPP. This article provides a comprehensive review of the literature and delineates the trichoscopic differences and peculiarities of scalp DLE and LPP, including the correlation of dermoscopic features with histopathological findings.

English

BACKGROUND Cicatricial alopecia is the term used for permanent areas of hair loss due to destruction of hair follicles. It may occur due to a disease that primarily affects hair follicles or due to external causes that damages hair follicle secondarily. The common causes of primary cicatricial alopecia include discoid lupus erythematosus, lichen plano pilaris, pseudopelade of Brocq, folliculitis decalvans and folliculitis keloidalis. Exact diagnosis at an early stage will help to provide disease specific management at the earliest thus, preventing further progression of the disease. We conducted this study to assess the role of clinico-pathological correlation to find out the exact aetiology of primary scarring alopecia in our patients. METHODS We conducted a descriptive cross sectional study to find out aetiology of primary cicatricial alopecia based on clinical and histopathological findings of 50 patients who attended the outpatient department of Dermatology in our hospital. After a detailed history and clinical examination of scalp, biopsy of lesional scalp skin was taken in all patients. In relevant cases direct immunofluorescence study was also done. RESULTS Age of the patients ranged from 16-75 years. M: F ratio was 1:1.5. Hair loss, itching, scaling and scalp pain were the reported symptoms. Commonly affected sites were parietal and temporal areas. 76 % of patients had multiple lesions. Absent follicular ostia, follicular plugging, atrophy, pigmentary changes, scaling and telangiectasias were the commonly observed clinical scalp findings. 88 % of cases showed lymphocytic infiltrate on histopathology. After clinico-pathological correlation, 48% patients had discoid lupus erythematosus followed by follicular lichen planus in 28% and pseudopelade of Brocq in 20 % cases. Folliculitis decalvans and folliculitis keloidalis each were observed in 2 % cases of primary scarring alopecia. CONCLUSIONS Clinicopathological correlation is highly useful to make an early diagnosis in primary cicatricial alopecia. In our patients discoid lupus erythematosus was found to be the predominant cause. KEY WORDS Cicatricial Alopecia, Clinicopathological Correlation, Discoid Lupus Erythematosus, Lichen Planus

Clinico-histopathological correlation of follicular skin lesions

Introduction: Follicular skin lesions are common skin problems which are caused by inflammation and infection of the hair follicles. The objective of the study was to know the incidence of the follicular skin lesions among patients attending Dermatology department and correlate them clinically and histopathologically. Materials and Methods: This study was conducted January 2019 to June 2019. One hundred patients with follicular skin lesions were included in the study. Detailed history, clinical examination and skin biopsy for histopathology was done. In all cases clinical diagnosis was confirmed by histopathology. Results: Phrynoderma was found to be most common (42 cases) followed by Keratosis pilaris (24 cases), pityriasis rubra pilaris (8 cases), Kyrle’s (6 cases), Darier’s disease (5 cases), follicular lichen planus (4 cases), perforating folliculitis (4 cases), lichen spinulosus (2 cases), follicular psoriasis (1 case), lichen scrofulosorum (1 case). Three cases were found to be non -specific on histopathology. Phrynoderma was most common (42%) follicular skin lesion among children. Keratosis Pilaris was common in adult females whereas Darier’s disease and Kyrle’s disease in adult males. Atopy was most commonly associated with keratosis pilaris. Conclusions: The present study emphasizes the various follicular skin lesions in this geographical location. Both clinical examination and histopathology helps in differentiating different follicular skin lesions. Keywords: Follicular, Keratosis pilaris, Phrynoderma.

A Study of Clinical, Dermoscopic and Histopathological Correlation in Follicular Keratotic Diseases: Preliminary Observations in 30 Cases.

Context:Follicular keratotic disorder is an abnormal keratinization affecting the follicular orifices and clinically characterized by hyperkeratotic follicular papules affecting various sites. Dermoscopy is a non-invasive diagnostic tool and differentiates closely resembling diseases as well as possibly prevents need for an invasive biopsy.Aim:This study was aimed to find the correlation between clinical, dermoscopic and histopathological findings in follicular keratotic diseases and to establish the dermoscopic criteria in the diagnosis of primary follicular keratotic diseases.Materials and Methods:This was a hospital-based prospective cross-sectional study of 30 consecutive patients clinically diagnosed with follicular keratotic diseases, irrespective of age and duration of the disease.Results:The study consisted of 30 patients with a mean age of 19.57 ± 9.69 years. The most common primary follicular keratotic disease observed was phrynoderma and secondary follicular keratotic disease was follicular lichen planus (lichen planopilaris). The predominant dermoscopic finding among all the follicular keratotic diseases was perifollicular scaling 29 (96.7%) followed by keratotic plug 28 (93.3%). The most common histopathological feature was dilated follicular infundibulum 22 (73.3%) followed by follicular plug 15 (50%) and dermal perivascular infiltration 22 (73.3%). The clinical and dermoscopic features showed a significant statistical association with the histopathological findings.Conclusion:Dermoscopy is a simple, non-invasive diagnostic tool that helps in differentiating and diagnosing the closely resembling follicular keratotic diseases.

Graham-Little-Piccardi-Lassueur Syndrome: Two Case Reports and Review of the Literature

Abstract Graham-Little-Piccardi-Lassueur syndrome (GLPLS) is a rare syndrome characterized by the triad of cicatricial alopecia of the scalp, non-cicatricial alopecia of the axilla and groin and follicular lichen planus eruptions on the trunk and extremities. GLPLS is considered to be a variant of lichen planopilaris. We report two cases that have fulfilled all of the criteria for GLPLS. The first case was a 71-year-old woman, admitted to the Department of Dermatology for pruritic perifollicullar erythema and scaling of the scalp, cicatricial scalp alopecia and hair loss of the axilla and pubic region for five months. Subsequently, follicular hyperkeratotic eruptions and hyperpigmented macules on the skin of the chest and abdomen appeared. The second case was a 48-year-old man with pruritic follicular papules on the face, trunk and extremities for four months. All of the laboratory examinations in both patients were within normal limits. No alternation in the general condition of the patients was observed. Histological examinations in both patients confirmed the diagnosis GLPLS. The patients were treated with systemic and local corticosteroid resulting in marked improvement of the skin lesions; however, cicatricial scalp alopecia showed no response to the treatment.

Lichen planus follicularis tumidus

In this work, the authors described a case of a patient with lichen planus follicularis tumidus (LPFT), an extremely rare variant of lichen planus. The article provides an overview of literature on clinical features characterizing this rare condition. Differential diagnosis as well as treatment of this condition is considered.

Five year descriptive study of the histomorphological features of lichen planus

Background: Lichen planus is a chronic or sub-acute disorder characterized by small, flat-topped, shiny, erythematous or violaceous, pruritic polygonal papules most commonly involving the wrists and/or ankles in symmetric fashion. The spectrum of clinical diseases related to the lichenoid tissue reaction is getting wider with a recent increase in new subgroups of the lichenoid clinical picture. Lichen Planus contributes to the major bulk of cases of lichenoid tissue reactions. This study is designed to study the histopathology of clinical variants of lichen planus and its distribution in relation to age, sex and site of lesion. Objectives of the study: To study the histopathological features of lichen planus and its variants and clinicopathological correlation with respect to age and sex. Methods: This study was carried out over 5 years (retro and prospective) at Mahadevappa Rampure Medical College, Kalaburagi on clinically diagnosed cases of lichen planus. The tissue was fixed in 10% formalin and paraffin embedded sections were obtained for microscopic examination. Results: We studied 107 skin biopsy specimens. The variants of lichen planus received were classical lichen planus (55), hypertrophic lichen planus (27), follicular lichen planus (12), actinic lichen planus (6), isolated oral lichen planus (3), lichen planus pigmentosus (3), lichen planus pemphigoides (1). Maximum number of cases occurred in 2nd decade (29.9%). A slight female preponderance was noted (53.2%). Extremities were the most common site affected in 59 cases (55.1%). Conclusion: Lichen planus presents with varied morphology and microscopy, hence detailed clinical examination with data collection and proper histopathological examination is necessary for categorization and understanding of lichen planus and differentiation from various, diverse and perplexing lichenoid tissue reactions.

Recurrent retroauricular cystic nodules: lichen planus follicularis tumidus

Lichen planus follicularis tumidus (LPFT) is a rare subtype of lichen planus (LP) that has been most commonly described in middle-aged women. LPFT clinically manifests as recurrent cystic follicular nodules that preferentially involve the retroauricular area; concurrent classic LP lesions on the extremities and mucosal surfaces may also be present. Histologically, LPFT demonstrates epithelial-lined follicular cysts filled with orthokeratotic keratin surrounded by a dense lichenoid infiltrate. We present a case of a 67-year-old man with clinical and histopathologic findings consistent with LPFT and discuss differential diagnostic considerations for entities resembling LPFT. Lastly, treatment options for LPFT are reviewed.

Rare evidence of follicular lichen planus that arise in the process of its evolution

Case study of the patient with a follicular lichen planus long-flowing form was presented. In the process of its evolution there formed a focal atrophy of the smooth skin. This atypical form clinical features data is provided.

Graham Little-Lassueur Syndrome with Hypertrophic Lichen Planus in a Patient with Chronic Hepatitis C

Abstract Graham Little-Lassueur Syndrome (GLLS) is considered a form of lichen planopilaris which associates follicular lichen planus, cicatricial alopecia of the scalp and noncicatricial alopecia of the axillary and/or pubic regions. We present the case of a 47 years old female patient, known for 5 years with chronic hepatitis C and a poor therapeutic control of the disease due to Interferon intolerance. She presented to our clinic for the occurrence on the shins of some well-defined, intensely pruritic erythematous plaques, covered with thick scales, with a verrucous appearance, accompanied by excoriations. The skin biopsy reveal hypertrophic lichen planus on the shins and lichen planopilaris on the scalp. The patient was treated with systemic antihystamines, topical corticosteroids and salicylic acid under occlusion, emollients, phototherapy UVB narrow band 4 sessions/week for 3 weeks, cryotherapy. From our knowledge this is the first case of GLLS associated with chronic viral hepatis C.

Facial follicular cysts: a case of lichen planus follicularis tumidus?

Lichen planus follicularis tumidus (LPFT) represents an uncommon variety of lichen planus (LP). Clinically, it presents with prominent purplish lesions or white-pigmented yellowish cysts and comedones. Histopathologically, it is similar to lichen planopilaris, and it is additionally characterized by follicles and cysts surrounded by a lichenoid lymphocytic infiltrate. The most common location is the retroauricular region, and it may be associated with other variants of LP. Herein, we describe the case of a 50-year-old woman with a history of lower limb hypertrophic LP who subsequently presented with multiple pink, tumid, pruritic plaques with white-yellow cysts and comedones extensively affecting the bilateral face. Histopathologic examination revealed a lichenoid infiltrate surrounding the follicles and cysts. We diagnosed LPFT and began treatment with topical corticosteroids, antihistamines, systemic corticosteroids and oral acitretin without improvement. Subsequently, the patient had an acceptable response to cyclosporine at doses of 5 mg/kg/day with remission of itching and tumidity but with residual cysts and comedones remaining. To date, the literature contains only 16 cases of LPFT. To our knowledge, this is the most severe case and is the only one with cessation of disease activity in response to cyclosporine.

Coexistence of flexural and follicular lichen planus

The Journal of DermatologyVolume 39, Issue 2 p. 188-189 LETTER TO THE EDITOR Coexistence of flexural and follicular lichen planus Han MA, Han MA Department of Dermatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, ChinaSearch for more papers by this authorLei GUAN, Lei GUAN Department of Dermatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, ChinaSearch for more papers by this authorXiang-yang SU, Xiang-yang SU Department of Dermatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, ChinaSearch for more papers by this authorWei LAI, Wei LAI Department of Dermatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, ChinaSearch for more papers by this authorChun LU, Chun LU Department of Dermatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, ChinaSearch for more papers by this author Han MA, Han MA Department of Dermatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, ChinaSearch for more papers by this authorLei GUAN, Lei GUAN Department of Dermatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, ChinaSearch for more papers by this authorXiang-yang SU, Xiang-yang SU Department of Dermatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, ChinaSearch for more papers by this authorWei LAI, Wei LAI Department of Dermatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, ChinaSearch for more papers by this authorChun LU, Chun LU Department of Dermatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, ChinaSearch for more papers by this author First published: 04 October 2011 https://doi.org/10.1111/j.1346-8138.2011.01300.x Professor Chun Lu, M.D., Department of Dermatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, China. Email: luliyuan@tom.com Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume39, Issue2February 2012Pages 188-189 RelatedInformation

Frontal fibrosing alopecia presenting with components of Piccardi-Lassueur-Graham-Little syndrome

Frontal fibrosing alopecia (FFA), a cicatricial alopecia of the frontoparietal hairline affecting mainly postmenopausal women, is commonly associated with nonscarring alopecia of the eyebrows. This association has led some authors to relate it to Piccardi-Lassueur-Graham-Little syndrome (PLGLS), which is characterized by the triad of multifocal scalp cicatricial alopecia, nonscarring alopecia of the axillae and/or groin, and keratotic follicular papules. This is in spite of the absence of the follicular keratotic papules typical of PLGLS, and the different patterns of the cicatricial alopecias. We report a 37-year-old premenopausal woman with FFA associated with nonscarring alopecia of the eyebrows and axillae and follicular lichen planus-like lesions of the face. This case illustrates that FFA and PLGLS may share characteristics that, in addition to the overlap between FFA and PLGLS reported in the literature, would suggest they may be phenotypically related.

A clinical and epidemiological study of lichen planus among Egyptians of AL-Minya province

Lichen planus (LP) is a papulosquamous disease that affects skin and mucous membranes. It may also affect hair and nails. From the middle east, studies concerning its prevalence and clinical characteristics are few. This study presents the clinical and epidemiological pattern of LP among the Egyptian people. We analyzed the clinical and epidemiological data obtained from 50 LP patients who attended the dermatology outpatient clinic of al-Minya University Hospital, al-Minya, Egypt over a 1-year period. Lichen planus was present in 0.28 percent of the patients (females 44%, males 56%). The age range was 10-65 years; the majority fall in the 21-50 age group. Presentations include actinic LP (36%), classic LP (30%), hypertrophic LP (12%), guttate LP (6%), atrophic LP (4%), follicular LP (4%), and isolated oral LP (8%). Pruritus was the chief complaint of 50 percent of these patients. In 56 percent of patients, limbs were the initial site of onset.

Liquen plano folicular tumidus retroauricular: a propósito de un caso

Abstract—Retroauricular lichen planus follicularis tumidus (RLPFT) is an infrequent variety of lichen planus characterized by violaceous plaques with whitish-yellow cysts that mimic milia. The most frequent location is in the retroauricular region, but there may be associated lesions typical of lichen planus in other areas. We describe a case of RLPFT in a 53-year-old female patient diagnosed with diabetes mellitus and depression.

Scarring alopecias

The irreversibility and the possible important cosmetic consequences of scarring alopecia demand special diagnostic attention in order to promptly attain a precise diagnosis and specific treatment. Scarring alopecias are either due to permanent damage to essential parts of the hair follicle or destruction of the entire hair follicle. They are classified into the categories of primary scarring alopecias, where the hair follicle is the primary target of destruction, and secondary scarring alopecias, where the follicular damage results incidentally from events around impinging on the follicular unit. The differential diagnosis of the more common primary scarring alopecias, e.g. follicular lichen planus, chronic cutaneous lupus erythematosus and folliculitis decalvans, can be difficult when based only on anamnestic and clinical findings. The scalp biopsy is essential for appropriate nosologic classification and has prognostic relevance. The primary therapeutic goal is to halt progression of the irreversible process as early as possible by means of immunomodulatory, immunosuppressive or antiinfectious agents, respectively.

Tufted folliculitis of the scalp: a distinctive clinicohistological variant of folliculitis decalvans.

Tufted folliculitis is an uncommon folliculitis of the scalp that resolves with patches of scarring alopecia within which multiple hair tufts emerge from dilated follicular orifices. The clinicohistological data from a group of 15 patients with tufted folliculitis were reviewed and compared with those of seven patients with folliculitis decalvans, five with acne keloidalis nuchae, four with dissecting cellulitis of the scalp, three with kerion celsi and 20 with follicular lichen planus. It was found that tufted folliculitis could be differentiated from folliculitis decalvans only by finding several hair tufts scattered within patches of scarring alopecia. Histologically, a single tuft consisted of peculiar clustering of adjacent follicular units opening at the bottom of an epidermal depression. Conversely, the presence of keloidal plaques in acne keloidalis nuchae, coalescing nodules discharging purulent material in dissecting cellulitis of the scalp, erythematous plaques covered by pustules replete with fungal elements in kerion celsi, and the absence of follicular pustules in follicular lichen planus distinguished these diseases from tufted folliculitis. On the basis of these findings, it is suggested that tufted folliculitis should be considered as a distinctive clinicohistological variant of folliculitis decalvans. Tufting of hair is caused by clustering of adjacent follicular units due to a fibrosing process and to retention of telogen hairs within the involved follicular units.

Lichen planus among Arabs--a study from Libya.

ABSTRACTAn analytical study of 134 patients with lichen planus is presented. The sex ratio was 1.6:1 (M:F) and most patients having the disease were in the age group from 31 to 50 years. Lichen planus vulgaris (common type) was seen in 97 (72.39%) patients, lichen planus hypertrophicus in 15 (11.19%), lichen planus actinicus in 8 (5.97%), lichen planus follicularis and lichen planus atrophicus each in 3 (2.24%) and lichen planus pemphigoides in 1 patient. Mucous membrane involvement was seen in 19 (14.18%) patients and nail changes in only 3 (2.23%).