Idiopathic Lichen Planus Research Articles

Correlation of Serum Urate Levels and Lichen Planus in Male and Female Patients

Aim: To correlate serum urate level in male and female patients with lichen planus (LP) presenting at Dermatology department, Liaquat University Hospital Jamshoro.
 Methodology: This Cross-sectional study was conducted from 2019 to 2020.Total 126 patients, divided into two equal groups male(n=63) and female (n=63), between the age of 20-50 years and duration of disease from one month after eruption of lesion to 18 months were incorporated in this study. The patients having gout, obesity, chronic kidney disease, Pregnant ladies, smoker and those taking serum urate lowering drugs or steroids were excluded from this study. After taking history with clinical examination, patients were subject to height, weight, BMI, and duration of disease in months was stated.
 Results: Total 126 patients with age range between 20-50 years and the mean age was 32.5 ± 4.47 years in male and 35.3±6.74 years in females were analyzed. The mean BMI was 23.6 ± 2.68 kg/m2 in male and 22.5 ± 3.47 in kg/m2 females were recorded. The mean duration of disease was 35.4 ± 16.92 and 37.12 ± 18.92 weeks were recorded in male and female respectively. The mean serum urate level in Idiopathic Lichen Planus patients was 3.82 ± 0.79 mg/dL in male and 2.3+0.43 mg/dL in female were observed.
 Conclusion: Our study results indicate that there is a positive correlation between LP and serum serum urate levels in male and female patients.

Lichenoid eruption in a child receiving growth hormone for dwarfism.

A wide variety of medications have been associated with lichenoid drug eruption. They present similarly or even identically to idiopathic lichen planus, both clinically and histologically. Lichenoid eruption has been associated with recombinant human growth hormone intake in two previous patients. Herein, we describe a young boy who developed a lichenoid eruption following growth hormone injection for dwarfism.

A Descriptive Study of Clinico-histopathological Features of Lichen Planus

Background: Lichen planus is an idiopathic subacute or chronic inflammatory disease of the skin, mucous membranes and nails. We studied the clinicopathological profile of lichen planus in patients came to SMIMER hospital at Surat. Methods: A total of 50 cases of clinically diagnosed lichen planus samples were included. Clinical features like age, sex, type of lichen planus, location were recorded in the case record form. Histological features of lichen planus were studied. Results: Of the total 50 cases studied, Idiopathic Lichen Planus (76%) constituted the commonest type. The other types were Hypertrophic Lichen Planus (12%), followed by Lichen Planus Pigmentosus (8%), Lichen Planopilaris (2%) and Lichen Planus Pemphigoides (2%).21-30 years is the commonest age group affected, Female preponderance in incidence was seen (1.38:1). Lower limb was the commonest site of involvement. Conclusion: In cases with Lichen Planus, majority of the patients presented with violaceous to erythematous plaque, papule, and hyperpigmented plaque over the extremities. The histopathological examination showed hyperkeratosis, irregular acanthosis, saw toothed rete ridges and hypergranulosis, basal cell vacuolization, max joseph space and civatte bodies. Dermoepidermal junction showed band like infiltrate. Dermis showed melanin incontinence, perifollicular and perivascular inflammation. In the present study of 50 cases, 90% (45 cases) showed positive clinicopathological correlation, which emphasizes that histopathological examination, should be done in conjunction with clinical data to arrive at specific and final diagnosis of Lichen Planus lesions. This will help to reduce morbidity in patients with administration of timely and appropriate treatment, based on the histopathological diagnosis.

Oral-Genital Lichenoid Reaction: A Rare Hypersensitives to Drug, A Review

Background: Lichenoid reaction as the result of hypersensitivity from drug might be had similir clinical appearance to idiopathic lichen planus. Lichenoid drug reaction is termed as a condition of the oral cavity having an identifiable etiology, which is clinically and histologically similar to oral lichen planus and also manifest on genital. A number of drugs have been described as a causative factor of those reactive lesions. Objectives : The aim of this study is to finding mechanism of oral-genital lichenoid reaction caused by drugs. Problem Statement: Potential Pathway of Oral-genital lichenoid reaction caused by drugs. Discussion: Oral lichenoid lesions could be impact from medication and contact antigenic reaction. Clinical condition these two look similar to oral lichen planus, also its pathology. Studies of LDR caused by angiotensin-converting enzyme (ACE) inhibitors, antimalaria, antituberculosis, antitumor and non-steroidal anti-inflammatory drugs (NSAIDs) have been found. Conclusion: OLR is a disease condition with definite identifiable aetiology. Cell-mediated immune dysregulation has been associated with pathogenesis, explaining oral and genital manifestation.

Immune checkpoint inhibitor induced lichenoid reactions: A systematic review of characteristics and treatment outcomes

To the Editor: The use of immune checkpoint inhibitors (ICIs) as a method of cancer management has increased due to the efficacy; with the increased use of ICIs, there have been increased reports of immune-related adverse events. Lichenoid reactions (LRs) have been reported as specific cutaneous immune-related adverse events of ICIs.1 LRs are uncommon skin rashes that share many features with idiopathic lichen planus.2 This systematic review aimed to summarize reports of ICI-induced LRs, offending drugs, and treatment outcomes.

Clonazepam-induced lichenoid drug eruption: a case report

BackgroundLichenoid drug eruption is rare and can mimic idiopathic lichen planus and other dermatoses. Clonazepam, a commonly used drug for the treatment of anxiety-related disorders and seizures, is known to be an unlikely cause of cutaneous adverse effects. Only one case report of LDE due to clonazepam has been reported.Case presentationA 81-year-old male patient with Alzheimer’s disease developed a lichenoid eruption after taking clonazepam. He developed a violaceous scaly patch on his lower extremities, from both buttocks to the feet. The cutaneous eruption resolved 2 months after cessation of clonazepam and with initiation of corticosteroid therapy.ConclusionA skin eruption that develops after clonazepam administration can be a lichenoid drug eruption, which is less likely to resolve spontaneously and requires discontinuation of clonazepam administration.

Allopurinol-Induced Oral Lichenoid Drug Reaction with Complete Regression after Drug Withdrawal

Background: Lichen planus is a chronic mucocutaneous inflammatory disease. Oral manifestations are common, and may remain exclusive to the oral mucosa without involvement of the skin or other mucosae. A differential diagnosis includes oral lichenoid drug reactions. Allopurinol, which is the first line hypo-uricemic treatment, is often quoted as being a possible offending drug, though oral reactions have rarely been reported. Case presentation: We describe a 59-year-old male gout patient, successfully treated with allopurinol, who developed acute onset of oral lichenoid lesions, involving bilaterally the buccal mucosa, the tongue and the labial mucosa. Histopathology was consistent with a lichen planus or a drug-induced lichenoid reaction. Improvement of the patient’s condition after withdrawal of allopurinol confirmed the lichenoid nature of the lesion. Remission was complete after a few weeks. Discussion: Although unusual, allopurinol may induce a lichenoid drug reaction. These reactions may mimic clinically and histopathologically idiopathic lichen planus. Improvement or complete regression of the lesions may be attempted to confirm the diagnosis. According to the latest WHO recommendations, these lesions have a potential for malignant transformation.

Asymptomatic Hepatitis C in Patient with Oral Lichen Planus: A Case Report

Lichen planus (LP) is a chronic inflammatory condition that affects the oral mucous membrane/skin with a variety of clinical presentations. Oral Lichen Planus (OLP) is considered to be associated with numerous systemic conditions one of which includes hepatitis C virus (HCV) infection. The geographic variation of the hepatitis C prevalence proved to be an important factor influencing the statistical results of the studies analyzing the association of the oral plan lichen with the hepatitis C virus. LP patients have about a fivefold higher risk than the controls of being HCV seropositive, with geographic variability, being most prevalent in the region of Japan, Mediterranean countries and the USA. Treatment outcomes in patients with oral lichen planus associated with chronic hepatitis C virus are often unsatisfactory compared to patients suffering from idiopathic oral lichen planus. Also, the evolution of oral lesions is often fluctuating, with repeated periods of relapse according to the degree of liver function decompensation. Herewith, a case of oral lichen planus in a female patient is reported, which on investigation revealed hepatitis C antibodies.

Generalized lichenoid drug eruption associated with imatinib mesylate therapy

Imatinib mesylate (IM), an anticancer drug, has been widely used to treat chronic myeloid leukemia (CML), gastrointestinal stromal tumors (GIST), and dermato-fibrosarcoma protuberans. Cutaneous reactions to IM have been reported to occur in varying number of patients in different case series. Non-lichenoid cutaneous reactions secondary to IM have been well-documented in the literature and are the commonest non-hematologic adverse reactions associated with its use. Lichenoid drug eruption (LDE) associated with IM therapy has rarely been reported in the literature. A case of a generalized LDE associated with IM therapy has been described here for its rarity and interesting clinical presentation. As the clinical usage of IM is increasing, one might expect an increasing number of similar patients in the future. It is thus important to realize the potential of IM to produce LDE and to differentiate this entity from idiopathic lichen planus. In the present article, the reports of IM-associated LDE, described in the PubMed and Medline database (in English language literature), have also been reviewed.

Lichen Planus-Like Drug Eruptions Due to β-Blockers

Lichen planus-like drug eruptions (LDE) can appear similar or identical to idiopathic lichen planus. We present a 45-year-old man with a widespread, violaceous, papular, generalized exanthema with histologic features of a lichenoid reaction, which subsequently resolved with the cessation of labetatol. We found 29 cases of previously reported β-adrenoceptor antagonist (β-blocker)-associated LDE. This is a relatively rare complication that may present as classic lichenoid papules indistinguishable from lichen planus and has a predilection for the limbs, chest, back, and oral mucosa. Histologically, there is a lichenoid infiltrate often with eosinophils. LDE may be due to drug cross-reactivity or as a result of a suppressed skin adrenergic system. Multiple potential medications in case studies and the inability to differentiate LDE from idiopathic lichen planus in cross-sectional association studies make any conclusive analysis difficult.

HLA antigen distribution in different clinical subgroups demonstrates genetic heterogeneity in lichen planus.

HLA-A, B, Cw, DR and DQ antigens were serologically determined in 105 patients suffering from lichen planus (LP). Of these patients, 87 had idiopathic LP and 18 had secondary LP. In the first group, 43 had cutaneous LP without mucosal lesions, 17 had cutaneous LP with mucosal lesions and 27 had purely mucosal LP. No HLA antigen was found to be significantly associated with secondary LP or with mucosal idiopathic LP. In cutaneous idiopathic LP with or without mucosal lesions, the HLA-DR1 and DQ1 antigen frequency was significantly increased, and that of HLA-DQ3 significantly decreased. Among the HLA-DR1 cutaneous idiopathic LP patients, 78.5% carried the DRB1*0101 allele, and 21.4% the DRB1*0102 allele, compared with 35.7 and 67.8%, respectively, of the HLA-DR1 controls. Our data demonstrate that idiopathic LP is influenced by HLA-associated genetic susceptibility and resistance factors not involved in secondary LP, and that cutaneous idiopathic LP is a genetically and therefore pathogenetically different condition from purely mucosal idiopathic LP.

Erupción liquenoide inducida por olanzapina

Lichenoid drug eruptions can mimic idiopathic lichen planus and other dermatoses. The list of drugs that can cause them is long and growing steadily. Although cutaneous side effects of antipsychotics are rare, various cutaneous manifestations have been reported in association with olanzapine. We present the case of a patient who developed an atypical lichenoid eruption due to olanzapine. A review of the literature in Medline from 1951 to 2007 and in the Índice Médico Español (Spanish Medical Index) revealed no previous cases of lichenoid eruptions associated with the use of this drug.

Lichenoid Drug Eruption Induced by Olanzapine

Lichenoid drug eruptions can mimic idiopathic lichen planus and other dermatoses. The list of drugs that can cause them is long and growing steadily. Although cutaneous side effects of antipsychotics are rare, various cutaneous manifestations have been reported in association with olanzapine. We present the case of a patient who developed an atypical lichenoid eruption due to olanzapine. A review of the literature in Medline from 1951 to 2007 and in the Índice Médico Español (Spanish Medical Index) revealed no previous cases of lichenoid eruptions associated with the use of this drug.

Naproxen‐induced lichen planus: report of 55 cases

Clinical and histopathological differential diagnosis is usually impossible in drug-induced lichen planus (LP) and idiopathic LP. Naproxen is a nonsteroidal anti-inflammatory drug, which is widely used for its analgesic, antipyretic and anti-inflammatory effects. To the best of our knowledge, two case reports on naproxen-induced LP have been reported. Fifty-five patients with LP, and a history of naproxen intake before their eruption, were investigated. Twenty-five patients (45.5%) had a history of naproxen intake prior to their eruption without any other medication. Twelve patients (21.8%) had a history of simultaneous use of naproxen with other drugs that were reported as inducers of LP. Eighteen patients (32.7%) had given a history of using naproxen together with drugs that had not been previously reported as inducers of LP. Moreover, in 42 patients, eruptive-type LP development after naproxen intake, is an interesting observation. New lesions were not observed after the cessation of naproxen intake in any of the patients. Naproxen might be accepted as an important inducer for LP, especially for the eruptive form.

Lichenoid Drug Eruption with HMG-CoA Reductase Inhibitors (Fluvastatin and Lovastatin)

Sir, Cutaneous drug reactions have a wide variety of clinical features. Lichenoid drug eruptions (LDE) are rare and it may be difficult to differentiate them from idiopathic lichen planus (1, 2). Gold, quinine, quinidine and penicillamine are well-known inducers of such eruptions (1, 2), but there are only a few reports of lichenoid eruption induced by 3-hydroxy-3-methyl-glutaryl coenzyme A (HMG-CoA) reductase inhibitors (2, 3). Here we report a case of fluvastatinand lovastatin-induced lichenoid eruption.

Oral lichenoid drug eruptions: their recognition and management.

Lichen planus is a relatively common, often clinically distinctive, mucocutaneous condition with an uncertain aetiology. One variant of lichen planus is the so-called 'lichenoid drug eruption'. In contrast to idiopathic lichen planus, lichenoid drug eruptions, where practicable, may be managed by substitution of the offending drug. The dental clinician is in a prime position to identify these lesions and liaise with medical colleagues regarding their management. This article reviews oral lichenoid drug eruptions, emphasizing those aspects of relevance to the general dental practitioner.

Oral Metronidazole for Lichen Planus

Investigators in Turkey conducted an open study to see if oral metronidazole is effective in the treatment of generalized idiopathic lichen planus

Oral metronidazole treatment of lichen planus

Background: Oral metronidazole has been reported to be effective in some patients with idiopathic lichen planus (LP) who did not have concomitant protozoal infections of the intestinal or genital tracts. Objective: Our purpose was to evaluate the efficacy of this drug in the treatment of generalized LP. Methods: Nineteen patients with LP who were free from intestinal and genital protozoal infections were treated with oral metronidazole, 500 mg twice daily, for 20 to 60 days and were followed up for a period of 5 to 36 months. Results: Fifteen patients (78.9%) improved with metronidazole treatment. Complete response was observed in 13 patients (7 women and 6 men). Two patients responded partially. Worsening of the lesions was observed in 1 of the 4 nonresponding patients. Conclusion: Metronidazole may be an alternative therapy for the treatment of generalized LP. Its immunomodulatory activity seems to be a possible mechanism of action besides its antimicrobial activity. (J Am Acad Dermatol 2000;43:260-2.)

Lichen planus-specific antigen in oral lichen planus and oral lichenoid drug eruptions

To investigate the usefulness of lichen planus-specific antigen as a marker to distinguish idiopathic oral lichen planus from oral lichenoid drug eruptions. Biopsy samples were taken from 6 patients with oral lichenoid drug eruptions and 6 patients with idiopathic oral lichen planus. Each biopsy sample was examined for the presence of lichen planus-specific antigen by using a modification of a previously described immunofluorescence method that uses autologous serum and also allogenic sera from the remaining 11 cases. All autologous and allogenic immunofluorescence tests showed negative findings for lichen planus-specific antigen. Lichen planus-specific antigen is not a useful marker to distinguish oral lichenoid drug eruptions from idiopathic lichen planus. This finding is in contrast with our findings in an earlier study of basal cell cytoplasmic autoantibodies.

Drug-Induced Lichen Planus

T he first drugs reported to cause lichenoid skin reactions were arsenicals. In 1929, Lortab-Jacob proposed, in a discussion of a patient presented by Gougerot, that the lichenoid eruption was secondary to arsenic used in the treatment of syphilis.1 The importance of drugs in the pathogenesis of lichen planus became evident during World War II by the large number of lichenoid skin reactions in servicemen taking antimalarial drugs.2 The relationship between drug administration and clinical symptoms had to be proven by deliberate rechallenge. Nowadays, a large variety of causative drugs is known.3 Although the pathogenesis is much better understood, at the moment we cannot reliably differentiate between lichenoid drug eruption and drug-induced lichen planus. It is even questionable whether these are, in fact, two different entities. For this reason we have avoided the expression “drug-induced lichen planus.” Instead, in the following review we prefer to differentiate between idiopathic lichen planus (LP) and lichenoid drug eruption (LDE). In the following survey, we summarize the literature about epidemiology, clinical features, and histologic patterns of LDE. Differences and similarities between LDE and LP concerning pathogenetic mechanisms, clinical features, and course as well as diagnostic and therapeutic procedures will be discussed. Moreover, some of the most important drugs and substance classes causing LDE will be mentioned as examples and in alphabetical order: angiotensin-converting enzyme inhibitors, antimalarials, b-blockers, gold, lithium, methyldopa, nonsteroidal anti-inflammatory drugs, penicillamine, quinidine, and sulfonylurea agents. Also, paraphenylendiamine derivatives, which are part of color film developers, will be considered.