Hypertrophic Lichen Planus Research Articles

Solitary verrucous plaque on a leg.

We present the case of a female in her 70s who presented with a solitary verrucous plaque on her left leg accompanied by painful oral erosions. Various differential diagnoses were considered, like lichen simplex chronicus, hypertrophic lichen planus, and chromoblastomycosis. We diagnosed pemphigus vegetans (PVeg) on a nonintertriginous site through comprehensive clinical examination and histopathological and immunopathological evaluations. This case highlights the importance of considering PVeg in the differential diagnosis of solitary verrucous plaques, even in atypical extra-flexural anatomical locations.

CHILDHOOD LICHEN PLANUS: A STUDY OF 54 CASES FROM PAKISTAN

Background: To determine the clinical profile of Childhood Lichen Planus (LP) in Pakistani patients presenting to Dermatology outdoors of a Tertiary Care Hospital. It was a cross-sectional study, conducted at the Dermatology Outpatient of a Tertiary Care Hospital in Pakistan from December 2021 to December 2023. Methods: All new patients with either gender up to the age of 15 years with clinical diagnosis of LP were included. Clinical data was recorded for each patient separately. Physical examination was performed to determine the type of disease, presence or absence of Koebner phenomenon and the presence of other associated diseases. The data collected was analyzed using Statistical Package for Social Sciences (SPSS) version 23. Results: The mean age of onset was 9.792±2.774 and mean duration was 11.63±6.83 months. Pruritus was found in 51 (94.4%) patients. Classic LP was found in 35 (64.9%) cases, hypertrophic LP was found in seven (13.0%) cases and linear LP was found in six (11.1%) patients. Lichen planopilaris, actinic lichen planus and atrophic lichen planus were seen in one (1.9%) patient each. Nail involvement was seen in 5 (9.3%) patients with only one (1.9%) having nail only lichen planus. Similarly, mucosal involvement was seen in 7 (13.0%) patients and only two (3.7%) patients had mucosal only lichen planus. Conclusion: Lichen planus is uncommon in children. Childhood LP largely resembles adult LP. There is no significant gender predominance. Nail Lichen planus and mucosal LP are rare and family history and associated systemic diseases are found very rarely.

Dermoscopy to differentiate clinically similar inflammatory and neoplastic skin lesions.

Over the few last decades, dermoscopy has become an invaluable and popular imaging technique that complements the diagnostic armamentarium of dermatologists, being employed for both tumors and inflammatory diseases. Whereas distinction between neoplastic and inflammatory lesions is often straightforward based on clinical data, there are some scenarios that may be troublesome, e.g., solitary inflammatory lesions or tumors superimposed to a widespread inflammatory condition that may share macroscopic morphological findings. We reviewed the literature to identify dermoscopic clues to support the differential diagnosis of clinically similar inflammatory and neoplastic skin lesions, also providing the histological background of such dermoscopic points of differentiation. Dermoscopic differentiating features were identified for 12 relatively common challenging scenarios, including Bowen's disease and basal cell carcinoma vs. psoriasis and dermatitis, erythroplasia of Queyrat vs. inflammatory balanitis, mammary and extramammary Paget's disease vs. inflammatory mimickers, actinic keratoses vs. discoid lupus erythematosus, squamous cell carcinoma vs. hypertrophic lichen planus and lichen simplex chronicus, actinic cheilitis vs. inflammatory cheilitis, keratoacanthomas vs. prurigo nodularis, nodular lymphomas vs. pseudolymphomas and inflammatory mimickers, mycosis fungoides vs. parapsoriasis and inflammatory mimickers, angiosarcoma vs granuloma faciale, and Kaposi sarcoma vs pseudo-Kaposi. Dermoscopy may be of aid in differentiating clinically similar inflammatory and neoplastic skin lesions.

CUTANEOUS LICHEN PLANUS - UNEXPECTED MALIGNANT DEGENERATION

Carcinoma occurring in the cutaneous lesions of Lichen Planus (LP) though rarely mentioned in literature does occur and should be kept in mind while treating such lesions. We report a 70-year-old women who developed an SCC (Squamous Cell Carcinoma) in a long-standing lesion of hypertrophic LP on the lower leg. This observation is being presented to indicate the possibility of malignant transformation of cutaneous lichen planus to carcinoma, and suggest more regular monitoring especially in the hypertrophic forms and the need to have an early diagnosis so that it can be treated in the initial stages.

Squamous Cell Carcinoma Arising in Chronic Inflammatory Dermatoses.

Squamous cell carcinoma (SCC) is a known sequela of chronic inflammatory conditions of the skin. Labial discoid lupus erythema-tosus (DLE), oral lichen planus (OLP), and lichen sclerosus have a relatively short lag time from dermatosis onset to manifestation of malignancy; cutaneous DLE, hypertrophic lichen planus, chronic wounds, hidradenitis suppurativa (HS), and necrobiosis lipoidica can be present for decades before an associated malignancy is observed. Vigilant monitoring is essential for orolabial DLE, chronic HS, and chronic wounds because malignancies in these settings are particularly aggressive and often fatal. We summarize what is known about the nature and demographics of SCC arising within chronic inflammatory dermatoses, emphasizing lag time from dermatosis diagnosis to malignancy onset of common inflammatory conditions.

A Case of Alopecia Totalis with Lichen Planus Hypertrophicus Responded Excellently to Oral Tofacitinib-An Observation.

A Case of Alopecia Totalis with Lichen Planus Hypertrophicus Responded Excellently to Oral Tofacitinib-An Observation.

AYURVEDA APPROACH IN THE MANAGEMENT OF HYPERTROPHIC LICHEN PLANUS – A CASE REPORT

Lichen planus is a dermatological condition with challenging symptoms. Conventional treatments often have limitations. This case report explores the successful Ayurvedic management of hypertrophic lichen planus in a 19- year-old male patient. The treatment involved Purgation (Virechana), oral Ayurvedic medicines, and therapeutic phlebotomy (Raktamokshana). The patient experienced significant relief from symptoms, illustrating the potential of Ayurveda in addressing complex dermatological conditions.

Hypertrophic Lichen Planus in a 38-year-old Filipino Male: A Case Report

Abstract Hypertrophic lichen planus (HLP) is a papulosquamous eruption presenting with extremely pruritic hyperkeratotic flat-topped papules, plaques, and nodules. This is a case of 38-year-old male who presented with a 2-month history of generalized erythematous-to-hyperpigmented papules, patches, and plaques topped with white-to-gray oyster shell-like scales on a background of hyperpigmented macules and patches. There was no involvement of the conjunctival, otic, oral, and genital mucosae, and palmar and plantar aspects of the hands and feet. Dermoscopy showed reticular pearly white structures corresponding to the Wickham striae, comedo-like openings, blue-gray dots, brownish-black dots, and scales. Histopathologic examination revealed marked compact hyperkeratosis, wedge-shaped hypergranulosis, irregular saw-toothed epidermal acanthosis, scattered dyskeratotic keratinocytes, and superficial perivascular lichenoid infiltrate of lymphocytes, histiocytes, and melanophages. The patient was managed as a case of HLP. He was started on methotrexate 10 mg per week, bath psoralen photochemotherapy (PUVA) three times a week, betamethasone valerate 1mg/g cream twice a day for 2 weeks alternating with tacrolimus 0.1% ointment twice a day for another 2 weeks, 10% lactic acid, emollients, and sunscreen. After 6 months of treatment, there was almost 80% improvement of lesions and relief of pruritus.

Giant renal cell carcinoma in a patient with ipsilateral lower limb hypertrophic lichen planus; Case report and literature review

Giant renal cell carcinoma in a patient with ipsilateral lower limb hypertrophic lichen planus; Case report and literature review

Eosinophils in Traditionally Noneosinophil-Rich Dermatoses.

The presence or absence of tissue eosinophilia has previously aided in the diagnosis of inflammatory skin conditions. However, recent studies have elucidated the presence of eosinophils in traditionally eosinophil-poor inflammatory skin diseases, such as dermatomyositis (DM), psoriasis, and lichen sclerosus (LS). This systematic review of the literature explores previous studies of tissue eosinophilia in skin biopsies of dermatoses that are believed to be classically poor in eosinophil. We identified 26 studies, the majority of which were retrospective reviews. The percent of specimens with increased eosinophils in psoriasis ranged from 18%-73%, pityriasis rubra pilaris (PRP) 22%-63%, LS 29%-53%, DM 15%-44%, morphea 8%-45%, hypertrophic lichen planus (LP) 0%-21%, and oral LP 0%-4%. These reports of tissue eosinophilia in reputed eosinophil-poor dermatologic conditions present a diagnostic pitfall and suggest that tissue eosinophilia itself should not be used to rule out a diagnosis of one of these conditions.

Clinical and histopathological study of cutaneous lichen planus in a tertiary care center of central India

Abstract Background: Lichen planus (LP) is an idiopathic, chronic inflammatory disease of the skin, mucous membrane, and nails. Worldwide distribution is seen, with 0.38% of the lesions prevalent in India. Objective: The present study was conducted to study the demographic profiles (such as age and gender) and histopathology of LP and their clinical presentation. Materials and Methods: The present study was conducted in the Department of Pathology at Sri Aurobindo Medical College and Post Graduate Institute, Indore. All cases presenting with LP and undergoing skin biopsy from December 2018 to May 2021 were included in the study. Detailed clinical history was taken, and histomorphological evaluation was performed for all the included cases. Results: A total of 155 cases of LP were analyzed. The mean age of presentation was 34.89 ± 16.02 years, with slight male predominance. The mean duration of the disease was 7.82 ± 5.34 months. Clinically, most cases presented with mild to moderate pruritis (64.51%), followed by intense pruritis (25.16%). Violaceous papules and plaques were the predominant findings in 80.64% of patients, followed by hyperpigmented papules and macules (13.54%). Histomorphologically, hyperkeratosis was observed in almost all cases (99.35%), followed by wedge-shaped hypergranulosis (65.80%). The most common variant found was classic LP (30.96%), followed by hypertrophic LP (29.6%) and LP pigmentosus (26.4%). Clinicopathological discordance was seen in ~14 (10%) cases. Conclusion: Detailed history, clinical examination, and careful histological assessment help diagnose LP and differentiate its variants.

CPC05 A case of extensive hypertrophic lupus erythematosus responsive to topical steroids

Abstract Hypertrophic lupus erythematosus (HLE) is a rare variant of lupus erythematosus, occurring in 2% of cases of chronic cutaneous lupus erythematosus (CCLE). It is an exaggerated proliferative epithelial response manifesting as verrucous-appearing hypertrophic indurated lesions occurring on sun-exposed sites. We present a case of the development of extensive HLE in a patient with subacute cutaneous lupus erythematosus (SCLE) with underlying pulmonary malignancy. A 74-year-old woman with Sjögren syndrome presented to dermatology with a 2-month history of a rash affecting her face and décolletage. Laboratory studies illustrated elevated antinuclear and anti-Ro antibodies. Biopsy from her chest confirmed SCLE. Malignancy screening revealed T1aN0 pulmonary lepidic adenocarcinoma, which was successfully managed with a lower lobectomy. Hydroxychloroquine was initially trialled but required discontinuation following intolerable side-effects. Mepacrine was then initiated, which allowed clearance of the rash, alongside yellow discoloration of the skin. Six months later, she developed a raised pruritic rash on her arms, legs and buttocks, resistant to current management alongside a trial of mycophenolate mofetil. Examination revealed violaceous hypertrophic plaques affecting 40% of her body-­surface area. The differential included hypertrophic lichen planus, nodular prurigo and HLE. Repeat lesional biopsies highlighted a lichenoid inflammatory infiltrate with overlying scale, favouring HLE. Owing to patient choice, topical mometasone furoate 0.1% was used to manage cutaneous disease, with a reduction in lesion size. HLE is a distinct subset of CCLE, regarded as a separate entity to SCLE. Twenty per cent of patients with SCLE also exhibit other types of cutaneous lupus erythematosus (CLE) lesions. No cases in the literature describe progression from SCLE to CCLE, or HLE, in particular. Hallmarks of HLE include verrucous lesions, chronicity and treatment resistance. Early recognition and follow-up are essential as malignancy may arise in long-standing lesions. Lung adenocarcinomas and hypertrophic lupus are both associated with p53 mutations and decreased granzyme B expression. Mutated p53 results in constitutive cell proliferation and DNA damage can accumulate in cells. Granzyme B is a protease in cytotoxic T cells involved in immune-mediated cell lysis. Both processes result in the potential to produce exaggerated hyperproliferative lesions, such as those observed in HLE and the lepidic adenocarcinomas. HLE is a rare clinical entity that can be easily misdiagnosed clinically and histopathologically. Increased awareness of this condition is essential to highlight the variety of clinical presentations of uncommon variants of CLE, to ensure they are considered while approaching clinical diagnosis.

Hypertrophic Lichen Planus: An Up-to-Date Review and Differential Diagnosis.

Hypertrophic lichen planus (HLP) is a variant of lichen planus that can be difficult to diagnose based on histopathologic features alone. Thus, patient clinical history and clinicopathologic correlation are essential considerations to make the correct diagnosis. To discuss the clinical and histologic presentation of HLP and provide a thorough review of commonly encountered mimickers in the differential diagnosis. Data were derived from a literature review, personal clinical and research experiences, and a review of cases in the archives of a tertiary care referral center. In general, HLP involves the lower extremities and is characterized by thickened, scaly nodules and plaques that are often pruritic and chronic in nature. HLP affects both males and females and is most common in adults 50 to 75 years of age. Unlike conventional lichen planus, HLP tends to have eosinophils and classically displays a lymphocytic infiltrate most concentrated around the tips of rete ridges. The differential diagnosis for HLP is broad and encompasses numerous entities in many different categories, including premalignant and malignant neoplasms, reactive squamoproliferative tumors, benign epidermal neoplasms, connective tissue disease, autoimmune bullous disease, infection, and drug-related reactions. Therefore, a high index of suspicion must be maintained to avoid a misdiagnosis and potential inappropriate treatments.

Hypertrophic lichen planus of the soles: A rare variant in a rare location

Hypertrophic lichen planus of the soles: A rare variant in a rare location

Demographic and Clinical Variants of Lichen Planus: A Retrospective Study in Aden, Yemen

Background: Lichen planus is a group of chronic inflammatory diseases affecting stratified squamous epithelia. Objective: To determine the demographic characteristics, the clinical variants, and the site involvement and to compare the study results with the findings of the literature. Materials and methods: The study was based on the retrospective analysis of the medical files of patients who attended two private clinics in Almansoora district, Aden, between the years of 2019 – 2020. SPSS 17 was used. Data were analyzed using descriptive statistics and chi-square test. P < 0.05 was considered statistically significant. Results: The study patients were 102 (62.2%) females and 62 (37.8%) males. The age ranged between 20 – 60 years. The age group 41 – 50 had the highest number of patients 56 (34.1%). The involvement of skin only was observed in (58.6%) patients. Concomitant involvement of mucous membranes with skin was seen in (16.3%) patients, nails with skin in (7.3%), face in (6.1%) and skin + mucous membranes + nail in (4.9%) patients. Classic variants of lichen planus were predominant in (63.4%) patients followed by hypertrophic lichen planus in (15.9%), (p = 0.001). Koebner phenomenon found in (18.3%) patients with lichen planus. The arterial hypertension found in (11.0%) patients followed by diabetes mellitus in (8.6%) patients. Conclusion: Most study infers that with Buteyko breathing technique, the stress can be reduced significantly. Also, the levels of perceived stress are less after taking the Buteyko breathing technique sessions. Thus, this study concludes that stress and its related outcomes can be minimized with Buteyko breathing technique governorate. Keywords: Lichen planus, demographic characteristics, clinical variants, Aden, Yemen.

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.

A RARE CASE REPORT ON ROLE OF TOFACITINIB IN TREATMENT OF REFRACTORY HYPERTROPHIC LICHEN PLANUS.

Lichen planus¹ is an Chronic dermatoses with various types of clinical presentations. Hypertrophic² Lichen planus is one type , with severe pruritus³not responding to variety of medications like topical and systemic steroids , immunosuppressive agents. This is a rare case report where refractory Hypertrophic Lichen planus was treated with Tofacitinib with excellent clinical outcome and noticeable improvement in parameters

Prurigo Nodularis: Literature Review

Multiple, hard, flesh-to-pink papules, plaques, and nodules, often seen on the extensor surfaces of the limbs, are characteristic of prurigo nodularis, a persistent skin condition. The itchy lesions may strike people of any age. It often occurs in tandem with another condition that causes constant itching, such atopic dermatitis or another dermatosis. The clinical symptoms are the primary indicators. However, there may be numerous instances when lichen simplex chronic us and hypertrophic lichen planus are indistinguishable from a clinical standpoint. Therefore, it is crucial to confirm the diagnosis by dermoscopy and histology. Many other therapy strategies are being used, including those using powerful antipruritics, immunomodulators, and neuromodulators. After a diagnosis has been made, treatment might take a long time, thus patient education and counseling are crucial to ensuring they stick with the plan. A subset of chronic prurigo, prurigo nodularis (PN) manifests as hyperkeratotic, very itchy papules and nodules that are often seen in a symmetrical pattern. PN develops with persistent pruritus in the setting of a wide variety of dermatological, systemic, neurological, or mental disorders. Although the specific pathophysiology of PN is not well understood, chronic scratching may be a primary cause. Topical steroids, capsaicin, calcineurin inhibitors, ultraviolet (UV) treatment, systemic injection of gabapentinoids, -opioid receptor antagonists, antidepressants, and immunosuppressants are the current gold standard in treating PN. Clinical trials are being conducted on cutting-edge therapeutic modalities such blockers of neurokinin-1, opioid, and interleukin-31 receptors.

The Role of Lasers in Connective Tissue and Inflammatory Dermatoses: A 10-Year Retrospective Review of 60 Patients in a UK Tertiary Laser Clinic.

The role of lasers in the treatment of standard therapy-resistant inflammatory dermatoses and connective tissue disorders has been controversial and evidence supporting the role of lasers in this setting is scarce. To assess the efficacy of lasers in the management of inflammatory dermatoses and connective tissue disorders (CTD). A retrospective case review of all inflammatory dermatoses/connective tissue diseases treated in a tertiary laser clinic between March 2010 and 2020 was undertaken. A total of 60 cases (48 = female) were included and the average age was 51 years (range 21 to 74). The following conditions were treated: scleroderma n = 22 (37%), granuloma faciale n = 10 (17%), sarcoidosis n = 8 (13%), discoid lupus erythematosus n = 7 (12%), and systemic lupus erythematosus n = 2 (3%). Other diagnoses included necrobiosis lipoidica, pyoderma vegetans, hypertrophic lichen planus, and dermatomyositis. The most common type of laser used was pulsed dye laser (PDL) in n = 41 (68%) cases. Eight (13%) patients received treatment with the carbon dioxide (CO2) laser. The most common site treated was the face. A good response with a marked reduction of signs was seen in 62% of patients while 10% of the patients did not respond to laser treatment. Self-limiting complications included purpura and hyperpigmentation. Lack of objective assessment and outcome measures. This is the largest cohort of patients to have undergone laser treatment for inflammatory dermatoses/connective tissue disease. Based on this retrospective review, we conclude that lasers can be a useful adjunct in the management of otherwise difficult-to-treat selected inflammatory and connective tissue diseases.

Hypertrophic lichen planus of the vulva

AbstractVulvovaginal lichen planus is a type of chronic inflammatory dermatosis of the vulva, usually seen as a part of widespread lichen planus. The common clinical types of vulval lichen planus include papulosquamous, erosive, and pigmented types. Hypertrophic lichen planus of the vulva is a rare entity. We report a case of hypertrophic lichen planus of the vulva