Linear Lichen Planus Research Articles

Lichen planus (LP) affects between 0.5 and 1% of the population. Linear LP accounts for <0.2% of LP cases. Linear LP of the face is even rarer, with only a handful of cases. Linear facial LP follows Blaschko’s lines, usually along the mandible, has follicular localization and leaves long-standing pigmentation and atrophy. There is a paucity of data for the treatment of LP esthetic sequelae, more so for facial linear LP in darker skin types with atrophy. Most treatments are attempted to stabilize the spreading of the disease and limit its progression but do not successfully address esthetic pigmentation and atrophy. Our case is an Indian woman with isolated facial linear LP clinically who was successfully treated for esthetic sequelae with 1064 nm Q-switched neodymium: Yttrium-aluminiumgarnet laser and microneedling pen without relapse even after 1 year.

The term „lichenoid“ was first established as a clinical definition for diseases characterized by flat, dull red papules with smooth surface. Over time, a second definition of lichenoid became commonly used as well, the histopathological one, which refers to a dense, ban-dlike inflammatory infiltrate obscuring the dermo-epidermal junction. Today, the term li-chenoid is used interchangeably in its clinical and histopathological meanings to define the so-called lichenoid dermatoses. Lichenoid dermatoses represent a group of unrelated inflammatory conditions that share some clinical and/or histopathological features; some of these are clinically but not histopathologically lichenoid, while others are histopatholog-ically but not clinically lichenoid. Lichen planus (LP) represents the prototype of a cutane-ous inflammatory disease that presents with both clinical and histopathological lichenoid features. Besides the skin, the disease commonly affects the oral mucosa and the nails. Involvement of the hairs (lichen planopilaris) can result in a form of scarring alopecia. Several clinical and/or histopathological variants of LP have been described over the years, including such disparate forms as linear, atrophic, hypertrophic, and ulcerative LP among others. In some cases, association with other diseases (e.g., LP pemphigoides, LP/lupus erythematosus overlap syndrome) is well described. It is important to understand that the variants of LP are not specific entities; for example, an atrophic LP is commonly pigment-ed, often located at sites of inverse LP, and may present with an annular configuration. In this article we briefly review the protean clinicopathological spectrum of LP.

Acquired inflammatory Blaschko-linear dermatoses have not been studied extensively. Descriptive studies on segmental vitiligo have yielded insights helpful in counseling patients. Similar insights are expected from studies on other acquired inflammatory Blaschko-linear diseases. Consecutive patients with an acquired inflammatory Blaschko-linear disease presenting to the dermatology outpatient department of the study center were recruited in a case series. Detailed history and examination, clinical photographs, and histopathological findings were recorded and analyzed. Features were compared between linear and generalized forms to look for any differences. Out of 99 patients, linear lichen planus (n = 47), linear morphea (n = 31), and lichen striatus (n = 9) were observed most commonly. Skin lesions were present in multiple lines in 52 (52.5%). In 12 (12.1%), more than one anatomical site was involved. In 10 (10.1%), two different Blaschko-linear diseases were seen, and in 3 (3.1%) both diseases occurred in the same/adjacent segments. The disease extended from one or both ends in 64 (88.9%). Nineteen (19.2%) had both linear and generalized disease, with linear lesions being more severe than the generalized lesions (P = 0.038133). Some (18/47, 38.3%) linear lichen planus cases showed prominent atrophy since the onset and formed a distinct subset, predominantly over the head and neck site (P < 0.00001). Histopathology of linear lichen planus differed from controls with generalized lesions in terms of having deeper infiltrate (P = 0.000124), and multi-focal, rather than confluent, lichenoid infiltrates. Atrophy was noted from the onset in 13/31 (41.9%) cases of linear morphea. Limitations include cross-sectional design and lack of controls with generalized nonlinear diseases. Acquired inflammatory Blaschko-linear disorders show distinct characteristics like involvement of multiple lines and sites, directional progression, and atrophic variants. These can be used for differentiating among different Blaschko-linear diseases, monitoring progression, and counseling patients.

Reported cases of linear lichen planus following multiple Blaschko’s lines are rare. Herein, we present a middle-aged female patient who had unilateral lesions of linear lichen planus that followed Blaschko’s lines in three different sites of the body. The only history given was previous triple immunization against COVID-19 with the Pfizer vaccine and backache with right-sided trochanteric pain over the past year. Interestingly enough, during the diagnostic process, raised serum angiotensin-converting enzyme (SACE) was revealed along with signs of sacroiliitis and trochanteric bursitis. Key words: Linear lichen planus, Blaschko lines, SACE, COVID-19 immunization

Lichen linear planus is a rare variant of lichen planus that appears as pruritic, polygonal, purple papules in a blaschkoid distribution. This review critically assesses all reported cases of linear lichen planus (LLP) for proposed etiology, clinical and histologic traits, treatment options, and recurrence. A PubMed search from inception through March 2023, followed by article screening and full-text review, identified 51 unique cases of LLP. Data from each case including the sex of the patient, anatomic distribution of lesions, biopsy results, proposed etiology, treatment, and recurrence were recorded. LLP did not show a significant gender or age predilection, most frequently presented unilaterally with pruritus, and involved numerous anatomic regions. Various triggers including metal implants, vaccinations, infections, malignancy, and pregnancy were identified. The most common histopathologic descriptions included band-like lymphocytic or lichenoid infiltrate, basal liquefactive, vacuolar degeneration, hypergranulosis, hyperkeratosis, civatte or colloid bodies, melanin incontinence, and orthokeratosis. Treatment options, duration of treatment, and recurrence rate of LLP lesions were variable. Although LLP is rare, dermatologists should be aware of this presentation and appropriate diagnostic and treatment options because swift diagnosis can reduce patient morbidity.

Lichen Planus (LP) is a condition in which autoreactive T lymphocytes attack basal keratinocytes in the skin, mucous membranes, hair follicles, and/or nail units. Lesions are classically described using the 6 Ps (purple, planar, polygonal, pruritic, papules, and plaques), but some lesions develop fine, grayish-white streaks called Wickham’s striae. There are also several variations of LP including hypertrophic, follicular, ulcerative, annular, and linear. We report a case of a 60-year-old male who presented with a worsening rash on the left upper back that had been present for months. The rash started as individual red papules that darkened and coalesced into violaceous plaques in a linear distribution. He noted occasional pruritus but no oral lesions, joint pains, or nail changes. Linear LP can imitate many other skin conditions including psoriasis, subacute cutaneous lupus erythematosus, lichen striatus, inflammatory linear verrucous epidermal nevus, and mycosis fungoides. Distinguishing LP from other skin conditions is important in guiding management, and healthcare providers should perform a thorough oral mucosa examination if LP is suspected. While cutaneous LP will typically spontaneously resolve within 1-2 years, severe or persistent oral LP needs to be carefully followed as these patients are at higher risk for oral squamous cell carcinoma.

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. 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. 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. 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.

This study delves into the intricate realm of Blaschko-linear dermatoses, initially described by Alfred Blaschko in 1901. The Blaschko lines forms V-shapes on the upper back, S-shapes on the abdomen, inverted U-shapes from the breast area to the upper arm, and perpendicular lines on the extremities. Blaschko’s lines are attributed to the widely accepted theory of embryonic mosaicism in epidermal cells.In this study, the Blaschko-linear manifestations of polygenic inflammatory disorders (BLMMPD) in Indian population is analyzed. Despite various studies on individual linear dermatoses, few Indian studies have explored the correlation between different Blaschko-linear dermatoses and their dermoscopic and histopathological features.The study, conducted from July 2023 to December 2023, includes 28 cases of Blaschko-linear dermatosis of diverse spectrum. Those with dermatosis along blood vessels, lymphatics, nerve trunk and following koebnerization were excluded. The demographic details, clinical manifestations and dermoscopic-histopathological characteristics were documented. In our case series, Lichen striatus and Linear Lichen planus (LP) were noted to be the most common among linear dermatosis, with a notable female predominance (Male: female ratio 0.75:1) and unilateral distribution (85.7%) on the extremities. Other conditions were linear psoriasis, verrucous epidermal nevus, epidermal nevus, hypomelanosis of Ito and Blaschko-linear acquired inflammatory skin eruption (BLAISE). The clinical-histopathological correlation manifested in 64.2% of cases, while dermoscopy exhibited an even higher correlation in 92.8% of cases. While the distribution pattern of linear dermatoses by itself serves as a valuable diagnostic clue, specific diagnosis can be achieved with more accuracy with the help of distinctive dermoscopic features and correlating them further with histopathological features.

Abstract A form of lichen planus (LP) which follows the Blaschkos line pattern known as linear LP, presents with lichenoid eruptions and violaceous papules in a linear distribution. It is a rare form of LP affecting &lt;0.2% population with LP. We present a case of a 52-year-old female with hyperpigmented patches and plaques distributed linearly along the Blaschkos line in her right leg. From a clinical perspective, the lesions on the patient’s right leg resembled those of lichenoid epidermal naevus, which is a type of linear verrucous epidermal nevus but the dermoscopic findings and the presence of oral mucosa LP indicate that the patient has the uncommon variant of LP which is called linear LP. It is thus critical for clinicians to distinguish linear LP from other acquired dermatoses following the lines of Blaschko both clinically and dermoscopically.

Lichen striatus (LS), linear psoriasis (LPs), linear cutaneous lupus erythematosus (LCLE) and linear lichen planus (LLP) often have similar clinical manifestations, which makes clinical diagnosis with the naked eye difficult; therefore, they are easily misdiagnosed. The purpose of this study was to determine whether reflectance confocal microscopy (RCM) is helpful in differentiating between these four linear dermatoses in children. This retrospective study included 14 patients with LS, nine with LPs, eight with LCLE and 12 with LLP. All patients were analysed using RCM, and biopsies were collected from lesions previously imaged by RCM. For LS, the dermal papillary rings were partially absent, but when present, manifested with small, homogeneously round, bright cells and occasionally highly refractive plump cellular structures, aggregated in clusters. LPs exhibited dark cyst-like structures with small, bright, round cells aggregated at the epidermal level; at the dermal-epidermal junction, homogeneously distributed, enlarged, faint dermal papillary rings and numerous enlarged low-refractive canalicular structures were observed in the superficial dermis. LCLE and LLP exhibited similar manifestations, including epidermal disarray, almost total absence of dermal papillary rings, and various sized refractive structures densely distributed in the dermis. The key distinguishing features of LCLE were the different sized structures mainly clustered around hair follicles, while LLP demonstrated dense structures with a scattered distribution. RCM may be used to distinguish between the key features of LS, LPs, LCLE and LLP in children.

Liken planus (LP) deride kaşıntılı, morumsu papüller karakterize olup saç, tırnak, mukoza tutulumu da yapabilen etiyolojisi tam olarak bilinmeyen kronik, inflamatuvar bir hastalıktır. Lezyonun şekline, morfolojisine ve anatomik lokalizasyonuna göre LP sınıflaması yapılmaktadır. Burada bu sınıflama içinde ender görülen Blaschko çizgilerine yerleşen Lineer LP olgusu sunmaktayız.

We report the first ever case of the immune-related adverse event (irAE) of a linear variant of lichen planus in the lines of Blaschko. We believe that our case provides novel insight into new aspects of cutaneous mosaicism, in which skin manifestations can appear as a form of irAE.

Sir, Lichen planus (LP) is categorized as a chronic inflammatory skin disease of unknown etiology that involves immune reactions. It is characterized by flat-topped, polygonal, violaceous papules and plaques. It has various clinical presentations, such as classical LP, hypertrophic LP, LP pigmentosus, and linear LP (LLP). Primary aldosteronism (PA) is known to pose a higher risk of causing multiple autoimmune diseases [1]. Herein, we report a case with LLP and PA present at the same time. A 72-year-old Japanese female presented herself to our hospital with a three-month history of slightly itchy skin lesions on the lower right leg. A physical examination revealed flat-topped plaques on the lower right limb extending from the middle of the leg to the dorsum of the foot (Fig. 1a). There was no oral or nail involvement. The patient had a history of hypertension from the age of 62 years and was diagnosed with PA afterward. The patient had been treated with an antihypertensive drug since then without change in internal medication. The patient had no history of a preceding trauma, dental metal fillings, hepatitis, metastatic cancer, or any other infections. A histopathological examination of a skin biopsy from a lesion on the right leg revealed hyperkeratosis, a saw-tooth appearance of the epidermis, and severe liquefaction degeneration. A band-like lymphocytic infiltration was present in the upper dermis (Figs. 2a and 2b), as well as lichenoid infiltration into the dermis composed of CD4+ and CD8+ T lymphocytes. Predominantly, CD8+ T lymphocytes infiltrated into the epidermis (Figs. 2c and 2d). Clinical and histological findings confirmed the diagnosis of LPP.

Blaschko-linear lichen planus of the face: A retrospective study of 6 cases and a literature review

25959 Clinical and histopathologic evolution of inflammatory linear verrucous epidermal nevus in a pediatric patient

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Skin lesions present with innumerable patterns like discoid, petaloid, arcuate, annular, polycyclic, livedo, reticulate, target, stellate, digitate, linear, serpiginous and whorled. Most of the linear lesions follow the Blaschko’s lines. Aim was to study the incidence of linear dermatoses, the age and sex incidence, various types of clinical presentation, various sites of distribution and their clinical correlation. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Detailed history including family history, History of disease documented with clinical examination. After counselling and after recording their consent for the test, skin biopsy along with routine investigations was done wherever needed and the results were evaluated. &lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Lichen striatus was seen in 29.91% followed by linear herpes zoster in 24.7%, linear lichen planus in 18.22%, linear verrucous epidermal nevus in 14.01%, segmental vitiligo in 3.73%, nevus depigmentation in 2.33% and others. Maximal cases were asymptomatic and reported for cosmetic reason. Intense itching was the main reason to bring the lichen planus patients and few cases of the lichen striatus patients for treatment. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Lichen striatus was found to be more common, female preponderance. Majority of patients showed unilateral distribution more on the extremities. Histopathological correlation shows the importance of histopathology which ultimately changes the management in any given condition.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Lichen planus pigmentosus and lichen planopilaris are two clinically and histologically distinct forms of lichen planus. Lichen planus pigmentosus presents with sudden onset hyperpigmented macules and patches, predominantly in darker skin phototypes. On the other hand, lichen planopilaris is a scarring follicular variant of lichen planus that presents with progressive, permanent patches of alopecia. It is not uncommon for different variants of lichen planus to clinically coexist with each other. However, to our knowledge, there has been no previous reporting of linear lichen planus pigmentosus of the face with histological features of lichen planopilaris. We herein present a hybrid case of these two entities.

A 73-Year-Old With a Linear Rash

Pigmented lichen planus is a rare variant of lichen planus that is characterized by oval and round shape dark brown macules with indistinct border. Linear pigmented lichen planus is a clinical pattern of planus disease that presents unilaterally along one or more lines of blaschko. We report a 30–year-old female patient with Linear pigmented lichen planus along the lines of blaschko with mucosal involvement. Keywords: Pigmented lichen planus; Blaschko line; Mucosal involvement.

&lt;p class="abstract"&gt;Lichen planus (LP) is a papulosquamous disorder with both cutaneous and mucosal manifestation. Linear lichen planus is rare variant of lichen planus which occurs in the extremities. Oral lichen planus is another variant of lichen planus. Coexistence of linear lichen planus with oral lichen planus is rare and only one case has been reported before this case. A 35 year old female presented with hyperpigmented linear lesion in the leg and whitish plaques in the oral cavity. Biopsy of the skin lesions showed features of lichen planus. The patient was started on topical steroids and oral hydroxychloroquine. Patient responded to treatment.&lt;/p&gt;