Manifestations Of Lichen Planus Research Articles

ФИЗИОТЕРАПЕВТИЧЕСКИЕ МЕТОДЫ В КОМПЛЕКСНОМ ЛЕЧЕНИИ КРАСНОГО ПЛОСКОГО ЛИШАЯ СЛИЗИСТОЙ ОБОЛОЧКИ РТА

Abstract. Over the past five years, the number of patients has increased, especially after suffering a coronavirus infection COVID-19, with manifestations of lichen planus on the oral mucosa. Objective. Improving the effectiveness of complex therapy of lichen planus of the oral mucosa with the use of physiotherapeutic methods of treatment. Materials and methods. Under supervision in the clinic of the Department of General Dentistry of the Military Medical Academy n. a. SM Kirov, there were 26 patients, aged 35 to 62 years, 19 women and 7 men, with a diagnosis of Lichen planus, erosive-ulcerative form. All patients with lichen planus underwent a general clinical dental examination, and the dynamics of reparative processes was monitored. Treatment of all patients began with the sanitation of the oral cavity, which included filling carious cavities, extraction of teeth in order to eliminate foci of chronic infection, and the exclusion of traumatic factors. If necessary, patients were recommended rational prosthetics. Patients were divided into 2 groups, depending on the local treatment. By age, sex and forms of the disease, the control and working groups were comparable. The first group - 12 people (46.15%) were patients who received only drug treatment (general and local). In the second group - 14 people (53.85%), there were patients who were included in the treatment complex sessions with diode laser radiation of red light with a wavelength of 665 ± 15 nm, a frequency of 80 ± 5 Hz for 10 days, every other day (5 procedures). Also, every other day (5 procedures) sessions of ultraphonophoresis were performed on the elements of the lesion with 0.5% hydrocortisone ointment. Results and discussion. Papules epithelialization processes were monitored on the 7th, 10th and 20th days, pain sensations were assessed on a visual analogue scale. The effect of the treatment in the first group was significantly lower than in the second group. Conclusion. Treatment of lichen planus should be complex, including physical factors, and individual, with the involvement of specialists from other profiles.

Clinical manifestations of Grinspan–Potekaev syndrome on the buccal mucous membrane (a case report)

Grinspan–Potekaev syndrome is a rare disorder facing dentists in practical activity. That is why the detailed analysis of the disease clinical course peculiarities is important and urgently needed. The aim of the work: to analyze the clinical course of Grinspan–Potekaev syndrome on the buccal mucous membrane using the example of a patient treatment in the dental clinic Denta Plus (Zhytomyr city). Materials and methods. Bibliosemantic method (analysis, correlation, comparison, generalization, systematization of scientific literature on the studied issues), system analysis and logical generalization (for developing the algorithm of diagnostics and treatment), medical documentation analysis of the patient, who sought medical assistance in the dental clinic Denta Plus, were used. Results. The clinical course of Grinspan–Potekaev syndrome on the buccal mucous membrane was described and analyzed. The conducted diagnostic methods allowed to determine the diagnosis, to develop and to apply the complex drug therapy that positively influenced the general well-being, promoted the transformation of erosive-ulcerous form of lichen planus into less aggressive and safer exudative-hyperaemic one. The difficulties during the diagnostic and differential diagnostic stages concerned the fact that typical skin lesions were not observed and the “fern pattern” on the buccal mucous membrane (within the period of exacerbation) was not clear. Besides, the patient did not have any complaints specific to diabetes mellitus, therefore a blood glucose level and glycemic profile were determined only in the process of case follow-up, the patient was further referred to an endocrinologist, who diagnosed type 2 diabetes mellitus. Conclusions. The described case of Grinspan–Potekaev syndrome allowed to analyze the clinical course of the disease in the oral cavity within the exacerbation period and to examine the components of diagnostic and treatment process. The treatment response in Grinspan–Potekaev syndrome (with isolated manifestations of lichen planus on the buccal mucous membrane) depends not only on a dentist competence but also on cooperation between other specialists: dermatologist, oncologist, psychotherapist, family physician, and endocrinologist. Despite the positive clinical effect, the need to follow-up the further course of the disease is associated with the possibility of erosive-ulcerous form of lichen planus relapses and its malignant transformation.

S1956 An Unusual Case of Proximal Esophageal Stricture​: Esophageal Lichen Planus

INTRODUCTION: Lichen planus (LP) is an inflammatory disease of unknown etiology that most commonly affects the skin and mucous membranes. Roughly 0.5-2% of the population is affected and it usually affects middle-aged females. A rare manifestation of this disease is esophageal lichen planus (ELP). Often correct identification and diagnosis of ELP is difficult and delayed, as presented below. CASE DESCRIPTION/METHODS: A 58-year-old male with a history of DM2, HTN, HLD, tobacco use and obesity presented with complaints of progressively worsening dysphagia and emesis. He denied odynophagia, weight loss or difficulty swallowing liquids. His physical exam was unremarkable. An esophagram demonstrated a 2.5 cm long area of narrowing within the upper esophagus at the level of the sternoclavicular joint. A CT chest showed no evidence of a mediastinal mass. An EGD showed a smooth circumferential luminal narrowing at 25 cm insertion in the proximal esophagus. There were no focal lesions; however, the mucosa did show scattered white exudates. This area could not be traversed with the endoscope and the lumen was ∼ 8 mm in diameter. The stricture was dilated and biopsies were obtained. Of note, both the stomach and duodenum appeared normal. Pathology showed a basilar lymphocytic infiltrate with scattered apoptotic squamous cells (Civatte bodies); no intraepithelial eosinophils were identified. These findings were consistent with a diagnosis of ELP and the patient was started on swallowed fluticasone. Repeat EGD, again demonstrated a proximal, smooth, non-focal, circumferential, luminal stricture. Multiple small white plaques with new punctate circular erosions were appreciated throughout the proximal and mid-esophagus; biopsies were again obtained. Pathology resulted in similar findings as prior with the addition of concurrent fungal yeast and hyphae identified on H&E stain. He was advised to continue current treatment and start fluconazole with close follow-up. DISCUSSION: ELP is a rare disease with variable presentations. In our case specifically, the patient did not fit the usual demographic for a patient with ELP and he had no other manifestations of LP. Delays in diagnosis are likely related to a lack of both suspicion for the disease and strict diagnostic criteria. ELP is difficult to treat and often requires trials of multiple different medications. Added awareness, timely diagnosis and a better understanding of its underlying pathogenesis will likely result in more effective treatments in the future.Figure A.: Esophageal surgical pathology specimen showing basilar lymphocytic infiltrate with scattered apoptotic squamous cells known as civatte bodies (black arrows).Figure B.: EGD demonstrating proximal esophageal stricture with white exudates.

Oral lichen planus: a novel staging and algorithmic approach and all that is essential to know.

Lichen planus (LP) is a chronic autoimmune disease. Oral lesions may occur in isolation or in combination with other affected muco-cutaneous sites. Oral LP (OLP) may present as one of the various manifestations of LP or may present as a disease sui generis with a broad range of severity. Despite this disease targeting the oral mucosa, its great impact on quality of life is underrated. In this article, we provide an updated review of the pathophysiology and epidemiology of OLP and offer guidance for its diagnosis and management. We also propose an algorithmic approach to the clinical forms of OLP and a novel staging system to facilitate management decisions.

Is erythema dyschromicum perstans a variant of lichen planus? A case of erythema dyschromicum perstans presenting concurrently with lichen planus nail changes without any other cutaneous manifestations of lichen planus

Is erythema dyschromicum perstans a variant of lichen planus? A case of erythema dyschromicum perstans presenting concurrently with lichen planus nail changes without any other cutaneous manifestations of lichen planus

ВЛИЯНИЕ ХАРАКТЕРА ПИТАНИЯ НА ТЕЧЕНИЕ КРАСНОГО ПЛОСКОГО ЛИШАЯ СЛИЗИСТОЙ ПОЛОСТИ РТА

<p>The feeding habits of patients with manifestations of lichen planus on the oral mucosa are demonstrated in the article).</p>

Skin Manifestations Induced by TNF-Alpha Inhibitors in Juvenile Idiopathic Arthritis

The tumor necrosis factor alpha (TNFα) inhibitors have been used with good clinical results in the treatment of juvenile idiopathic arthritis (JIA). Anti TNFα therapy is generally well tolerated. Besides the site injection reactions, other various cutaneous manifestations have been encountered as adverse events. Here, we report four young patients receiving treatment with anti-TNFα (infliximab, adalimumab, and etanercept) for JIA developing different skin manifestations more than 1year after the initiation of therapy. They underwent a dermatological exam. All four patients were ACR-Ped 30 responders to anti-TNF drugs. The first patient developed cutaneous vasculitis, the second one had lichen planus manifestations, while the third and the fourth developed psoriatic palmoplantar pustulosis accompanied by plaque-type psoriasis localized to the scalp. None of the patients had a personal or family history of dermatological diseases. In the first two patients, skin lesions healed with topical treatment after the discontinuation of anti-TNF agent, while psoriatic lesions did not resolve despite discontinuation of the drug and dermatological treatment. TNF inhibition can be both anti-inflammatory and pro-inflammatory. Cutaneous manifestations could be considered as a paradoxical adverse event of the anti-TNF-alpha treatment not only in rheumatoid arthritis but also in juvenile idiopathic arthritis.

Erosive mucosal lichen planus and secondary epiphora responding to systemic cyclosporin A treatment

Erosive mucosal lichen planus (LP) is a well-established variant of LP characterized by the formation of ulcerative lesions predominantly involving the oral and genital mucosae. Less commonly, this condition may involve oesophageal and/or ocular mucosal surfaces, and case reports within the ophthalmology literature have recently confirmed the potential for this condition to affect the nasolacrimal ducts. We report the case of a woman with severe cicatrizing mucosal LP and ocular symptoms secondary to presumed nasolacrimal duct involvement. We also report the potential for this newly appreciated manifestation of LP to respond to systemic cyclosporin A.

P1226 Oral manifestations of lichen planus in patients with hepatitis C virus and HIV/AIDS

P1226 Oral manifestations of lichen planus in patients with hepatitis C virus and HIV/AIDS

Management of the nails in inflammatory dermatoses

All clinicians will be familiar with the typical protective measures that can be combined with topical steroid treatments in inflammatory skin diseases affecting the nail. However, there are choices concerning the strength of the treatments, how they might be applied and for how long. In addition there are topical alternatives to steroids in some instances, such as calcipotriol and the oral nonsteroidal anti-inflammatory nimeluside, in hyperkeratotic pustular variants of psoriasis. In this presentation we will also cover the further alternative of injected steroid, detailing the technique, selection of the subject and pattern of injection according to different practitioners. This is of relevance mainly in nail psoriasis, but can also be helpful in hyperkeratotic eczema, lupus erythematosus and some manifestations of lichen planus. Nail lichen planus represents a particularly resistant category of nail disease and justification of potent systemic therapy may require nail biopsy to provide diagnostic certainty. Unlike in psoriasis, potent therapy may be justified in children as well as in adults and may take the form of local or systemic injected steroid as well as courses of oral steroids lasting for several months. In children there is a spectrum of nail disease where the rough nails of ‘20 nail dystrophy’ may be in the nondestructive category of a histologically eczematous process, or may be lichen planus. The latter is at risk of progression with scarring, especially in children of Asian origin. In addition to steroid in its various forms, there are other treatments for psoriasis and lichen planus that cover a range of mechanisms. These include 5-fluorouracil, dithranol, cyclosporin, methorexate and oral retinoids as well as forms of electromagnetic radiation such as PUVA16 and superficial X-ray. As a final resort, certain forms of dystrophy wholly resistant to medical therapy may necessitate nail avulsion and matrix ablation. This is mainly seen with upgrowing big toenails and pincer nail deformity.

Lichen Planus of the Eyelids - A Report of 5 Cases

Involvement of the eye and related structures is rarely reported in lichen planus. Only eleven cases with eyelid involvement are reported in the literature. Lesions on the eyelids may be the only manifestation of lichen planus or it may be a part of the disease process present on other parts of the body. When only eyelids are involved, clinical diagnosis may be difficult. Lichen planus should be considered in the differential diagnosis of erythematous papular lesions on the eyelids.

Lichen planus.

Lichen Planus is a relatively common inflammatory dermatosis of unknown origin. The present review summarizes the histological and clinical features of lichen planus and variants, including lichenoid drug reactions, are described. Possible mechanisms of pathogenesis of lichen planus are reviewed. The development of malignancy in association with lichen planus and the association with hepatitis are discussed. Treatment options for the more difficult manifestations of lichen planus are proposed.