Typical Lichen Planus Research Articles

Hepatitis C virus and lichen planus: A case-control study of 340 patients

Lichen planus (LP) has been associated with liver disease, particularly hepatitis C virus (HCV) infection, in several studies to date. Most of these reports, especially the larger series, were conducted in Europe. In addition, the type of LP associated with HCV was reported to be oral LP in most studies. We conducted a case-control study in a US metropolitan population known to have a low seroprevalence of HCV infection to explore the impact of geography and endemicity of HCV on the association between cutaneous LP and HCV. The study comprised 340 patients with cutaneous LP (as case ) against 577 patients with psoriasis (as control-1 ). Hepatitis antibody titers and liver function abnormalities were our main outcome measures. Prevalence of HCV antibody among 149,756 regional volunteer blood donors (as control-2 ) was also used for comparison. Twelve (55%) of 22 patients with LP tested for HCV were antibody positive. This was significantly higher than 25% of 40 psoriasis patients tested for HCV antibody ( P = .04) or than 0.17% of blood donors tested for HCV antibody ( P < 10 –5). Thus a small but significant percentage of US patients with cutaneous LP had HCV antibody. Because LP may be the first presentation of HCV infection, it is important for clinicians to actively look for such infection in patients with LP. (J Am Acad Dermatol 1999;41:787-9.)

Clinical and histopathologic analysis of the relationship between lichen planus and chronic hepatitis C.

A prospective clinical investigation of 45 patients with lichen planus (LP) demonstrated a significant association between LP and chronic hepatitis C. Anti-hepatitis C virus (HCV) antibodies were found in 17 (37.8%) of the 45 LP patients. This was significantly higher than in the controls. This higher prevalence of anti-HCV antibodies was found equally in both male and female patients in the three types of LP; cutaneous only type, mucous only type, and both cutaneous and mucous type. Most of the patients with positive anti-HCV antibodies had abnormal values of transaminase enzymes and/or a past history of chronic hepatitis. Histological and immunohistological investigations of three cases with LP and chronic hepatitis C demonstrated some morphologic similarities between these two diseases. Histopathologic findings of both LP and chronic hepatitis C were based on a T lymphocytic infiltrate with keratinocyte or hepatocyte damage. The degrees of infiltrating cells positive to UCHL-1, MX-panB, Leu-7, and human leukocyte antigen (HLA)-DR antibodies in the chronic hepatitis C lesions seemed to be similar to those in the LP lesions. These results may support a possible relationship between LP and chronic hepatitis C and the hypothesis that LP may be associated with chronic liver diseases as a result of a cytotoxic attack on the hepatocytes.

Erosive, flexural lichen planus-an uncommon variant

An unusual pattern and type of lichen planus is described in a 57-year-old female in which the flexures were exclusively involved. The affected areas were chronically eroded and ulcerated and resistant to topical treatment. Erosive lichen planus is known to occur on mucosal surfaces and cases of ulcerative lichen planus have been described involving the feet and lower limbs. Lichen planus involving flexures alone is uncommon and for erosion and ulceration to occur at these sites seems rare. We report a case of erosive, flexural lichen planus of long standing in a middle-aged female.

Childhood lichen planus (LP).

In adults, lichen planus (LP) is relatively more common than in children. Among 222 cases of LP, there were 25 (11.2%) children in our study. The majority of the cases were females in the age group of 8-14; the youngest child was 3 years old. Papular and linear types of LP were common in children. There was no familial history of LP in any of the cases. The patients with classic LP lesions responded well to dapsone therapy. This study supports the suggestion of Ramsay and Hurley that childhood LP is more common in the tropics.

Ultrastructure of oral leukoplakia and lichen planus. I. Basal region and inflammatory cells.

Nine cases of homogenous leukoplakia and 21 cases of lichen planus (11 reticular and 10 erosive) were studied under the electron microscope. The changes found in leukoplakia were limited to occasional breaks in the basal lamina and modest changes in the cytoplasm of the basal cells. The basal lamina in lichen planus was found to exhibit 3 distinctly different pictures reflecting the clinical types of lichen planus. The structural abnormalities in the basal cells increased with increasing severity of the lesions. The inflammatory infiltrate in lichen planus was found to contain mainly small-to-medium-sized lymphocytes but plasma-cells with widely dilated rough endoplasmic reticulum containing a granular substance were frequently seen. Similar changes are seen in other disorders and, therefore, specific diagnostic criteria cannot be established on the basis of the present material.

Immunophenotyping of the dermal cell infiltrate in lichen planus treated with PUVA

To evaluate the immunoregulatory mechanisms in lichen planus (LP) responding to PUVA therapy, the LP skin lesions of eight patients were biopsied before and after treatment with trioxsalen baths and UVA. The percentages of B, T, and MPS (monocyte-macrophage) cells as well as OKT-4+ (helper) and OKT-8+ (suppressor) T cells were calculated. OKT-8+ T cells were the dominating cell type in untreated LP lesions. Following PUVA therapy, the percentage of OKT-8+ T cells decreased very significantly (p less than 0.001) as did also the number of MPS cells. These results suggest that cell-mediated immune mechanisms are involved in the pathogenesis of LP, and T suppressor cells most probably participate in evolvement of the typical LP lesions. T suppressor cells in the LP lesions are reduced after local PUVA therapy, occurring simultaneously with complete healing of the affected skin.

Oral discoid lupus erythematosus. III. A histopathologic study of sixty-six patients

A detailed histopathologic study was conducted blindly on biopsy specimens from 66 patients with oral discoid lesions (oral DLE) mixed in random order with biopsy specimens from control groups of 25 cases of oral lichen planus (LP), 25 cases of oral leukoplakia, 13 cases with an uncertain diagnosis termed DLE? LP? and 7 cases of galvanic lesions related to amalgam fillings. Fifty-two histopathologic variables were examined, and a ranking was calculated for the variables that provided the best discrimination between the subgroups of clinically typical oral DLE and LP and between typical DLE and leukoplakia, respectively. Histopathologic variables not previously described in oral DLE but characteristic of this disease were identified: multinucleated epithelial cells containing three or more nuclei and the presence of epithelial islands in the connective tissue. Patients with systemic lupus erythematosus (SLE) in addition to oral DLE showed generally the same histopathologic features as those without SLE. The inflammatory infiltrates were slighter and more diffuse among the SLE patients as compared to the non-SLE patients. The simplest possible combination of histopathologic variables diagnostic for oral DLE consisted of the following five: (1) hyperkeratosis with keratotic plugs, (2) atrophy of the rete processes, (3) deep inflammatory infiltrate, (4) edema in the lamina propria, and (5) thick patchy or continuous PAS-positive juxtaepithelial deposits. This combination is suggested as new histopathologic criteria for oral DLE. These criteria were tested among clinically atypical cases of DLE and the other groups of mucosal lesions, with a sensitivity of 92% and a specificity of 96% against both LP and leukoplakia for the presence of two or more of the five criteria.

Lichen plan avec dépôts linéaires d’lgG et de C3 à la jonction dermo-épidermique

Report of 4 cases of clinically and histologically typical lichen planus with a linear IgG and C3 deposit at the dermal-epidermal junction in involved (4/4) and healthy (2/2) skin, as detected by direct immunofluorescence. Indirect immunofluorescence was negative (3/3). In these 4 cases, the clinical aspect was different: there were no vesiculo-bullous lesions in case 1; case 2 and 3 were of the partly vesicular type with dermal-epidermal separation only in the involved skin; in case 4, bullae were present on both healthy and lesional skin. This suggests that there might exist a broad spectrum ranging from lichen planus without clinical vesiculo-bullous lesions, but with linear IgG and C3 deposits, to lichen planus associated with clinical, histological and immunological symptoms of bullous pemphigoid.

The frequency of Candida in oral lichen planus.

ABSTRACT – Histologic material of typical lichen planus lesions from 43 patients was studied. Two sections of each specimen were stained with hematoxylin‐eosin and 10 sections by the PAS method. Only 1 of 43 biopsies was invaded by Candida, and hyphae were present in all of the 10 PAS‐stained sections of this case. The results show that oral lichen planus has a considerably lesser susceptibility than oral leukoplakia to invasion by Candida albicans.

Hypertrophic Lichen Planus Treated by Local Injection of Prednisolone

This report concerns the successful treatment of the hypertrophic type of lichen planus by the local injection of prednisolone suspension. Cessation of severe pruritus and the involution of hypertrophy in these lesions were accomplished in all lesions treated by this method. Method A sterile aqueous suspension containing 25 mg. per cc. prednisolone * was used. It was found that the 24-gauge hypodermic needle allowed the particles in suspension to pass through without stoppage. The lesions were treated at weekly intervals, and no more than 1 cc. (25 mg.) of the prednisolone suspension was injected in one week. The amount injected into any one lesion varied from 0.3 cc. to 0.5 cc. Treatment Three patients with typical lesions of lichen planus of the verrucous or hypertrophic type were treated. One patient was a Negro housewife, age 42, with some 30 lesions on the lower limbs, varying in size from 6

Familial lichen planus; report of three cases in one family.

The occurrence of lichen planus in three members of one family is of sufficient rarity and interest to warrant reporting. REPORT OF CASES Case 1.— M. R., a white woman aged 38, consulted me in June 1941 for an eruption on the legs, arms and trunk. The lesions were of the chronic variety of lichen planus. No other lesions were found. Pruritus was intense. Case 2.— E. R., the 36 year old sister of M. R., consulted me in December 1947 for an eruption which had been present for three years. Examination revealed typical lichen planus on both axillas and the chest area. Pruritus in this case was intense. Case 3.— C. P., aged 63, mother of M. R. and E. R., consulted me in December 1947 for a widespread eruption of lichen planus. The lesions involved the legs, thighs, arms, chest and the back of the hands. Severe pruritus required local x-ray

Lichin planus hypertrophicus; possible clue to etiology.

A. H., a 58 year old married woman, was first seen by us on Nov. 4, 1947, and a diagnosis of lichen planus hypertrophicus of the anterolateral surface of the left thigh was made. Pronounced varicose veins of both legs were found. The lesions had first appeared one year previous to the patient's first visit. Leading from the area was a moderately large varicose vein, tortuously running toward the saphenous vein at the junction of the upper and the middle third of the thigh. This varix had been present for some time previous to the appearance of the lesions. Biopsy showed typical lichen planus hypertrophicus. Microscopic observations were as follows: The keratin layer was thickened. One follicle was widened, with decided keratotic plugging. Relative and absolute hyperkeratosis, an increase in the stratum granulosum, acanthosis, slight liquefactive degeneration of the basal cell layer and mild lymphocytic infiltration in the upper portion

LICHEN PLANUS IN THE NEGRO

LICHEN planus in the Negro offers a challenge in its clinical diagnosis and interesting histologic characteristics in microscopic examination. Cutaneous eruptions in the Negro have often been clinically masked by the intensive content of melanin. Further, the pigmentation of eruptions in the Negro has often been increased and at other times diminished. Frequently lichen planus has been known to have been followed by vitiligo. SUMMARY OF LITERATURE Fox, 1 in 1910, presented a case of lichen planus in a Negro woman, which early showed large numbers of typical lichen planus papules, but later the typical eruption was replaced by increased pigmentation. Jacob, 2 in a study of 179 cases of lichen planus in St. Louis, observed only 5 cases in Negroes and stated that Gilchrist, at Johns Hopkins Dispensary in Baltimore, saw only a half-dozen cases in twenty years. He stated that the eruption was typical in every respect except

COMPLICATIONS OF LICHENOID DERMATITIS

F ROM New Guinea and its neighboring islands a large number of cases of the severe generalized lichen planus type of lichenoid dermatitis with decided pigmentation have been observed. As yet little has appeared in the literature on this disease, but in the near future much will doubtless be published. 1 The case being presented had several unusual features which are of significance. REPORT OF A CASE Early in September 1944 the patient, a 31 year old artillery lieutenant, was admitted to the hospital. He had no past history of cutaneous disease or renal trouble of any type. He was in good health in February 1944, when he landed in New Guinea. According to his history, he took quinacrine hydrochloride, 0.2 Gm. daily for the prevention of malaria for the next five months. Early in June 1944 he noticed a peeling of the skin of his hands, with underlying redness. This eruption spread in a few weeks to involve

LICHEN PLANUS CONFINED TO THE ORAL CAVITY IN TWINS

Familial lichen planus is rare. As far as I can see its occurrence in twins, as presented here, has not been reported in the literature. <h3>REPORT OF CASE</h3> V. S., a white man, born Aug. 31, 1914, was first seen at the office on Jan. 13, 1939. He had noticed white lesions in the mouth about two months previously. Examination revealed typical lichen planus confined to the oral cavity. Numerous confluent reticular lesions covered nearly all of the mucous membranes of the cheeks. On the left side of the tongue, two oval annular lesions were present, unnoticed by the patient. The lips were not involved. No other lesions were found. The results of urinalysis and a blood count were normal, and the Wassermann reaction of the blood was negative. Six months later, after the intake of 60 cc. of solution of potassium arsenite U. S. P., the eruption cleared up

LICHEN PLANUS BULLOSUS

Cases of bullous lichen planus that have been shown recently before dermatological societies have provoked some discussion. On the occasion of the presentation of one of these cases recently before the New York Dermatological Society, 1 it was considered doubtful by some whether the few vesicles and bullae present were part of the lichen planus eruption. One speaker considered the case an example of the rare lichen planus pemphigoides. In another case, presented before the Chicago Dermatological Society, 2 there was a much more profuse eruption of bullae, some of which were hemorrhagic. Several of the members who discussed this case had seen such cases before; apparently all were agreed in considering that the bullous lesions were part of the lichen planus eruption and that such cases were rare. It is believed that the following case furnishes a good example of this unusual type of lichen planus. REPORT OF

LICHEN PLANUS CONFINED TO THE MOUTH

Involvement of the mouth in the ordinary type of lichen planus is a commonplace occurrence. Involvement of the mouth alone by this disease is, however, uncommon and causes many to hesitate to make the diagnosis unless it is corroborated by histologic examination. During the past eight years I have had a series of ten such cases which is somewhat unusual in that biopsies were performed in six of them, seven were presented before a dermatologic society, and all have been followed up to the time of writing. In this communication I shall describe the frequency, diagnosis, duration and response to treatment of lichen planus confined to the mouth. ANALYSIS OF CASES In my series of ten cases, nine occurred in private patients and one was seen at the University and Bellevue Clinic. Four of the patients were men and six women; their ages varied from 23 to 55, the