Typical Lichen Planus Research Articles

Zosteriform lichen planus after healed herpes zoster: Report of a new case of Wolf\'s isotopic phenomenon

"The wolf isotopic phenomenon corresponds to the appearance of a skin disease in a place on the body that was previously affected by another, already healed dermatosis." A 35-year-old woman presented with a transversely distributed zosteriform eruption about 12 to 14 cm in length, consisting of erythematous, scaly, moderately pruritic papules on the left flank that spread to the back (does not cross the midline) for several weeks after locally healed herpes zoster (HZ) lesions. No other skin or mucosal sites were included. Routine examination of blood, urine and stool showed no abnormality. A biopsy sample was taken from one of the lesions. Histopathological examination showed typical lichen planus changes, confirming the diagnosis of post-Herpes zoster zosteriform lichen planus (ZLP). The lesions resolved after treatment with topical steroids. Zosteriform lichen planus (ZLP) is an example of a Wolf isotopic phenomenon appearing after HZ at the same site. The exact pathogenesis of ZLP is unknown, it is assumed that persistent viral proteins could be responsible for the hypersensitivity reaction.

Vulvar lichen planus — clinical spectrum (results of a cross-sectional uncontrolled study)

Background. Lichen planus (LP) is a chronic dermatosis, which can affect vulva. Currently, there are no sufficient data about clinical picture of vulvar LP and a valuation combined lesion on the vulva, oral mucous and smooth skin in patients with different forms of LP.
 Aims. Is to study the features of the vulvar LP clinical picture.
 Materials and methods. A cross-sectional (simultaneous) uncontrolled study of 46 patients with vulvar LP was performed. We assessed the structure of vulvar LP, the duration and the manifestation of disease, localization of lesions, the involvement of the skin and oral mucosa. LichenSclerosus-Square was used to assess the area of lesions in vulvar LP.
 Results. The erosive form dominated in the structure of vulvar LP morbidity, which was diagnosed in 73,9% of cases. The process in erosive and hypertrophic form of LP was more common than in the typical form of LP. Distinctive features of the erosive form of the disease were the involvement of the inner surfaces of the labia minora and the vestibule (73,5% и 70,6%, p 0,001). The erosive LP is also characterized by a damage of normal vulvar architectonics (58,8%, p = 0,007).
 Lesions in typical LP affected labia majora (66,7%) and labia minora (33,4%), and to a lesser extent the commissure posterior (16,7%). The involvement of labia majora was found in all patients with hypertrophic form LP. The involvement of inguinal folds distinguished the hypertrophic form from other forms of LP and was observed in 33,4% of patients.
 Vulva lesions without the involvement of the skin and mucous membranes of other localizations were more typical for patients with erosive and hypertrophic LP (35,4% и 33,3%). Almost half of the patients (47,0%) with erosive LP had the involvement of mucous membranes, 29,0% of them were diagnosed with vulvovaginal-gingival syndrome. In 14.7% of cases, vulvovaginal-gingival syndrome combined with lesions in the scalp (vulvovaginal-gingival-pillar syndrome).
 Conclusions. We have identified clinical features of different forms of vulvar LP, which can be used for differential diagnosis.

Efficacy and safety of oral methotrexate versus oral mini pulse betamethasone therapy in the treatment of lichen planus: a comparative study

Background Lichen planus (LP) is a chronic inflammatory mucocutaneous disease. Systemic corticosteroids are the treatment of choice for generalized LP but their use is limited due to side effects. Oral mini pulse (OMP) therapy represents a good alternative. Also, Methotrexate (MTX) can be used as an alternative and safe modality in LP. Objectives To compare the efficacy and safety of oral MTX versus OMP betamethasone in the treatment of different types of LP. Patients and method The study included 40 patients presenting with LP who were randomly divided into two groups. Group A for oral MTX 7.5 mg weekly & group B for OMP betamethasone 3 mg weekly for a maximum of 12 weeks. Basic laboratory investigations were done on both groups. Follow-up investigations were done on the 2nd, 4th, 8th and 12th weeks. The percentage of improvement in each patient was calculated on a scale according to the appearance of new lesions, degree of pruritus/pain, subsidence of cutaneous lesions and clearance of the oral lesion Results In the MTX group, 55% of patients showed excellent improvement, 25% showed good improvement and 20% showed partial improvement. In the OMP group, 85% of patients showed excellent improvement, 10% showed good improvement and 5% showed partial improvement. The reported clinical and laboratory adverse effects were tolerable and didn’t lead to the discontinuation of treatment. Conclusion OMP betamethasone and low dose MTX may be considered effective and safe lines of treatment for different types of LP and may represent good and safe alternative options for conventional daily corticosteroid therapy.

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.

Male genital lichen planus: A retrospective study of 89 cases

BackgroundUnlike other types of lichen planus (LP), there are no series concerning male genital LP. ObjectiveTo describe the clinical characteristics, diagnosis, and response to treatment of male genital LP. Patients and methodsA retrospective study of male patients with genital LP consulting a dermatologist specialized in anogenital diseases between January 2010 and 2019. Demographic data, history, functional signs, clinical characteristics, pathology, complications, and treatment efficacy were collected. ResultsEighty-nine patients were included at four centers. The median age was 51 years. Most patients were uncircumcised and asymptomatic. In 88.8% of cases, only the genital mucosa was involved. Erythema (71%), papules (21.3%), lacy network (15.7%), atrophic lesions (15.7%), erosions (14.6%), and post-inflammatory hyperpigmentation (2.2%) were less frequently observed. Biopsy results confirmed LP in 61.3% of cases but could not rule out other inflammatory genital dermatoses in other cases. Anatomic complications were observed in 30.3% of patients. Topical corticosteroids (TCS) induced remission in most cases. Tacrolimus efficacy was comparable to that of TCS. ConclusionMale genital LP is a rare inflammatory disorder chiefly affecting uncircumcised men. It is found predominantly on the mucosal component of the penis and presents as non-erosive inflammatory balanitis in most cases, with frequent partial or complete remission on treatment with TCS.

The study of epidemiological, clinical, histopathological and dermoscopic features of lichen planus

<p class="abstract"><strong>Background:</strong> Lichen planus (LP) is a common papulosquamous condition seen by the dermatologists. It can involve the skin, mucous mebranes, hair and nails. There are many subtypes of LP with various clinical, histopathological and dermoscopic features. In this study we intended to study the epidemiological, clinical, histopathological and dermoscopic features of LP.</p><p class="abstract"><strong>Methods:</strong> A total of 73 patients of LP, above the age of 18 years who qualified the inclusion and exclusion criteria were included in the study. A proforma of epidemiological details was noted, clinical and dermoscopic examination of the lesions were done. The punch biopsy specimens of cutaneous lesions were subjected to histopathological examination and the findings noted.</p><p class="abstract"><strong>Results:</strong> Out of the 73 patients included in the study, 44 were males and 29 females with a ratio of 1.51:1. Classic LP was the commonest type of LP. Wickham’s striae (WS) was the most typical and commonest dermoscopic feature of cutaneous LP except lichen planus pigmentosus. Hyperkeratosis, hypergranulosis, acanthosis, band shaped lymphocytic infiltrate, melanophages, basal cell degeneration and saw tooth shaped rete ridges were the significant histopathological features.</p><p class="abstract"><strong>Conclusions:</strong> LP is more common in young adults and shows a male preponderance. WS is the most important diagnostic feature seen on dermoscopy of all the cutaneous types of LP excluding LPP. Interface dermatitis with a band of lymphocytic infiltrates and dermal melanophages is a notable feature of histopathology of LP.</p>

A study of serum cortisol levels in patients with lichen planus

Objectives: Primary objective was to compare between the serum cortisol levels in patients with lichen planus (LP) and normal subjects. The secondary objective was to compare between the serum cortisol levels of LP patients with and without oral lesions. Materials and Methods: This is a cross-sectional analytical study comparing the serum cortisol levels in patients with LP with that of age- and gender-matched normal subjects who attended a tertiary referral centre. Results: There were a total of 52 patients with LP in this study. The mean age was 48.1 ± 12.6 years. Male/female ratio was 1:1.9. Fifteen (28.8%) patients gave a history of recent stress in the 1 month before the onset of illness. Classical LP (34, 65.4%) was the most common type. Oral cavity was involved in 24 patients (46.2%). The mean serum cortisol level of patients with LP was higher than the same noted in age- and gender-matched normal subjects and this was statistically significant (P < 0.001). Statistically significant difference (P = 0.02) was noted between the serum cortisol levels of patients with different types of LP. No significant difference in the cortisol levels was observed between LP patients with and without oral lesions. Limitations: The main limitation of the study was the small sample size. Conclusion: This study showed a significant increase in serum cortisol levels in patients with LP when compared to normal subjects, while no significant difference was noted in cortisol levels between LP patients with and without oral lesions.

Lichen planus of anogenital region: clinical spectrum and approaches to therapy

Lichen planus is among the most common chronic anogenital noninfectious dermatoses both in male and female. The disease is characterized by clinical polymorphism, frequent involvement of skin and oral mucosa and protracted course. Typical, hypertrophic and erosive forms are distinguished. Erosive variant is commonly encountered in women and has a prominent tendency for scarring. The most common anogenital form in men is the typical lichen planus, which usually resolves completely. Vulvovagino-gingival and penogingival lichen planus are rare severe disease forms. Evolutional and biological heterogeny of clinical manifestations complicates the disease diagnosis. Lichen planus pathogenesis remains unclear. Pronounced scarring tendency in anogenital cases is believed to be the consequence of epithelial-mesenchimal transition. High-quality clinical trials of various therapeutic modalities in anogenital lichen planus are lacking. Management of such patients is mostly based on case series reports, practical experience and general principles of dermatologic treatment. This review focuses on contemporary views on clinical presentation, pathogenesis, diagnosis and approach to therapy of anogenital lichen planus.

Clinical, Histopathological and Outcome Analysis of Five Patients With Lichenoid Eruption Following Anti-Tumor Necrosis Factor-Alpha Therapy for Ankylosing Spondylitis: Report of One Case and Review of the Literature

Tumor necrosis factor-alpha (TNF-ɑ) inhibitors have become the mainstay of therapy for a wide range of autoinflammatory diseases, despite concerns regarding dermatological adverse reactions. In this paper, we describe the clinical and histological findings and outcome of a case of lichenoid eruption (LE) following adalimumab therapy for ankylosing spondylitis (AS) and review four earlier reports concerning this rare clinical association. The time of onset varied considerably (three weeks to 52 months) and lesions varied within the clinical spectrum (from typical lichen planus to psoriasiform), but all had LE-compatible histology, with acanthosis, necrotic keratinocytes and lymphocytic infiltrate as hallmarks. Most patients (3/5) improved with treatment and one experienced full recovery, while in one case the lesions persisted. TNF-ɑ has been implicated in the pathogenesis of lichen planus, making it difficult to explain how TNF-ɑ antagonists can induce lichenoid reactions. The appearance of LE may in some cases justify cessation of therapy.

Clinico-pathological profile of cutaneous lichenplanus: An experience from a tertiary care centre

Lichenplanus is a chronic inflammatory disorder with remissions and relapses. The pathogenesis is likely to be autoimmune, with T Lymphocytes targeting the basal keratinocytes. The clinical presentation is violaceous papules and plaques in skin, mucous membranes and nails. The aim of this study is to analyse the clinical and pathological profile of Cutaneous Lichen planus of all patients diagnosed with Lichen planus attending our hospital from 2016 to 2019.All cases diagnosed as Lichen planus clinically and confirmed histopathologically are analysed for age, sex, location, duration, associated comorbid conditions, type of Lichen Planus, histopathological features and for malignant transformation.Of the 91 patients diagnosed, 83 (91%) were classical Lichen Planus, 6 (6.5%) hypertrophic Lichen Planus, 2 (2.5%) lichenplanopilaris. The median age was 38 years and the mean age 40 years. Majority were in the age group of 20 to 40 years. Male : Female ratio was 1.1 :1. 10 (10.98%) patients were in paediatric age group. 7 (8%) had skin and oral involvement. 40 patients had violaceous plaques & papules, 46 pigmented and violaceous plaques and papules, 5 hypertrophic pigmented plaques. No nail or genital involvement was seen in any of our patients.The predominant type was classical Lichen planus. Few patients had Hypertension, diabetes Mellitus, diabetes mellitus and hypertension seemed to be age related. No malignant transformation was observed.

A study on incidence of oral lesions in lichen planus

<p class="abstract"><strong>Background:</strong> This study was done<strong> </strong>to evaluate the incidence of oral lesions in different types of lichen planus.</p><p class="abstract"><strong>Methods:</strong> A total of 30 patients clinically diagnosed with any form of lichen planus were subjected to a clinical examination and evaluated for the presence of oral lesions.<strong></strong></p><p class="abstract"><strong>Results:</strong> Of the 30 patients in this study with predominantly females, oral involvement was seen in 17 patients with a slight male preponderance. Lichen planus was seen commonly between the ages of 20 and 40 with the incidence of oral lesions following the same trend.</p><p class="abstract"><strong>Conclusions:</strong> This study has statistically proven the significance of oral involvement in cutaneous lichen planus and was done to highlight the importance of the same. Oral lichen planus can be a forerunner of genital involvement as well as malignancies and it is important to keep this in mind while examining a case of lichen planus.</p><p class="abstract"> </p>

Qualitative and quantitative study of immune cells in various types of cutaneous lichen planus

Background: Lichen planus (LP) is a common inflammatory skin disease. Pathogenesis of LP includes two possible mechanisms; related or unrelated to antigen. Regarding different clinical features of cutaneous and mucosal types of LP, for the first time, we decided to perform a qualitative and quantitative study of immune cells in different types of cutaneous LP and in comparison with normal skin. Methods: A total of 88 specimens (60 cases of cutaneous LP, 28 cases of normal skin) were selected from 2016 to 2017 in Kerman, Iran. Evaluation of immune cells was carried out based on qualitative and quantitative analysis. These findings were statistically calculated by descriptive statistical tests including frequency and mean ± standard deviation. Quantitative data were analyzed by independent t-test, chi-square, and analysis of variance (ANOVA). Data were analyzed using SPSS16 (SPSS Inc., Chicago, IL, USA). A p value less than 0.05 was considered statistically significant. Results: Our study demonstrated that the mean number of immune cells was significantly higher in lichen planus group in comparison with the control group. Number and staining intensity of Langerhans cells (LCs) in the LP group were significantly greater in epidermal than dermal region. Mastocytes were located mostly within the deep dermis in the LP group. Hypertrophic and atrophic LP had the highest and the lowest number of immune cells (i.e., mastocytes, LCs, and CD3 positive cells), respectively, with a significant difference. Conclusion: Our study demonstrated that immune cells were seen in larger numbers in the hypertrophic type of cutaneous LP which is consistent with the chronicity of this disease.

Immunohistochemical study of Wnt5a expression in cutaneous and oral lichen planus

Background Lichen planus (LP) is an inflammatory disease that affects the skin, mucous membranes, and skin appendages. Although the exact cause of LP is unclear, it was thought to be a T cell-mediated autoimmune disease. Wnt5a is one of the most extensively studied Wnt proteins, which has an important role in stimulating inflammation, cellular proliferation, differentiation, apoptosis, migration, and polarity. Objective To study the immunohistochemical expression of Wnt5a in patients with cutaneous and oral LP in comparison with healthy participants to study its possible role in the pathogenesis of the disease. Patients and methods Sixty patients with cutaneous and oral LP were included in this study, in addition to 40 healthy skin and oral mucosa specimens serving as controls. Punch biopsies of 3 mm were taken from lesional skin and control skin and were immunohistochemically stained for Wnt5a expression. Results There was a statistically significant increase in Wnt5a expression in cutaneous and oral LP lesions compared with normal controls. Moreover, Wnt5a expression was increased in hypertrophic and oral types of LP when compared with other types: classic, atrophic, and actinic. Moreover, a statistically higher expression of Wnt5a was found in hepatitis C antibodies-positive patients when compared with hepatitis C antibodies-negative patients. Conclusion Expression of Wnt5a was significantly increased in patients with LP than in controls, and this supports that Wnt5a might be involved in the pathogenesis of LP. Overexpression of Wnt5a in hypertrophic and oral types of lichen may predispose to malignant transformation. Therefore, these patients should be followed up regularly.

Classic and Hypertrophic Vulvar Lichen Planus.

ObjectivesThree types of lichen planus (LP) occur on the vulva: erosive, classic, and hypertrophic. The latter 2 occur on keratinized skin and little is known about their clinicopathologic appearance.Materials and MethodsVulvar biopsies of keratinized skin reported as LP or “lichenoid” between 2011 and 2017 were reviewed. Inclusion required age of older than 18 years, a lichenoid tissue reaction, and insufficient abnormal dermal collagen to diagnose lichen sclerosus. Clinical and histopathologic data were collected and cases were categorized as hypertrophic, classic, or nonspecific lichenoid dermatosis. Descriptive statistics were performed and groups were compared with the Fisher exact test.ResultsSixty-three cases met criteria for inclusion. Twenty-nine (46%) cases were categorized as hypertrophic LP, 21 (33%) as classic LP, and 13 (21%) as nonspecific lichenoid dermatosis. There were no significant differences in age, primary symptom, biopsy location, or duration of disease between the 3 groups. When compared with classic and nonspecific disease, hypertrophic LP was less likely to have comorbid dermatoses and more likely to be red, diffuse, have scale crust, and contain plasma cells in the infiltrate. Nonspecific disease had similar clinical features to classic LP but was less likely than the other 2 categories to have a dense lymphocytic infiltrate and exocytosis.ConclusionsVulvar LP on keratinized skin has a diversity of appearances and presents a clinicopathologic challenge. Further research is required to understand the natural history of hypertrophic LP and the underlying diagnosis of nonspecific lichenoid cases.

Prevalence and characteristics of various types of lichen planus in the Moscow Region

Rationale: Lichen planus (LP) is an important problem for the healthcare due to its increasing prevalence, as well as typical, atypical and prone to malignization types of the disease that can be both severe and poorly responding to treatment. Accurate data on the prevalence of LP are lacking. Aim: To assess the prevalence of various LP types in the patient population of the Moscow Region. Materials and methods: We analyzed the results of examination of 338 patients with LP, who were getting standard treatment in the Department of Dermatovenereology and Dermato-oncology of the Moscow Regional Research and Clinical Institute (MONIKI) in 1999 to 2017. Results: Among 338 LP patients, atypical LP of the skin was diagnosed in 81 (23.96%): hypertrophic type, in 31 (38.27%), pigmented, in 23 (28.4%), atrophic, in 11 (13.58%), follicular, in 8 (9.88%), lichen obtusus, in 3 (3.7%), bullous, in 1 (1.23%), erythematous, in 1 (1.23%), vulvovaginal-gingival syndrome, in 2 (2.47%), and Grinspan's syndrome, in 1 (1.23%). In 35 (43.21%) of patients, cutaneous LP was associated with atypical oral LP (OLP): in 17 (48.57%) of cases with hyperkeratotic, in 11 (31.43%), with erosive, and in 7 (20%), with exudative-hyperemic type. In 19 (23.46%) cases, atypical cutaneous LP was associated with LP of the genital mucosae, including in 12 (63.16%) cases with a typical reticular type, in 6 (31.58%), with atypical erosive, and in 1 (5.26%), with hypertrophic type. In 16 (4.73%) of the patients there was atypical OLP only; in 6 (37.5%) of them it had the exudative-hyperemic type, in 5 (31.25%), erosive, and in 5 (31.25%), hyperkeratotic. The most severe course of the dermatosis was observed for follicular, atrophic, hypertrophic types of cutaneous LP, vulvovaginal-gingival syndrome, and erosive OLP. Conclusion: Atypical LP was diagnosed in 81 (23.96%) cases, and in 45 (55.6%) cases it was associated with the OLP. The latter in 35 (43.21%) of cases was characterized by atypical lesions of OLP, including 11 (31.43%) cases of obligate precancerous erosive LP, which necessitates that this patient category should be managed with high cancer vigilance.

A rare case of isolated erosive ulcerative lichen planus of the vermilion zone

Unlike oral lichen planus (LP), isolated LP of the vermilion zone is a rare disease. It has a higher risk of malignization compared to other LP types, especially with the long course of the disease, which is to be related to frequent injuries and insolation of the area. In its turn, erosive/ulcerative form of LP under adverse circumstances (smoking, external irritants, immunosuppression, etc.) may antedate leukoplakia or transform into cancer; this clinical type of oral LP is difficult to differentiate from invasive squamous cancer. We describe a clinical case of isolated erosive LP of the vermilion of the lower lip, long lasting and resistant to therapy. Due to persisting erosion on the lip, we performed an assessment by immunohistochemistry and histology to exclude squamous cell carcinoma. After the malignancy had been excluded and the diagnosis has been made, the patient was administered the treatment with aromatic retinoid acitretin, which was effective and led to complete epithelialization of the lesion. In patients with a long lasting, persistent LP of the vermilion, diagnostic biopsy should be performed to exclude malignization before administration of treatment.

Lichen Planus and Its Management: An Update and Observation

Lichen planus (LP) is an inflammatory muco-cutaneous disease characterised by shiny, flat-topped papules and plaques. It affects around 1% of the population. The disease is usually self-limiting and benign in nature. However, some varieties of LP may cause considerable discomfort and recalcitrant in nature. So, treatment depends on appreciating the type, severity and nature of the disease. There are a good numbers of options for treating different types of LP. Few types of LP are difficult to treat and needs aggressive treatment to prevent complications like hair or nail loss. Author examined and summarized the published literature involving the treatment or management of LP. It is found that the large scale, evidence based trials are only few in number. At present, it is quite difficult to standardisation of treatment. This review outlines the ongoing trial and current treatment options. It is needed to assimilation and summarization of the recent findings to treat the critical cases in a more effective way

Prevalence of metabolic syndrome in patients with lichen planus: A cross-sectional study from a tertiary care center

Background:There have been reports of association between lichen planus (LP) and metabolic syndrome and its various parameters.Aims and Objectives:To determine the prevalence of metabolic syndrome in patients with LP and to determine the association between the morphologic types of LP and metabolic syndrome.Materials and Methods:In this cross-sectional study conducted over a period of 1 year, 70 clinically diagnosed patients with LP were included and evaluated for metabolic syndrome based on the modified National Cholesterol Education Program: Adult Treatment Panel III guidelines. Data were analyzed using Statistical Package for the Social Sciences version 17 software, and inferential statistical tools such as t-test for continuous data and Chi-square test for categorical data were used.Results:A 35.7% prevalence of metabolic syndrome was found in patients with LP. The average duration of LP was found to be higher in patients with metabolic syndrome. There was a higher prevalence of central obesity, increased fasting blood sugar, and low high-density lipoprotein-cholesterolin patients with LP.Conclusion:Metabolic syndrome was seen in 25 patients (35.7%) with LP. It is important to advise our patients to adopt healthy lifestyle choices to help prevent comorbidities and improve the general health of population. As this study was a cross-sectional study, the directionality of the association between LP and metabolic syndrome could not be assessed. Lack of controls and a small sample size are other limitations of our study.

Autoantibodies to desmogleins 1 and 3 in patients with lichen planus

There is controversy about the role of autoantibodies against desmoglein 1 and 3 (Dsg1 and 3) in the pathogenesis of lichen planus (LP); the authors planned this study to determine the presence of circulating levels of these antibodies in patients with different types of oral LP and to compare that with cutaneous LP and healthy controls. The enzyme-linked immunosorbent assay test was performed on serum samples of 24 cases of erosive oral LP, 29 cases of reticular oral LP, 30 cases of cutaneous LP and 30 healthy controls. The severity of oral LP was evaluated by Reticulation, Erosion and Ulceration scoring system. There were no significant differences in the concentrations of autoantibodies to Dsg1 between the four groups. Autoantibodies to Dsg3 were increased in erosive oral LP compared with healthy controls (p value=0.005) but no increase was observed between other groups. We did not detect a correlation between the severity of the disease and the levels of anti-Dsg1 and 3 in patients with erosive and reticular types of oral LP. In conclusion, regardless of the increased level of anti-Dsg3 antibody in erosive oral LP, serum concentrations of antibodies were under cut-off values. Moreover, the pathogenic role of anti-Dsg3 antibodies in erosive oral LP is uncertain.

Bullous lichen planus - a review.

Bullous lichen planus is a rare variant of lichen planus. It is characterized by vesicles or bullae, which usually develop in the context of pre-existing LP lesions. It is often misdiagnosed and should be differentiated from other subepidermal bullous diseases especially lichen planus pemphigoides. The diagnosis is based on clinical suspicion and is confirmed by histopathology and immunofluoresence. The clinical features of bullous lichen planus include typical lichen planus lesions, accompanied by the formation of bullae on the affected or perilesional skin. This is evident on histology, with alteration of the dermo-epidermal junction and intrabasal bullae as a consequence of extensive inflammation. The histologic features in conjunction with the negative immunofluoresence indicate that bullous lichen planus is a form of "hyper-reactive lichen planus" rather than a distinct entity. There is no standard treatment of bullous lichen planus. Topical and systemic corticosteroids, dapsone and acitretin have been described as effective choices.