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Kothari R, Sandhu S, Bhatnagar A, Walia GK, Valarmathi T. A Case Series on a Rare Clinical Presentation of Lichen Planopilaris Restricted to the Face. Cureus 2024; 16:e59987. [PMID: 38854167 PMCID: PMC11162256 DOI: 10.7759/cureus.59987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2024] [Indexed: 06/11/2024] Open
Abstract
Lichen planopilaris (LPP) restricted to the face is extremely rare. This case series includes five unique LPP cases that presented with a varied degree of pigmentation and scarring alopecia restricted to the face. We herein describe the clinical characteristics, dermoscopy, and treatment of these histopathologically confirmed facial LPP cases. None of them had lesions anywhere else on the body.
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Affiliation(s)
- Rohit Kothari
- Dermatology, Command Hospital Air Force Bangalore, Bangalore, IND
| | | | - Anuj Bhatnagar
- Dermatology, Command Hospital Air Force Bangalore, Bangalore, IND
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Merio L, Tounkara TM, Battesti G, Cordoliani F, Arsouze A, Bagot M, Battistella M, Petit A. Blaschko-linear lichen planus of the face: A retrospective study of 6 cases and a literature review. Ann Dermatol Venereol 2021; 149:112-118. [PMID: 34538651 DOI: 10.1016/j.annder.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/07/2021] [Accepted: 08/02/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND METHODS Different clinical and histological variants of lichen planus (LP) exist, such as lichen planopilaris, pigmentosus, linear, or atrophic LP. Recently, some cases came to our attention of hyperpigmented and atrophic linear lesions of the face with lichenoid histology, suggesting a combination of these different variants. We carried out a single-center, retrospective descriptive study of 6 similar cases selected from our database and compared them with a literature review. RESULTS There were 4 males and 2 females of mean age 42 years. Each had linear lesions located on one side of the face. All lesions were initially itchy; they appeared hyperpigmented in all patients and atrophic in 5 cases. Biopsies indicated lichen planopilaris in 5 patients, with deep peri-eccrine involvement in 4 of them. Only 2 of the 6 patients had extra-facial lesions. DISCUSSION AND LITERATURE REVIEW We found 24 cases in the literature having similar clinical and histological aspects. Men aged around 37 years seemed particularly affected. An atrophic course was noticed in 10 patients. Such a clinicopathological picture may suggest differential diagnoses like lichen striatus, lupus erythematosus, lichen sclerosus atrophicus, or Moulin's linear atrophoderma. Early histopathological examination could be of precious assistance in allowing the initiation of effective treatment immediately as of the initial inflammatory phase, thereby limiting the risk of cosmetic sequelae such as atrophy or residual pigmentation. CONCLUSION We describe a form of facial lichen planus that is highly particular in terms of its follicular tropism, its blaschkoid distribution, its pigmented character, and its atrophic progression.
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Affiliation(s)
- L Merio
- Department of Dermatology, Saint-Louis Hospital, University of Paris, AP-HP, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10, France.
| | - T-M Tounkara
- Department of Dermatology, Saint-Louis Hospital, University of Paris, AP-HP, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10, France; Gamal-Abdel-Nasser University of Conakry, Conakry, Guinea
| | - G Battesti
- Department of Dermatology, Saint-Louis Hospital, University of Paris, AP-HP, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10, France
| | - F Cordoliani
- Department of Dermatology, Saint-Louis Hospital, University of Paris, AP-HP, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10, France
| | - A Arsouze
- Department of Dermatology, Saint-Louis Hospital, University of Paris, AP-HP, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10, France
| | - M Bagot
- Department of Dermatology, Saint-Louis Hospital, University of Paris, AP-HP, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10, France
| | - M Battistella
- Department of Pathology, Saint-Louis Hospital, University of Paris, AP-HP, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10, France
| | - A Petit
- Department of Dermatology, Saint-Louis Hospital, University of Paris, AP-HP, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10, France
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Turegano MM, Sperling LC. Lichenoid folliculitis: A unifying concept. J Cutan Pathol 2017; 44:647-654. [PMID: 28345255 DOI: 10.1111/cup.12938] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/13/2017] [Accepted: 03/21/2017] [Indexed: 12/19/2022]
Abstract
Skin diseases presenting with keratotic papules, atrophy, cicatricial alopecia and/or "lichenoid" histopathologic changes have been described under at least 30 names. This family of diseases contains 2 subgroups, largely based on clinical features: keratosis pilaris atrophicans (KPA; including keratosis pilaris atrophicans faciei/ulerythema ophryogenes, atrophoderma vermiculatum, and keratosis follicularis spinulosa decalvans); and the lichen planopilaris (LPP) subgroup (including LPP, frontal fibrosing alopecia, Graham-Little-Piccardi-Lassueur Syndrome and fibrosing alopecia in a pattern distribution). An interface dermatitis with lichenoid inflammation is characteristic of the LPP group of disorders, but the literature provides scant information about the histopathology of the KPA group. Our experience has been that the 2 subgroups show a unifying histologic similarity as well as considerable clinical overlap. Because these conditions overlap clinically and histologically, we propose that the term lichenoid folliculitis (LF) be used to refer to this group of diseases, thus simplifying cumbersome nomenclature and highlighting the possibility of shared pathogenesis and treatment options.
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Affiliation(s)
- Mamina M Turegano
- Department of Pathology and Laboratory Medicine, Division of Dermatopathology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Maryland
| | - Leonard C Sperling
- Department of Dermatology, Uniformed Services University of the Health Sciences, Los Angeles, Maryland
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Asz-Sigall D, González-de-Cossio-Hernández AC, Rodríguez-Lobato E, Ortega-Springall MF, Vega-Memije ME, Arenas Guzmán R. Linear Lichen Planopilaris of the Face: Case Report and Review. Skin Appendage Disord 2016; 2:72-75. [PMID: 27843930 DOI: 10.1159/000446967] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 05/18/2016] [Indexed: 01/05/2023] Open
Abstract
We describe the case of a 45-year-old man who presented with a 5-month history of unilateral pruritic linear erythematous papules and atrophy on the chin and mandibular area. Dermoscopy showed areas of cicatricial alopecia with absence of follicular openings, perifollicular erythema and pigment. Lichen planopilaris of the face is a rare variant with only 13 cases reported in the literature.
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Affiliation(s)
- Daniel Asz-Sigall
- Dermato-Oncology and Trichology Clinic, National University of Mexico, México City, Mexico
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Abstract
Background: Lichen planopilaris (LPP) is believed to be a follicular variant of lichen planus that affects pilosebaceous units, mainly of the scalp. An extremely rare variant of LPP is a linear form, which follows the lines of Blaschko. Of the five previously documented cases of linear LPP, all were limited to the face. Objective: We report the case of a 34-year-old male who presented with a nonpruritic eruption on the trunk consisting of erythematous, keratotic, folliculocentric papules following Blaschko's lines. Results: Biopsy revealed lichenoid and interface dermatitis involving the basilar epidermis and hair follicles, as well as apoptotic keratinocytes, consistent with LPP. Conclusion: This represents the first documented case of LPP, following the Blaschko's lines, in a nonfacial distribution.
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Affiliation(s)
- Kristi Baker
- Department of Pathology, Division of Dermatology, SMBD-Jewish General Hospital, McGill University, Montreal, QC
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Kluger N, Jegou MH, Assouly P. [Beard and moustache dermatosis and alopecia]. Ann Dermatol Venereol 2014; 141:624-32; quiz 623, 633. [PMID: 25288068 DOI: 10.1016/j.annder.2014.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 05/02/2014] [Accepted: 05/23/2014] [Indexed: 10/24/2022]
Affiliation(s)
- N Kluger
- Departments of dermatology, allergology and venereology, Institute of Clinical Medicine, University of Helsinki, Skin and Allergies Hospital, Helsinki University Central Hospital, Meilahdentie 2, PO Box 160, 00029 HUS, Finlande.
| | - M-H Jegou
- Cabinet de dermatologie, 8, rue Jules-Ferry, 33290 Blanquefort, France
| | - P Assouly
- Centre Sabouraud, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France
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Rácz E, Gho C, Moorman PW, Noordhoek Hegt V, Neumann HAM. Treatment of frontal fibrosing alopecia and lichen planopilaris: a systematic review. J Eur Acad Dermatol Venereol 2013; 27:1461-70. [PMID: 23531029 DOI: 10.1111/jdv.12139] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 02/18/2013] [Indexed: 02/06/2023]
Abstract
Frontal fibrosing alopecia (FFA) is a primary lymphocytic cicatricial alopecia with characteristic clinical pattern of progressive frontotemporal hairline recession, perifollicular erythema and hyperkeratosis and symptoms of itch and burning, occurring mainly in post-menopausal women. FFA is considered a subtype of lichen planopilaris (LPP), based on their identical histopathology. Currently, no evidence-based treatment is available for FFA. Our aim was to determine the effectiveness of available treatment options for FFA, and to identify promising treatment options for future studies. For this, literature search was conducted to find all primary studies on the treatment of FFA and LPP. From the primary studies, data were subtracted and analysed. No randomized controlled trials were found, and one controlled trial. Treatment of 114 patients is described in the literature. They received 10 different regimes, of which oral 5-alpha-reductase inhibitors were provided most often, resulting in good clinical response in 45% of them. Hydroxychloroquine resulted in good clinical response in 30% of the 29 treated patients. Topical corticosteroid preparations are ineffective in FFA. The remaining treatments were all reported in less than 10 patients. For the treatment of LPP, topical corticosteroid preparations are the first line of treatment, followed by oral cyclosporine and systemic corticosteroids, although they are characterized by a high relapse rate. Summarizing, there is currently no effective treatment of FFA, the most effective being oral 5-alpha-reductase inhibitors that possibly affect the accompanying androgenetic alopecia. We argue that oral cyclosporine A might be a good candidate for future studies on the treatment of FFA.
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Affiliation(s)
- E Rácz
- Department of Dermatology and Venereology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Giménez-García R, Lázaro-Cantalejo TE, Sánchez-Ramón S, Velasco Fernandez C. Linear lichen planopilaris of the face. J Eur Acad Dermatol Venereol 2005; 19:770-2. [PMID: 16268895 DOI: 10.1111/j.1468-3083.2005.01260.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Shemer A, Weiss G, Trau H. Wolf's isotopic response: a case of zosteriform lichen planus on the site of healed herpes zoster. J Eur Acad Dermatol Venereol 2001; 15:445-7. [PMID: 11763387 DOI: 10.1046/j.1468-3083.2001.00345.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Based on histological findings, the patient had lichen planus. The clinical picture suggests Wolf's isotopic response on the site of healed herpes zoster. These conditions taken into account lead to the diagnosis of zosteriform lichen planus. Lichenoid papules in a dermatomal arrangement are extremely rare. The clinical, dermoscopic and histological features of this case are described.
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Affiliation(s)
- A Shemer
- Department of Dermatology, Chaim Shea Medical Center, Tel Hashomer, Israel
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Abstract
The lines of Blaschko describe distribution patterns which may represent embryologic developmental pathways. This distribution may occasionally be followed by some congenital and acquired skin disorders. We describe a child with linear cutaneous lupus erythematosus (LCLE) following Blaschko lines on the face.
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Affiliation(s)
- M W Lee
- Department of Dermatology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
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Lee MW, Choi JH, Sung KJ, Moon KC, Koh JK. Linear eruptions of the nose in childhood: a form of lichen striatus? Br J Dermatol 2000; 142:1208-12. [PMID: 10848749 DOI: 10.1046/j.1365-2133.2000.03552.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report four children with linear eruptions on the nose, with overlapping features of lichen striatus and linear cutaneous lupus erythematosus. However, linear lupus erythematosus has rarely been reported, and lichen striatus, although classically linear, rarely affects the face. The linear distribution of lesions from the glabella to the ala nasi may represent distribution following Blaschko's lines.
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Affiliation(s)
- M W Lee
- Department of Dermatology, Asan Medical Center, College of Medicine, University of Ulsan, 388-1 Poongnap-Dong, Songpa-Gu, Seoul 138-736, Korea.
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Reply. J Am Acad Dermatol 1999. [DOI: 10.1016/s0190-9622(99)70213-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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