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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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Cyclosporine or methotrexate, which one is more promising in the treatment of lichen planopilaris?; A comparative clinical trial. Int Immunopharmacol 2020; 86:106765. [PMID: 32674048 DOI: 10.1016/j.intimp.2020.106765] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/28/2020] [Accepted: 06/29/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Lichen Planopilaris (LPP) is a primary scarring alopecia with unknown etiology and its management is a challenge for dermatologists. We aimed to compare the safety and efficacy of methotrexate and cyclosporine in LPP patients. METHODS In a randomized clinical trials, 33 patients were randomly allocated to receive either 15-mg oral methotrexate per week or 3-5-mg/kg/day cyclosporine for six months. During the treatment course, side effects, signs/symptoms and laboratory test were assessed periodically. Lichen planopilaris activity index (LPPAI) was measured at baseline and 2, 4, and 6 months after the intervention. Score of both photography and patient's opinion were also obtained. The collected data were analyzed in SPSS software (Ver.25.0. Armonk, NY: IBM Corp). RESULTS Both medications had positive effects on the signs and symptoms of LPP with a significant difference between the variables (p < 0.05), and the results showed similar efficacy at the end of 6th months of the therapy with both cyclosporine and methotrexate (p > 0.05). CONCLUSIONS Regarding the results of the present study, both cyclosporine and methotrexate are effective in treating refractory lichen planopilaris and we propose methotrexate as a possible earlier choice over cyclosporine. This study was registered in Iranian Registry of Clinical Trials (IRCT20190717044256N1).
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Tziotzios C, Brier T, Lee JY, Saito R, Hsu CK, Bhargava K, Stefanato CM, Fenton DA, McGrath JA. Lichen planus and lichenoid dermatoses. J Am Acad Dermatol 2018; 79:807-818. [DOI: 10.1016/j.jaad.2018.02.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Bulbul Baskan E, Yazici S. Treatment of lichen planopilaris: methotrexate or cyclosporine a therapy? Cutan Ocul Toxicol 2017; 37:196-199. [PMID: 28944688 DOI: 10.1080/15569527.2017.1382503] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Because of irreversible outcome of the lichen planopilaris (LPP), systemic therapy should be used in early inflammatory stages of the disease, without allowing the irreversible scar formation and permanent hair loss. OBJECTIVE We assessed the efficacy and safety of methotrexate (MTX) and cyclosporine A (CsA) in the management of recalcitrant, extensive LPP and compared their efficacy and safety profile. METHODS We retrospectively analysed the 16 LPP cases treated with either CsA or MTX therapy. Clinical improvement was defined as the absence of reported symptoms, lack of progression and reduction in erythema and follicular hyperkeratosis found in SIAscopic images. RESULTS A total of 16 patients received either CsA (six cases) or MTX (10 cases) therapy. The dosage of CsA was between 3 and 5 mg/kg/day. The initial dosage of MTX was 10-15 mg/wk and tapered gradually. The clinical improvement was demonstrated significantly at SIAscopic images taken at the third months of therapy. CONCLUSIONS Our observations suggest that both MTX and CsA therapies provide similar clinical efficacy at the end of first month of therapy with dosages used in psoriasis therapy. MTX was found to be better tolerated in this study.
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Affiliation(s)
- Emel Bulbul Baskan
- a Department of Dermatology and Venereology , Uludag University School of Medicine , Bursa , Turkey
| | - Serkan Yazici
- a Department of Dermatology and Venereology , Uludag University School of Medicine , Bursa , Turkey
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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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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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