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Rousseau MA, Nelson EE, Rashid RM. A Review of Linear Lichen Planus Case Reports. Am J Dermatopathol 2024; 46:553-562. [PMID: 39150180 DOI: 10.1097/dad.0000000000002661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
ABSTRACT Lichen linear planus is a rare variant of lichen planus that appears as pruritic, polygonal, purple papules in a blaschkoid distribution. This review critically assesses all reported cases of linear lichen planus (LLP) for proposed etiology, clinical and histologic traits, treatment options, and recurrence. A PubMed search from inception through March 2023, followed by article screening and full-text review, identified 51 unique cases of LLP. Data from each case including the sex of the patient, anatomic distribution of lesions, biopsy results, proposed etiology, treatment, and recurrence were recorded. LLP did not show a significant gender or age predilection, most frequently presented unilaterally with pruritus, and involved numerous anatomic regions. Various triggers including metal implants, vaccinations, infections, malignancy, and pregnancy were identified. The most common histopathologic descriptions included band-like lymphocytic or lichenoid infiltrate, basal liquefactive, vacuolar degeneration, hypergranulosis, hyperkeratosis, civatte or colloid bodies, melanin incontinence, and orthokeratosis. Treatment options, duration of treatment, and recurrence rate of LLP lesions were variable. Although LLP is rare, dermatologists should be aware of this presentation and appropriate diagnostic and treatment options because swift diagnosis can reduce patient morbidity.
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Affiliation(s)
- Morgan A Rousseau
- Resident Physician, Internal Medicine, The University of Texas Health Science Center at Houston John P. and Kathrine G. McGovern Medical School, Houston, TX
| | - Emelie E Nelson
- Medical Student, Dermatology, The University of Texas Health Science Center at Houston John P. and Kathrine G. McGovern Medical School, Houston, TX; and
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Tekin B, Xie F, Lehman JS. Lichen Planus: What is New in Diagnosis and Treatment? Am J Clin Dermatol 2024:10.1007/s40257-024-00878-9. [PMID: 38982032 DOI: 10.1007/s40257-024-00878-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2024] [Indexed: 07/11/2024]
Abstract
Lichen planus (LP), an idiopathic, multifaceted chronic inflammatory disease with a heterogeneous clinical presentation, affects approximately 0.5-1% of the population. The various clinical manifestations of LP fall into three broad categories, namely cutaneous, appendageal, and mucosal, with further subclassification depending on the morphology and distribution patterns of individual lesions. There is mounting evidence that LP has systemic associations, including autoimmune conditions, glucose intolerance, dyslipidemia, and cardiovascular disorders. Cutaneous hypertrophic and mucosal forms of LP are at a heightened risk for malignant transformation. Familiarity with these potential associations in conjunction with long-term follow-up and regular screening could lead to a timely diagnosis and management of concomitant conditions. In addition, the frequent quality of life (QoL) impairment in LP underscores the need for a comprehensive approach including psychological evaluation and support. Several treatment strategies have been attempted, though most of them have not been adopted in clinical practice because of suboptimal benefit-to-risk ratios or lack of evidence. More recent studies toward pathogenesis-driven treatments have identified Janus kinase inhibitors such as tofacitinib, phosphodiesterase-4 inhibitors such as apremilast, and biologics targeting the interleukin-23/interleukin-17 pathway as novel therapeutic options, resulting in a dramatic change of the treatment landscape of LP. This contemporary review focuses on the diagnosis and management of LP, and places emphasis on more recently described targeted treatment options.
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Affiliation(s)
- Burak Tekin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Fangyi Xie
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
- Department of Dermatology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Julia S Lehman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.
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Boch K, Langan EA, Kridin K, Zillikens D, Ludwig RJ, Bieber K. Lichen Planus. Front Med (Lausanne) 2021; 8:737813. [PMID: 34790675 PMCID: PMC8591129 DOI: 10.3389/fmed.2021.737813] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/11/2021] [Indexed: 12/17/2022] Open
Abstract
Lichen planus (LP) is a T cell-mediated disease affecting the stratified squamous epithelia of the skin and/or mucus membrane. Histologically, the disease is characterized by a lichenoid inflammatory infiltrate and vacuolar degeneration of the basal layer of the epidermis. LP has three major subtypes: Cutaneous, mucosal and appendageal LP. Rarely, it may affect the nails in the absence of skin and/or mucosal changes. LP may also be induced by several drugs, typically anti-hypertensive medication or be associated with infections, particularly viral hepatitis. The diagnosis is based on the clinical presentation and characteristic histological findings. Although the disease is often self-limiting, the intractable pruritus and painful mucosal erosions result in significant morbidity. The current first-line treatment are topical and/or systemic corticosteroids. In addition, immunosuppressants may be used as corticosteroid-sparing agents. These, however are often not sufficient to control disease. Janus kinase inhibitors and biologics (anti-IL-12/23, anti-IL17) have emerged as novel future treatment options. Thus, one may expect a dramatic change of the treatment landscape of LP in the near future.
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Affiliation(s)
- Katharina Boch
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Ewan A Langan
- Department of Dermatology, University of Lübeck, Lübeck, Germany.,Dermatological Sciences, University of Manchester, Manchester, United Kingdom
| | - Khalaf Kridin
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Detlef Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Ralf J Ludwig
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Katja Bieber
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
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Belhareth K, Korbi M, Belhadjali H, Soua Y, Moussa A, Youssef M, Zili J. Pediatric lichen planus pigmentosus possibly triggered by mercury dental amalgams. Pediatr Dermatol 2020; 37:375-376. [PMID: 31876002 DOI: 10.1111/pde.14078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Lichen planus pigmentosus is uncommon in childhood and its treatment is often challenging. We report a case of cutaneous lichen planus pigmentosus in a 10-year-old boy, without oral mucosal involvement, two months after an amalgam dental restoration. The diagnosis was based on the histopathological examination of a skin biopsy, the positive patch test to mercury, and the improvement after amalgam removal. Our case report suggests that metal allergy may play a role, and amalgam replacement may be followed by clinical improvement.
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Affiliation(s)
- Kamar Belhareth
- Dermatology Department, Fattouma Bourguiba University Hospital, University of Medicine, University of Monastir, Monastir, Tunisia
| | - Mouna Korbi
- Dermatology Department, Fattouma Bourguiba University Hospital, University of Medicine, University of Monastir, Monastir, Tunisia
| | - Hichem Belhadjali
- Dermatology Department, Fattouma Bourguiba University Hospital, University of Medicine, University of Monastir, Monastir, Tunisia
| | - Yosra Soua
- Dermatology Department, Fattouma Bourguiba University Hospital, University of Medicine, University of Monastir, Monastir, Tunisia
| | - Adnene Moussa
- Anatomopathology Department, Fattouma Bourguiba University Hospital, University of Medicine, University of Monastir, Monastir, Tunisia
| | - Monia Youssef
- Dermatology Department, Fattouma Bourguiba University Hospital, University of Medicine, University of Monastir, Monastir, Tunisia
| | - Jameleddine Zili
- Dermatology Department, Fattouma Bourguiba University Hospital, University of Medicine, University of Monastir, Monastir, Tunisia
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Law DZ, Vahdani K, Ashdown M, Garrott H, Ford RL. Periorbital linear lichen planus pigmentosus-report of 2 cases and literature review. Can J Ophthalmol 2018; 54:e12-e14. [PMID: 30851786 DOI: 10.1016/j.jcjo.2018.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 03/18/2018] [Accepted: 03/27/2018] [Indexed: 10/17/2022]
Affiliation(s)
- David Zhiwei Law
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, U.K; National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore; Vision Performance Centre, Military Medicine Institute, Singapore Armed Forces, Singapore.
| | - Kaveh Vahdani
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, U.K
| | - Morag Ashdown
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, U.K
| | - Helen Garrott
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, U.K
| | - Rebecca Louise Ford
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, U.K
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Fukumoto T, Tsuchiyama S, Fukunaga A, Nishigori C. Hypohidrosis and metal allergy: Trigger factors for unilateral lichen planus. J Dermatol 2017; 44:963-966. [PMID: 28342246 DOI: 10.1111/1346-8138.13836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 02/10/2017] [Indexed: 11/28/2022]
Abstract
Unilateral lichen planus (LP) is a rare clinical variant of LP. The etiology of unilateral LP has not been clarified, although various causes have been reported because of the characteristic distribution. We focused on the contribution of metal allergy and sweating in the development of unilateral LP in this case. To confirm the presence of metal allergy, patch tests with metal allergens were performed. To investigate the cause of the unilateral distribution in unilateral LP, the function of sweating and sweat leaking in the dermis was assessed by a thermoregulatory sweat test and immunohistochemical staining of dermcidin. The patch tests with SnCl2 , H2 PtCl6 , ZnCl2 and MnCl2 were positive. The thermoregulatory sweat test using the starch-iodine method (Minor test) with sweating provoked by heat stimulation revealed hypohidrosis of the affected area, whereas no skin lesions were observed on the dorsal hand and wrist where sweating was normal. Histopathological examination showed keratin plugging of the acrosyringium and lymphocytic infiltrations in the papillary and subpapillary dermis around the intraepidermal and intradermal eccrine duct in the affected area. The immunohistochemical staining of dermcidin confirmed sweat leakage in the subpapillary dermis in the affected area. The symptoms refractory to the topical steroids were markedly improved after removal of the dental metals. The coexistence of metal allergy and sweat leakage in the hypohidrotic area may be involved in the development of unilateral LP.
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Affiliation(s)
- Takeshi Fukumoto
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shinji Tsuchiyama
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Atsushi Fukunaga
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Chikako Nishigori
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
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A case of unilateral linear lichen planus: related to orthopedic prosthesis or not? Postepy Dermatol Alergol 2015; 32:310-1. [PMID: 26366158 PMCID: PMC4565834 DOI: 10.5114/pdia.2015.48046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 08/25/2014] [Accepted: 09/10/2014] [Indexed: 11/24/2022] Open
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Miyachi M, Matsuno T, Asano K, Mataga I. Anti-inflammatory effects of astaxanthin in the human gingival keratinocyte line NDUSD-1. J Clin Biochem Nutr 2015; 56:171-8. [PMID: 26060346 PMCID: PMC4454080 DOI: 10.3164/jcbn.14-109] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 10/06/2014] [Indexed: 01/08/2023] Open
Abstract
Oral lichen planus is a chronic inflammatory disease that affects the mucous membrane of the oral cavity and can contribute to the development of other diseases. Inflammation in oral lichen planus is a T-cell-mediated autoimmune disease that acts through cytotoxic CD8+ T cells to trigger apoptosis of keratinocytes. However, the specific cause of oral lichen planus remains unknown and no effective medical treatment has yet been established. Astaxanthin is a carotenoid pigment with capacity for anti-inflammatory and anti-oxidant activities. In this study, we evaluated whether astaxanthin could be used to improve the pathology of oral lichen planus by reducing inflammation. In particular, the anti-inflammatory effects of astaxanthin on the chronic inflammation caused by lipopolysaccharide derived from Escherichia coli O55 in human gingival keratinocytes (NDUSD-1) were evaluated. Following astaxanthin treatment, localization of nuclear factor κB/p65 and the level of inflammatory cytokines (interleukin-6, tumor necrosis factor-α) tended to decrease, and cell proliferation significantly increased in vitro. These results suggest that astaxanthin could be useful for improving chronic inflammation such as that associated with oral lichen planus.
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Affiliation(s)
- Masashiro Miyachi
- Department of Oral and Maxillofacial Surgery, The Nippon Dental University School of Life Dentistry at Tokyo, 1-9-20 Fujimi, Chiyoda-ku, Tokyo 102-8159, Japan
| | - Tomonori Matsuno
- Department of Oral and Maxillofacial Surgery, The Nippon Dental University School of Life Dentistry at Tokyo, 1-9-20 Fujimi, Chiyoda-ku, Tokyo 102-8159, Japan
| | - Kazunari Asano
- Department of Oral and Maxillofacial Surgery, The Nippon Dental University School of Life Dentistry at Tokyo, 1-9-20 Fujimi, Chiyoda-ku, Tokyo 102-8159, Japan
| | - Izumi Mataga
- Department of Oral and Maxillofacial Surgery, The Nippon Dental University School of Life Dentistry at Tokyo, 1-9-20 Fujimi, Chiyoda-ku, Tokyo 102-8159, Japan
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Abstract
Linear lichen planus (LLP) is a very rare form of lichen planus (LP) characterized by a linear distribution of the lichenoid lesions. It usually follows the lines of Blaschko with unilateral involvement. We report such a case of LLP. A 50-year-old man presented with slightly pruritic, linear, violaceous, papular lesions on the right side of his jaw. A biopsy specimen demonstrated the typical histology of LP. Based on the clinical and pathological findings, the diagnosis was LLP.
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Affiliation(s)
- Ibrahim Kökçam
- Department of Dermatology, Firat University School of Medicine, Elaziğ, Turkey
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Gunning ST, Turiansky GW. Successive linear, generalized, and oral lichen planus in a patient with chronic hepatitis C infection*. J Am Acad Dermatol 2003; 49:1190-1. [PMID: 14639418 DOI: 10.1016/s0190-9622(03)01579-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ramón-Fluixá C, Bagán-Sebastián J, Milián-Masanet M, Scully C. Periodontal status in patients with oral lichen planus: a study of 90 cases. Oral Dis 1999; 5:303-6. [PMID: 10561718 DOI: 10.1111/j.1601-0825.1999.tb00094.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study was carried out to relate periodontal status to the oral lesions in patients with oral lichen planus (OLP). MATERIALS AND METHODS Periodontal status was evaluated in 90 patients with OLP and in 52 controls, in terms of the plaque index (PII), simplified calculus index (CIS) and periodontal disease index (PDI). RESULTS No significant differences were observed between the two groups as regards the different periodontal indices. The plaque and calculus indices were higher in the more extensive forms of OLP (P = 0.02 and P = 0.012, respectively), and in the presence of gingival involvement (P = 0.004 and P = 0.04). A significant association was also observed between the presence of atrophic-erosive lesions and increased periodontal deterioration (P = 0.037). CONCLUSIONS Increased plaque and calculus deposits are associated to a significantly higher incidence of atrophic-erosive gingival lesions in patients with OLP.
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