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Direct Immunofluorescence as a Helpful Tool for the Differential Diagnosis of Oral Lichen Planus and Oral Lichenoid Lesions. Am J Dermatopathol 2018; 40:491-497. [DOI: 10.1097/dad.0000000000001071] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Montague L, Bhattacharyya I, Islam M, Cohen D, Fitzpatrick S. Direct immunofluorescence testing results in cases of premalignant and malignant oral lesions. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119:675-83. [DOI: 10.1016/j.oooo.2015.02.478] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 02/19/2015] [Accepted: 02/20/2015] [Indexed: 01/03/2023]
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Ismail SB, Kumar SKS, Zain RB. Oral lichen planus and lichenoid reactions: etiopathogenesis, diagnosis, management and malignant transformation. J Oral Sci 2008; 49:89-106. [PMID: 17634721 DOI: 10.2334/josnusd.49.89] [Citation(s) in RCA: 312] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Lichen planus, a chronic autoimmune, mucocutaneous disease affects the oral mucosa (oral lichen planus or OLP) besides the skin, genital mucosa, scalp and nails. An immune mediated pathogenesis is recognized in lichen planus although the exact etiology is unknown. The disease most commonly affects middle-aged females. Oral lichenoid reactions (OLR) which are considered variants of OLP, may be regarded as a disease by itself or as an exacerbation of an existing OLP, by the presence of medication (lichenoid drug reactions) or dental materials (contact hypersensitivity). OLP usually presents as white striations (Wickham's striae), white papules, white plaque, erythema, erosions or blisters. Diagnosis of OLP is established either by clinical examination only or by clinical examination with histopathologic confirmation. Direct immunofluorescence examination is only used as an adjunct to the above method of diagnosis and to rule out specific autoimmune diseases such as pemphigus and pemphigoid. Histopathologic features of OLP and OLR are similar with suggestions of certain discriminatory features by some authors. Topical corticosteroids are the treatment of choice for OLP although several other medications have been studied including retinoids, tacrolimus, cyclosporine and photodynamic therapy. Certain OLP undergo malignant transformation and the exact incidence and mechanisms are still controversial. In this paper, etiopathogenesis, diagnosis, management and malignant transformation of OLP and OLR have been reviewed.
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Affiliation(s)
- Sumairi B Ismail
- Department of Oral Pathology, Oral Medicine and Periodontology, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
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Gürbüz Y, Apaydin R, Müezzinoğlu B, Bilen N, Ozkara SK. Altered cytokeratin expression in lichen planus. J Eur Acad Dermatol Venereol 2003; 17:235-6. [PMID: 12705766 DOI: 10.1046/j.1468-3083.2003.00577_7.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Yih WY, Maier T, Kratochvil FJ, Zieper MB. Analysis of desquamative gingivitis using direct immunofluorescence in conjunction with histology. J Periodontol 1998; 69:678-85. [PMID: 9660337 DOI: 10.1902/jop.1998.69.6.678] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Chronic desquamative gingivitis (DG) is a common condition often first recognized by periodontists. DG is characterized clinically by erythema with epithelial desquamation, ulceration, and/or the presence of vesiculobullous lesions of the free and attached gingiva. However, DG is actually a clinical manifestation of several different disease processes, particularly lichen planus and benign mucous membrane pemphigoid. Correct diagnosis in DG is critical since proper treatment and follow-up will depend on which disease is involved. However, the diseases that cause DG frequently present diagnostic problems because their lesions often resemble each other clinically and routine histological examination sometimes cannot differentiate between them. Thus, immunohistology, particularly immunofluorescence, is increasingly being used with routine histology to more accurately diagnose DG diseases. This article reviews our experience over the past 10 years in the diagnosis of 72 cases of DG using direct immunofluorescent (DIF) in conjunction with histology and clinical evaluation. Of the 72 DG cases in this study, 30 cases were diagnosed as erosive lichen planus or lichenoid mucositis; 29 cases were diagnosed as benign mucous membrane pemphigoid; 2 cases each of linear IgA disease and pemphigus vulgaris were diagnosed; there was 1 case of bullous pemphigoid; and 1 suspected case of paraneoplastic pemphigus. Even with DIF analysis, 7 cases could not be definitively assigned a particular cause. DIF analysis is not only proving very useful for differential diagnosis, but also adds insight into possible pathogenic mechanisms of DG.
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Affiliation(s)
- W Y Yih
- Department of Oral Pathology, School of Dentistry, Oregon Health Sciences University, Portland 97201-3097, USA
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Biermann H, Rauterberg EW. Expression of fetal cytokeratins in epidermal cells and colloid bodies in lichen planus. J Cutan Pathol 1998; 25:35-43. [PMID: 9508342 DOI: 10.1111/j.1600-0560.1998.tb01687.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Clusters of immunoglobulin (Ig)-coated colloid bodies (CBs) in the dermo-epidermal zone are a typical immunohistochemical feature in lichen planus (LP)-lesions. They are considered to represent dyskeratotic basal keratinocytes, yet their composition has not been completely elucidated. In the present study, skin biopsies of 10 LP-lesions, 3 other dermatoses, and 10 biopsies of normal skin were studied immunohistochemically using monoclonal antibodies (MAbs) against fetal and differentiated epidermal antigens. CBs were identified by FITC-anti-Ig. Binding of MAb was visualized by double staining technique. Cytokeratin (CK) 10/11, a marker of epidermal differentiation, was consistently detected in suprabasal keratinocytes and also in up to 95% of Ig-positive CBs in LP. CK10/11 was additionally detected in basal keratinocytes in 9 LP-lesions, but not in normal skin. The basal cell-specific MAb BL7 stained basal layer keratinocytes in all biopsies. In contrast to normal skin, in LP scattered suprabasal keratinocytes and CBs were also positive for BL7 in 10 and 7 cases, respectively. While fetal cytokeratins (CK13 and CK8/18) were completely absent in control skin specimens, both cytokeratins were detected in various numbers of keratinocytes and CBs in all LP-lesions. Our results support the hypothesis of an epidermal origin of CBs. The cytokeratin profile seems to be severely disturbed in LP. This includes both accelerated differentiation by the expression of suprabasal CK10/11 in basal keratinocytes and dedifferentiation by the expression of fetal epidermal antigens (CK13 and CK8/18). It is tempting to speculate that the observed alterations may trigger T-cell activation and inflammatory onset in LP.
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Affiliation(s)
- H Biermann
- The Institute of Immunology, University of Heidelberg, Germany
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ORAL PATHOLOGY IN THE AGING PATIENT. Oral Maxillofac Surg Clin North Am 1996. [DOI: 10.1016/s1042-3699(20)30895-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Raso DS, Greene WB, Maize JC, McGown ST, Metcalf JS. Caterpillar bodies of porphyria cutanea tarda ultrastructurally represent a unique arrangement of colloid and basement membrane bodies. Am J Dermatopathol 1996; 18:24-9. [PMID: 8721587 DOI: 10.1097/00000372-199602000-00004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Caterpillar bodies are eosinophilic, periodic acid-Schiff (PAS)-positive globules arranged in a linear fashion in the epidermis overlying subepidermal blisters of porphyria cutanea tarda (Am J Dermatopathol 1993;15:199-202). We retrospectively studied by transmission electron microscopy nine cases of porphyria cutanea tarda (PCT) that demonstrated caterpillar bodies. We identified three components of the eosinophilic bodies: degenerating keratinocytes, colloid bodies, and basement membrane bodies. The colloid bodies consisted of whorled masses of filaments containing degenerating melanosomes, vacuoles, mitochondria, and desmosomes. Basement membrane bodies were composed of convoluted basement membrane material and associated collagen. Both colloid and basement membrane bodies were often associated with degenerating keratinocytes, were located both intra-and extracellularly, and were occasionally fused to one another. We believe that caterpillar bodies are a combination of degenerating keratinocytes, colloid bodies, and basement membrane bodies formed by repeated blistering and reepithelialization with transepidermal migration. Furthermore, we believe that caterpillar bodies are a diagnostic clue for the diagnosis of PCT.
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Affiliation(s)
- D S Raso
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston 29425, USA
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CLINICAL MANAGEMENT OF IDIOPATHIC AND AUTOIMMUNE DISEASE INVOLVING ORAL MUCOUS MEMBRANE. Oral Maxillofac Surg Clin North Am 1994. [DOI: 10.1016/s1042-3699(20)30766-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Glover M, Leigh I. Dermatomyositis pemphigoides: a case with coexistent dermatomyositis and bullous pemphigoid. J Am Acad Dermatol 1992; 27:849-52. [PMID: 1469143 DOI: 10.1016/0190-9622(92)70264-g] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We describe a patient with coexistent dermatomyositis and bullous pemphigoid; both appeared within a few weeks. Protein blotting showed binding of the patient's serum to the classic 220 kd bullous pemphigoid antigen. Because of the close temporal association of the two disorders, we believe that they are almost certainly etiologically linked. One possibility is that exposure of basement membrane antigens by dermatomyositis led to exposure of bullous pemphigoid antigen and subsequent antibody formation.
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Affiliation(s)
- M Glover
- Department of Dermatology, Royal London Hospital, England
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Davis AL, Bhogal BS, Whitehead P, Frith P, Murdoch ME, Leigh IM, Wojnarowska F. Lichen planus pemphigoides: its relationship to bullous pemphigoid. Br J Dermatol 1991; 125:263-71. [PMID: 1911320 DOI: 10.1111/j.1365-2133.1991.tb14753.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Clinical and immunopathological studies of three patients with lichen planus pemphigoides (LPP) were carried out to investigate the relationship between LPP and bullous pemphigoid (BP) and to determine whether the antigen in LPP is the classical BP antigen. LPP is usually considered to be the coexistence of lichen planus with BP. The bullae in LPP were subepidermal and indistinguishable from BP. Indirect immunofluorescence demonstrated antibody binding to the epidermal surface of 1 M NaCl-split skin and mucosae, as in BP. The tissue distribution of the LPP antigen mirrored the distribution of BP in stratified squamous epithelia but was absent from transitional epithelia (pig bladder). Immunoelectron microscopy, both direct (two cases) and indirect (one case), showed binding to the lamina lucida as with BP antigen. Western blotting of epidermal extracts using the patients' sera showed that instead of reacting with the classical bullous pemphigoid antigen (220 kDa in our series), the antisera reacted with a unique band of 200 kDa in addition to the band of 180 kDa found as a minor antigen in bullous pemphigoid, but more commonly in pemphigoid gestationis. The relationship between these antigens awaits molecular characterization. These findings suggest that the target antigen in LPP may be unique.
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Affiliation(s)
- A L Davis
- Department of Dermatology, Wycombe General Hospital, U.K
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Abstract
Lichen planus is a chronic and recurrent inflammatory disease characterized by unpredictable exacerbations and remissions. It affects the skin and/or mucous membrane in nearly 2 percent of the adult population. The symptoms are transient, but clinical evidence of oral disease is more persistent.
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Affiliation(s)
- S D Vincent
- University of Iowa, College of Dentistry, Iowa City 52242
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Affiliation(s)
- J W Patterson
- Department of Pathology, Medical College of Virginia, Virginia Commonwealth University, Richmond
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Erythematous and Erythematosquamous Skin Diseases. Dermatology 1991. [DOI: 10.1007/978-3-662-00181-3_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Vincent SD, Fotos PG, Baker KA, Williams TP. Oral lichen planus: the clinical, historical, and therapeutic features of 100 cases. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1990; 70:165-71. [PMID: 2290644 DOI: 10.1016/0030-4220(90)90112-6] [Citation(s) in RCA: 122] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Lichen planus is a chronic inflammatory epidermal and mucosal disease, the cause of which is poorly understood. We reviewed the clinical and historic features of 100 patients referred to our clinic for diagnosis and management of lichen planus. The age, gender, chief complaint, duration of the chief complaint, medical history, medications, and clinical findings were recorded. Past therapeutic modalities were reviewed. Of therapeutic significance, 25 patients with oral lichen planus had a secondary oral candidiasis. Management of symptomatic lichen planus with topical and systemic steroid is discussed. The pharmacology of topical and systemic steroid usage and the rationale for treatment are discussed.
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Affiliation(s)
- S D Vincent
- Department of Oral Pathology and Diagnosis, University of Iowa College of Dentistry, Iowa City
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Abstract
A 61-year-old man with prurigo nodularis subsequently developed bullous pemphigoid. Direct immunofluorescence studies of a prurigo nodularis-like lesion and peribullous skin showed the deposition of IgG, IgA, and C3 in a linear pattern at the basement membrane zone. Indirect immunofluorescence studies disclosed circulating anti-basement membrane zone antibodies. Immunoelectron microscopy revealed IgG, IgA, and C3 distributed in the lamina lucida and on the undersurface of the basal keratinocytes in both peribullous and prurigo nodularis lesions. These findings confirmed the diagnosis of pemphigoid nodularis.
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Affiliation(s)
- M Tani
- Department of Dermatology, Kobe University School of Medicine, Japan
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Grubauer G, Romani N, Kofler H, Stanzl U, Fritsch P, Hintner H. Apoptotic keratin bodies as autoantigen causing the production of IgM-anti-keratin intermediate filament autoantibodies. J Invest Dermatol 1986; 87:466-71. [PMID: 2428883 DOI: 10.1111/1523-1747.ep12455510] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The presence of numerous keratin bodies in the upper dermis is a characteristic finding in skin lesions of patients with various dermatoses such as cutaneous graft-versus-host disease, lichen planus, or chronic discoid lupus erythematosus. These keratin bodies are generated by apoptotic keratinocyte death, consist largely of keratin intermediate filaments (KIF), and are constantly covered with immunoglobulins, mainly IgM. Apoptosis is also thought to occur under physiologic conditions in the skin as it does in other organs, but keratin bodies are not frequently reported as being found in nonlesional skin. In order to assess the frequency of keratin bodies in normal skin, we examined serial sections of 10 normal human skin specimens and 5 dermal sheets prepared from normal human skin for the presence of keratin bodies. They were visualized by direct immunofluorescence using a fluorescein isothiocyanate (FITC) rabbit antihuman IgM conjugate. In addition the KIF origin of keratin bodies was demonstrated by a double-staining immunofluorescence procedure using a FITC-conjugated rabbit antihuman IgM followed by a mouse monoclonal antibody against keratin and a sheep antimouse immunoglobulin conjugated with Texas Red. One specimen was also examined for keratin bodies at the ultrastructural level. In serial sections, all 10 normal human skin specimens had numerous keratin bodies as assessed by visualization of globular IgM deposits. Evaluated on dermal sheets, the number of keratin bodies ranged from 39-262 per mm2. Nearly all keratin bodies also stained with the antikeratin antibodies. Ultrastructurally the remarkable number of keratin bodies, which consist of filaments measuring approximately 10 nm in diameter or of more granular material, in normal human skin was confirmed. In order to investigate the capacity of KIF material in keratin bodies to function as autoantigen, we examined the sera of the 10 skin donors and, in addition, of 30 normal healthy individuals and 10 patients with rheumatoid arthritis for the occurrence and specificity of IgM-anti-KIF autoantibodies by an enzyme-linked immunosorbent assay and by immunoblot. IgM-anti-KIF autoantibodies were found in all 50 test sera. In the majority of the sera the specificity of these autoantibodies included the 51 kD and the 58 kD KIF protein, which are constituents of KIF in keratin bodies and basal keratinocytes. Quantitatively, the antibody activity of the IgM-anti-KIF autoantibodies varied from serum to serum, being highest in the sera of patients with rheumatoid arthritis.(ABSTRACT TRUNCATED AT 400 WORDS)
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Abstract
Fifty-four patients with lichen planus (LP) and 54 age- and sex-matched controls were studied. No increase in the incidence of autoimmune disease was found in the patients with LP or their relatives. There was no increase in the frequency of autoantibodies in the LP group and serum immunoglobulin levels were not altered significantly. In the majority of cases, LP is not part of a generalized autoimmune disturbance.
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Hsiao L, Yoshinaga A, Ono T. Drug-induced bullous lichen planus in a patient with diabetes mellitus and liver disease. J Am Acad Dermatol 1986; 15:103-5. [PMID: 3522669 DOI: 10.1016/s0190-9622(86)80136-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Abstract
Serological typing for HLA Class II antigens in 72 patients with lichen planus (LP) revealed a highly significant association with HLA DRI and MTI (DQWI). DRI was present in 80% of patients with generalized LP, 54% with localized LP, 56% of patients with drug-induced LP and in 31% of patients with mucosal LP, compared with 25% of normal controls. MTI (DQWI) was found in 83% of the LP group and 62% of the normal controls. These findings strongly suggest a genetic predisposition or susceptibility to the development of generalized LP and perhaps also to drug-induced LP.
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MESH Headings
- Animals
- Antibody Formation/drug effects
- Antibody Formation/radiation effects
- Biomechanical Phenomena
- Dermatitis, Atopic/immunology
- Dermatitis, Contact/immunology
- Dermatitis, Contact/pathology
- Gamma Rays
- Graft vs Host Disease/immunology
- Graft vs Host Disease/pathology
- Humans
- Hypersensitivity, Delayed/immunology
- Hypersensitivity, Delayed/pathology
- Immunity, Cellular
- Interleukin-1/immunology
- Langerhans Cells/immunology
- Lichen Planus/immunology
- Lichen Planus/pathology
- Lupus Erythematosus, Discoid/immunology
- Lupus Erythematosus, Discoid/pathology
- Lupus Erythematosus, Systemic/immunology
- Lupus Erythematosus, Systemic/pathology
- Lymphocyte Culture Test, Mixed
- Lymphoma/immunology
- Skin/immunology
- Skin Diseases/immunology
- Skin Neoplasms/immunology
- Steroids/therapeutic use
- T-Lymphocytes/immunology
- Ultraviolet Rays
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Zijdenbos LM, Starink TM, Spronk CA. Ulcerative lichen planus with associated sicca syndrome and good therapeutic result of skin grafting. J Am Acad Dermatol 1985; 13:667-8. [PMID: 3908506 DOI: 10.1016/s0190-9622(85)80448-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Korkij W, Chuang TY, Soltani K. Liver abnormalities in patients with lichen planus. A retrospective case-control study. J Am Acad Dermatol 1984; 11:609-15. [PMID: 6490985 DOI: 10.1016/s0190-9622(84)70215-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
A retrospective case-control study of 136 patients with lichen planus and 272 paired controls demonstrated a significantly higher occurrence of liver abnormalities in this dermatosis. There is currently no good explanation for the high occurrence rate of such abnormalities in lichen planus. Factors that alter epidermal cell antigenicity may induce reactions that can damage keratinocytes as well as hepatocytes.
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Mauduit G, Fernandez-Bussy R, Thivolet J. Sequential enumeration of peripheral blood T cell subsets in lichen planus. Clin Exp Dermatol 1984; 9:256-62. [PMID: 6234111 DOI: 10.1111/j.1365-2230.1984.tb00792.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Shelley WB, Shelley ED. Urinary tract infection as a cause of lichen planus: metronidazole therapy. J Am Acad Dermatol 1984; 10:905-7. [PMID: 6725678 DOI: 10.1016/s0190-9622(84)80444-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A 51-year-old woman with generalized lichen planus for 23 years experienced total involution of her lesions during metronidazole therapy. Discontinuance of the treatment on two occasions led to partial recurrence of the skin lesions, which again promptly cleared on reinstitution of metronidazole. It is believed that this patient's lichen planus was an immune reaction to circulating bacterial antigen. The presumed source was a chronic urinary bladder infection. Continued remission of the lichen planus and the cystitis was subsequently achieved for over a year by daily prophylactic nitrofurantoin therapy. Identification and eradication of chronic foci of infection are suggested for the management of generalized chronic lichen planus.
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Lacy MF, Reade PC, Hay KD. Lichen planus: a theory of pathogenesis. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1983; 56:521-6. [PMID: 6580596 DOI: 10.1016/0030-4220(83)90100-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
From a continuing study of 108 cases of oral mucosal lichen planus, including so-called drug-induced lichenoid reactions, the response of patients to topical therapy and to drugs implicated in inducing the lichenoid reactions was used to construct a hypothetical model regarding the pathogenesis of the condition. The results were interpreted to indicate that lichen planus is a predetermined condition or diathesis, perhaps genetically based, rather than a simple cause-and-effect disorder.
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Mora RG, Nesbitt LT, Brantley JB. Lichen planus pemphigoides: clinical and immunofluorescent findings in four cases. J Am Acad Dermatol 1983; 8:331-6. [PMID: 6339569 DOI: 10.1016/s0190-9622(83)70035-6] [Citation(s) in RCA: 70] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
During the last 5 years we examined four black male patients who had features of both lichen planus (LP) and bullous pemphigoid (BP). The clinical disorder included classical lesions of LP along with bullae that developed subsequently and arose on both lesional and nonlesional skin. Histologic findings correlated well with the type of lesion on which biopsy was done, as did the immunofluorescent findings. All patients had features of both LP and BP by direct immunofluorescence and of BP by indirect immunofluorescence of serum and blister fluid.
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Abstract
The association of lichen planus and primary biliary cirrhosis in five patients is reported. The coexistence of the two diseases is probably more than coincidental and may be due to the fact that both conditions are based on an alteration of mechanisms. There is great similarity between primary biliary cirrhosis and chronic graft-versus-host disease and a common pathogenesis for the two entities has been postulated. Since lichen planus is one of the most common manifestations of graft-versus-host disease, its association with primary biliary cirrhosis is of significance, although not unexpected.
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Abstract
The aim of the present study was to examine idiopathic lichen planus for possible changes in the serum concentration of the immunological marker beta 2 microglobulin (beta 2m), a component of HLA antigens. It was shown that serum levels of beta 2m were not different in lichen planus from those in controls. Although these findings do not support major systemic immunopathological changes in lichen planus, they do not exclude the involvement of local immune mechanisms.
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Laskaris G, Sklavounou A, Angelopoulos A. Direct immunofluorescence in oral lichen planus. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1982; 53:483-7. [PMID: 7048185 DOI: 10.1016/0030-4220(82)90461-3] [Citation(s) in RCA: 62] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Direct immunofluorescent staining (DIF) was performed on biopsy specimens from thirty-five patients with oral lichen planus. The results showed fibrin deposition in all cases at the mucosal-submucosal interface, within colloid bodies (fourteen of thirty-five) and within vascular walls (five of thirty-five). Deposition of IgG, IgA and IgM was detected to a lesser extent, while complement (C3) could not be identified in any case. The significance of these findings was assessed by comparison with the IF results obtained in thirty-five biopsies from various oral diseases other than lichen planus and ten healty persons. Although the presence of fibrin deposition at the mucosal-submucosal junction, within vessels and cytoid bodies, was found to be highly characteristic of lichen planus, these findings were not specifically diagnostic. Morphologically identical deposits were also seen in lupus erythematosus. It is known at present whether immunologic reactions may play a role in the pathogenesis of lichen planus. However, the immunopathologic findings may occasionally be additional suggestive markers in the diagnosis of the disease.
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Scully C. Serum IgG, IgA, IgM, IgD and IgE in lichen planus: no evidence for a humoral immunodeficiency. Clin Exp Dermatol 1982; 7:163-70. [PMID: 7083621 DOI: 10.1111/j.1365-2230.1982.tb02404.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Mann RJ, Wallington TB, Warin RP. Lichen planus with late onset hypogammaglobulinaemia: a casual relationship? Br J Dermatol 1982; 106:357-60. [PMID: 6978145 DOI: 10.1111/j.1365-2133.1982.tb01736.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A case of lichen planus of the mouth and vulva associated with late onset hypogammaglobulinaemia, alopecia areata and vitiligo is described, and the possible significance of a B cell defect in the pathogenesis of lichen planus is discussed.
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Mahoney DA, Barden AE, Vandongen R, Hurst P, Banks R, Beilin LJ, Saker B, Thatcher G. Urinary thromboxane B2 on allograft rejection. Lancet 1981; 2:1046. [PMID: 6118500 DOI: 10.1016/s0140-6736(81)91240-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Abstract
A skin biopsy from an 8-year-old boy with generalized lichen nitidus revealed a transepidermal perforating lesion never observed before in this disorder. A disturbance in dermo-epidermal interaction with alterations of epidermal cell kinetics could explain this finding in a disease which, curiously, shows many histologic features conducive to transepidermal perforation. A clear distinction should be made between primary and secondary perforating dermatoses, since perforation per se is a non-specific cutaneous reaction pattern occurring in the course of many unrelated disorders.
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Väätäinen N, Hannuksela M, Karvonen J. Trioxsalen baths plus UV-A in the treatment of lichen planus and urticaria pigmentosa. Clin Exp Dermatol 1981; 6:133-8. [PMID: 7261467 DOI: 10.1111/j.1365-2230.1981.tb02279.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Bauer F. Quinacrine hydrochloride drug eruption (tropical lichenoid dermatitis). Its early and late sequelae and its malignant potential: a review. J Am Acad Dermatol 1981; 4:239-48. [PMID: 6452466 DOI: 10.1016/s0190-9622(81)70025-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The totality of effects of a particular drug on patients cannot be truly assessed until many patients have taken it. In order to assess the side effects of any drug, many thousands of patients may have to be observed, and the observation may have to extend over decades. Quinacrine hydrochloride (quinacrine) was used as a malarial-suppressive drug by allied soldiers during World War II. The most commonly occurring side effect was a drug eruption. This at times led to permanent sequelae at an early stage. Further observation revealed late sequelae occurring 7 to 17 years after the war. Two of these late sequelae were observed to become malignant, and in most cases the palmar aspect was involved. This is an area which rarely shows malignant change. It has been observed that quinacrine can be instrumental in inducing skin cancers as late as 34 years after its ingestion.
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Daniels TE, Quadra-White C. Direct immunofluorescence in oral mucosal disease: a diagnostic analysis of 130 cases. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1981; 51:38-47. [PMID: 7007954 DOI: 10.1016/0030-4220(81)90124-9] [Citation(s) in RCA: 92] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
We retrospectively analyzed direct immunofluorescence (DIF) findings from 130 cases of oral mucosal disease. The diagnosis of each case was based on history, clinical features, histopathology, and clinical follow-up. To avoid circular reasoning, we did not use the DIF results in forming the diagnoses. Our results indicate that the presence of characteristic fluorescent patterns produced by several DIF reagents can establish the diagnosis of the oral lesions of pemphigus and pemphigoid and strongly indicate the diagnoses of lichen planus and lupus erythematosus. The absence of these fluorescent patterns can help to rule out these conditions, thereby strengthening the diagnoses of other oral mucosal diseases. The results of DIF are sufficiently distinguishing to be routinely helpful as diagnostic criteria for chronic ulcerative diseases of the oral mucosa.
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