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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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2
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Doss RW, El-Rifaie AA, Roshdy AN, Sabry D. Assessment of interleukin-18 gene polymorphism and serum levels in cutaneous lichen planus. Eur J Med Res 2024; 29:345. [PMID: 38918874 PMCID: PMC11202336 DOI: 10.1186/s40001-024-01846-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/16/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Lichen planus (LP) is a chronic inflammatory disease with uncertain etiology. Interleukin-18 (IL-18) is an interferon gamma (INFγ) inducing agent. It is a pro-inflammatory cytokine that was found to play a role in the pathogenesis of some autoimmune disorders. MATERIAL AND METHODS This study included 50 patients with classic cutaneous lichen planus (CLP) and 50 healthy volunteers serving as controls. Venous blood samples were withdrawn from the study subjects under complete aseptic precautions. Blood samples were examined for single nucleotide polymorphisms (SNPs) of IL-18 gene at promoter -137(G/C) and -656 (G/T) using polymerase chain reaction (PCR) and IL-18 level was assessed using enzyme linked immunosorbent assay (ELISA). RESULTS The mean level of IL-18 was significantly higher in CLP patients (31.63 ± 4.90) compared to control subjects (13.95 ± 6.82). Significantly high levels of IL-18 were found among patients with diabetes, hypertension (p < 0.01 in both). HCV positive patients and patients with both OLP and CLP also expressed higher levels of IL-18. Genotypic and allelic distribution at position -137(G/C) showed that the genotype GG was present at significantly higher frequency in cases (58%) compared to controls (28.0%). On the other hand the CC genotype at position -137 was significantly higher in the controls (28%) as compared to CLP cases (6%). Polymorphism of IL-18 at position -656(G/T) showed no significant difference between cases and controls. No significant difference could be detected in IL-18 level between different genotypic variants at position -137(G/C) and -656(G/T). CONCLUSION IL-18 may play important role in pathogenesis of LP. Elevated IL-18 levels could be part of the pro-inflammatory autoimmune process in LP. The presence of OLP, HCV, diabetes and hypertension is associated with higher production of IL-18. IL-18 promotor region -137(G/C) polymorphism might be a factor that increase the risk of development of lichen planus in Egyptian patients.
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Affiliation(s)
- Reham William Doss
- Dermatology Department, Faculty of Medicine, Beni-Suef University, Mohammed Hassan Street, Beni Suef, 62511, Egypt.
| | - Abdel-Aziz El-Rifaie
- Dermatology Department, Faculty of Medicine, Beni-Suef University, Mohammed Hassan Street, Beni Suef, 62511, Egypt
| | - Anton Nasr Roshdy
- Dermatology Department, Faculty of Medicine, Beni-Suef University, Mohammed Hassan Street, Beni Suef, 62511, Egypt
| | - Dina Sabry
- Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Badr University in Cairo, Cairo, Egypt
- Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Whittington CP, Saleh JS, Bresler SC, Patel RM. Hypertrophic Lichen Planus: An Up-to-Date Review and Differential Diagnosis. Arch Pathol Lab Med 2024; 148:659-665. [PMID: 37327190 DOI: 10.5858/arpa.2022-0515-ra] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 06/18/2023]
Abstract
CONTEXT.— Hypertrophic lichen planus (HLP) is a variant of lichen planus that can be difficult to diagnose based on histopathologic features alone. Thus, patient clinical history and clinicopathologic correlation are essential considerations to make the correct diagnosis. OBJECTIVE.— To discuss the clinical and histologic presentation of HLP and provide a thorough review of commonly encountered mimickers in the differential diagnosis. DATA SOURCES.— Data were derived from a literature review, personal clinical and research experiences, and a review of cases in the archives of a tertiary care referral center. CONCLUSIONS.— In general, HLP involves the lower extremities and is characterized by thickened, scaly nodules and plaques that are often pruritic and chronic in nature. HLP affects both males and females and is most common in adults 50 to 75 years of age. Unlike conventional lichen planus, HLP tends to have eosinophils and classically displays a lymphocytic infiltrate most concentrated around the tips of rete ridges. The differential diagnosis for HLP is broad and encompasses numerous entities in many different categories, including premalignant and malignant neoplasms, reactive squamoproliferative tumors, benign epidermal neoplasms, connective tissue disease, autoimmune bullous disease, infection, and drug-related reactions. Therefore, a high index of suspicion must be maintained to avoid a misdiagnosis and potential inappropriate treatments.
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Affiliation(s)
- Carli P Whittington
- From the Departments of Pathology (Whittington, Saleh, Bresler, Patel) and Dermatology (Whittington, Saleh, Bresler, Patel), University of Michigan, Ann Arbor
- the Department of Cutaneous Pathology, WCP Laboratories Inc, Maryland Heights, Missouri (Patel)
| | - Jasmine S Saleh
- From the Departments of Pathology (Whittington, Saleh, Bresler, Patel) and Dermatology (Whittington, Saleh, Bresler, Patel), University of Michigan, Ann Arbor
- the Department of Cutaneous Pathology, WCP Laboratories Inc, Maryland Heights, Missouri (Patel)
| | - Scott C Bresler
- From the Departments of Pathology (Whittington, Saleh, Bresler, Patel) and Dermatology (Whittington, Saleh, Bresler, Patel), University of Michigan, Ann Arbor
- the Department of Cutaneous Pathology, WCP Laboratories Inc, Maryland Heights, Missouri (Patel)
| | - Rajiv M Patel
- From the Departments of Pathology (Whittington, Saleh, Bresler, Patel) and Dermatology (Whittington, Saleh, Bresler, Patel), University of Michigan, Ann Arbor
- the Department of Cutaneous Pathology, WCP Laboratories Inc, Maryland Heights, Missouri (Patel)
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Böll SL, Zahn CA, Schlapbach C. Rapid and sustained improvement of cutaneous lichen planus with oral JAK1 inhibitors. J Eur Acad Dermatol Venereol 2024; 38:e82-e85. [PMID: 37595958 DOI: 10.1111/jdv.19440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/11/2023] [Indexed: 08/20/2023]
Affiliation(s)
- Simone L Böll
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Carole A Zahn
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Schlapbach
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Radu AM, Carsote M, Nistor C, Dumitrascu MC, Sandru F. Crossroads between Skin and Endocrine Glands: The Interplay of Lichen Planus with Thyroid Anomalies. Biomedicines 2023; 12:77. [PMID: 38255184 PMCID: PMC10813575 DOI: 10.3390/biomedicines12010077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/15/2023] [Accepted: 12/23/2023] [Indexed: 01/24/2024] Open
Abstract
In this narrative review, we aimed to overview the interplay between lichen planus (LP) and thyroid conditions (TCs) from a dual perspective (dermatologic and endocrine), since a current gap in understanding LP-TC connections is found so far and the topic is still a matter of debate. We searched PubMed from Inception to October 2023 by using the key terms "lichen planus" and "thyroid", (alternatively, "endocrine" or "hormone"). We included original clinical studies in humans according to three sections: LP and TC in terms of dysfunction, autoimmunity, and neoplasia. Six studies confirmed an association between the thyroid dysfunction (exclusively hypothyroidism) and LP/OL (oral LP); of note, only one study addressed cutaneous LP. The sample size of LP/OLP groups varied from 12-14 to 1500 individuals. Hypothyroidism prevalence in OLP was of 30-50%. A higher rate of levothyroxine replacement was identified among OLP patients, at 10% versus 2.5% in controls. The highest OR (odd ratio) of treated hypothyroidism amid OLP was of 2.99 (p < 0.005). Hypothyroidism was confirmed to be associated with a milder OLP phenotype in two studies. A single cohort revealed a similar prevalence of hypothyroidism in LP versus non-LP. Non-confirmatory studies (only on OLP, not cutaneous LP) included five cohorts: a similar prevalence of hypothyroidism among OLP versus controls, and a single cohort showed that the subjects with OLP actually had a lower prevalence of hypothyroidism versus controls (1% versus 4%). Positive autoimmunity in LP/OLP was confirmed in eight studies; the size of the cohorts varied, for instance, with 619 persons with LP and with 76, 92, 105, 108, 192, 247, and 585 patients (a total of 1405) with OLP, respectively; notably, the largest control group was of 10,441 individuals. Four clusters of approaches with respect to the autoimmunity in LP/OLP were found: an analysis of HT/ATD (Hashimoto's thyroiditis/autoimmune thyroid diseases) prevalence; considerations over the specific antibody levels; sex-related features since females are more prone to autoimmunity; and associations (if any) with the clinical aspects of LP/OLP. HT prevalence in OLP versus controls was statistically significantly higher, as follows: 19% versus 5%; 12% versus 6%; and 20% versus 9.8%. A single study addressing LP found a 12% rate of ATDs. One study did not confirm a correlation between OLP-associated clinical elements (and OLP severity) and antibody values against the thyroid, and another showed that positive TPOAb (anti-thyroperoxidase antibodies) was more often found in erosive than non-erosive OLP (68% versus 33%). Just the reverse, one cohort found that OLP subjects had a statistically significantly lower rate of positive TPOAb versus controls (9% versus 15%). Five case-control studies addressed the issue of levothyroxine replacement for prior hypothyroidism in patients that were diagnosed with OLP (no study on LP was identified); three of them confirmed a higher rate of this treatment in OLP (at 8.9%, 9.7%, and 10.6%) versus controls. In conclusion, with regard to LP/OLP-TC, we note several main aspects as practical points for multidisciplinary practitioners: OLP rather than LP requires thyroid awareness; when it comes to the type of thyroid dysfunction, mostly, hypothyroidism should be expected; female patients are more prone to be associated with ATDs; a potential higher ratio of OLP subjects taking levothyroxine was found, thus a good collaboration with an endocrinology team is mandatory; and so far, OLP individuals have not been confirmed to be associated with a higher risk of thyroid nodules/cancer.
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Affiliation(s)
- Andreea-Maria Radu
- Department of Dermatovenerology, Elias University Emergency Hospital, 011461 Bucharest, Romania
| | - Mara Carsote
- Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Clinical Endocrinology V, C.I. Parhon National Institute of Endocrinology, 020021 Bucharest, Romania
| | - Claudiu Nistor
- Department 4—Cardio-Thoracic Pathology, Thoracic Surgery II Discipline, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Thoracic Surgery Department, Dr. Carol Davila Central Military Emergency University Hospital, 010242 Bucharest, Romania
| | - Mihai Cristian Dumitrascu
- Department of Obstetrics and Gynaecology, C. Davila University of Medicine and Pharmacy & University Emergency Hospital, 050474 Bucharest, Romania;
| | - Florica Sandru
- Department of Dermatovenerology, Carol Davila University of Medicine and Pharmacy & Elias University Emergency Hospital, 011461 Bucharest, Romania;
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Doh JY, Lee JH. A Generalized Lichen Planus Following COVID-19 Vaccination: A Case Report. Ann Dermatol 2023; 35:S260-S264. [PMID: 38061717 PMCID: PMC10727909 DOI: 10.5021/ad.22.026] [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: 01/25/2022] [Revised: 03/14/2022] [Accepted: 04/24/2022] [Indexed: 12/20/2023] Open
Abstract
As part of the efforts to overcome the ongoing coronavirus disease 2019 (COVID-19) pandemic, mass vaccination programs against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been initiated. Since then, an increasing number of cutaneous adverse events associated with the COVID-19 vaccines have been reported. Lichen planus (LP) is a rare inflammatory mucocutaneous disease with various clinical presentations, although uncommon, occurring following vaccination. There have been several cases of LP reported following COVID-19 vaccination. However, there has been no report of generalized LP following the COVID-19 vaccine to our knowledge. Herein, we report a case of generalized LP following the Oxford/AstraZeneca (AZD1222) vaccine. A 68-year-old female presented with widespread, erythematous pruritic papules and plaques on the trunk and both limbs, which developed 2 to 3 days after administration of the AZD1222 vaccine. Histopathological examinations revealed cellular interface dermatitis. The patient was diagnosed with generalized LP and was successfully treated with systemic corticosteroid and cyclosporine. As the vaccination campaign against COVID-19 is ongoing and early recognition and treatment are essential to reduce the morbidity of this condition, clinicians should be aware that LP could follow COVID-19 vaccination regardless of the type of vaccine administered.
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Affiliation(s)
- Jee Yun Doh
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Hyun Lee
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Unnikrishnan SP, Rampersaud E, Mcgee A, Cruickshank ME, Abu-Eid R, Hijazi K. Disease severity scoring systems in mucosal lichen planus: A systematic review. Oral Dis 2023; 29:3136-3151. [PMID: 36404123 DOI: 10.1111/odi.14447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/03/2022] [Accepted: 11/14/2022] [Indexed: 11/22/2022]
Abstract
Several scoring systems have been developed to evaluate disease severity in mucosal lichen planus, but only a few have been validated to ensure reproducible and accurate assessment of disease severity. The current systematic review was undertaken to identify clinical severity scoring systems in mucosal lichen planus that have undergone validity or reliability testing and to describe their operating characteristics. We performed a bibliographic search in five databases from their inception to October 2022 for severity scoring systems in mucosal lichen planus that have undergone validity or reliability tests. Quality assessment was conducted using the Joanna Briggs Institute Critical Appraisal tools. We have included 118 studies and identified 11 clinical severity scoring systems for oral lichen planus that have undergone validity or reliability testing. Of these, the most reported were the Thongprasom score, the Oral Disease Severity Score (ODSS) and the REU (Reticular/hyperkeratotic, Erosive/erythematous, Ulcerative) scoring systems. We did not identify clinical scoring systems for extraoral mucosal lichen planus that have undergone validity or reliability testing. The ODSS and REU scoring systems have undergone the highest number of validation attempts and reliability assessments for oral lichen planus respectively. However, we have identified numerous factors that have hampered the universal adoption of a standardised scoring system. There is a need for the development and validation of scoring systems for extraoral mucosal lichen planus.
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Affiliation(s)
- Sreedevi P Unnikrishnan
- Institute of Dentistry, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Edward Rampersaud
- Institute of Dentistry, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Alice Mcgee
- Aberdeen Centre for Women's Health Research, Aberdeen Maternity Hospital, Aberdeen, UK
| | - Maggie E Cruickshank
- Aberdeen Centre for Women's Health Research, Aberdeen Maternity Hospital, Aberdeen, UK
| | - Rasha Abu-Eid
- Institute of Dentistry, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Karolin Hijazi
- Institute of Dentistry, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
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8
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Imafuku K, Iwata H, Natsuga K, Okumura M, Kobayashi Y, Kitahata H, Kubo A, Nagayama M, Ujiie H. Zonula occludens-1 distribution and barrier functions are affected by epithelial proliferation and turnover rates. Cell Prolif 2023; 56:e13441. [PMID: 36919255 PMCID: PMC10472521 DOI: 10.1111/cpr.13441] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 02/20/2023] [Accepted: 02/23/2023] [Indexed: 03/16/2023] Open
Abstract
Zonula occludens-1 (ZO-1) is a scaffolding protein of tight junctions, which seal adjacent epithelial cells, that is also expressed in adherens junctions. The distribution pattern of ZO-1 differs among stratified squamous epithelia, including that between skin and oral buccal mucosa. However, the causes for this difference, and the mechanisms underlying ZO-1 spatial regulation, have yet to be elucidated. In this study, we showed that epithelial turnover and proliferation are associated with ZO-1 distribution in squamous epithelia. We tried to verify the regulation of ZO-1 by comparing normal skin and psoriasis, known as inflammatory skin disease with rapid turnover. We as well compared buccal mucosa and oral lichen planus, known as an inflammatory oral disease with a longer turnover interval. The imiquimod (IMQ) mouse model, often used as a psoriasis model, can promote cell proliferation. On the contrary, we peritoneally injected mice mitomycin C, which reduces cell proliferation. We examined whether IMQ and mitomycin C cause changes in the distribution and appearance of ZO-1. Human samples and mouse pharmacological models revealed that slower epithelial turnover/proliferation led to the confinement of ZO-1 to the uppermost part of squamous epithelia. In contrast, ZO-1 was widely distributed under conditions of faster cell turnover/proliferation. Cell culture experiments and mathematical modelling corroborated these ZO-1 distribution patterns. These findings demonstrate that ZO-1 distribution is affected by epithelial cell dynamics.
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Affiliation(s)
- Keisuke Imafuku
- Department of Dermatology, Faculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoJapan
| | - Hiroaki Iwata
- Department of Dermatology, Faculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoJapan
- Department of DermatologyGifu University Graduate School of MedicineGifuJapan
| | - Ken Natsuga
- Department of Dermatology, Faculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoJapan
| | - Makoto Okumura
- Research Institute for Electronic ScienceHokkaido UniversitySapporoJapan
| | - Yasuaki Kobayashi
- Research Institute for Electronic ScienceHokkaido UniversitySapporoJapan
| | - Hiroyuki Kitahata
- Department of Physics, Graduate School of ScienceChiba UniversityChibaJapan
| | - Akiharu Kubo
- Division of Dermatology, Department of Internal RelatedKobe University Graduate School of MedicineKobeJapan
- Department of DermatologyKeio University School of MedicineTokyoJapan
| | - Masaharu Nagayama
- Research Institute for Electronic ScienceHokkaido UniversitySapporoJapan
| | - Hideyuki Ujiie
- Department of Dermatology, Faculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoJapan
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Xie F, Morken CM, Zhang N, Pittelkow MR, Sartori Valinotti JC, Comfere NI, Meves A, Murphree DH, Mangold AR, Lehman JS. Development of the lichen planus quality of life questionnaire (LPQoL) informed by expert clinician input and patient feedback: a retrospective survey study. Arch Dermatol Res 2023; 315:1561-1569. [PMID: 36715723 DOI: 10.1007/s00403-023-02534-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/31/2023]
Abstract
Lichen planus (LP) can affect multiple body sites including skin, mucosae, scalp and nails, causing considerable impact on patients' quality of life. Currently, there are no LP patient-reported outcome measures (PROMs) that address all body sites potentially affected by LP. We developed a LP Quality of Life Questionnaire (LPQoL), informed by an expert consortium and patient survey study, to address this gap. The study was approved by our institution's Institutional Review Board. First, a 22-item LPQoL was designed with input from LP experts at our institution. The tool was then optimized by garnering input from patients recently diagnosed with LP, who were asked to complete the LPQoL, as well as the Dermatology Life Quality Index (DLQI) and a feedback form about the LPQoL. Fifty-eight of 150 patients (39% response rate) returned the questionnaire. Mean DLQI score was 4.9 ± 5.6 SD (range 0-25) and mean LPQoL score was 13.6 ± 10.4 SD (range 0-54). LPQoL score was positively correlated with DLQI score (r = 0.79; p < 0.001). Forty-nine out of 56 (88%) and 6/56 (11%) rated the LPQoL as 'very easy' or 'fairly easy' to complete, respectively. Based on participants' feedback, we increased the recall period from one week to one month and added questions on esophageal involvement. With iterative input from LP experts and patients, we developed a LPQoL to address the gap in a multi-site PROM specific to LP. This is a pilot study and there is ongoing validation studies; therefore, this measure should not be used in clinical practice or research until validated.
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Affiliation(s)
- Fangyi Xie
- Department of Dermatology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Colleen M Morken
- Department of Dermatology, Mayo Clinic Arizona, 5777 E. Mayo Blvd., Phoenix, AZ, 85054, USA
| | - Nan Zhang
- Department of Quantitative Health Sciences, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Mark R Pittelkow
- Department of Dermatology, Mayo Clinic Arizona, 5777 E. Mayo Blvd., Phoenix, AZ, 85054, USA
| | | | - Nneka I Comfere
- Department of Dermatology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Alexander Meves
- Department of Dermatology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
- Department of Biochemistry and Molecular Biology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Dennis H Murphree
- Department of Dermatology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
- Department of Artificial Intelligence and Informatics, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Aaron R Mangold
- Department of Dermatology, Mayo Clinic Arizona, 5777 E. Mayo Blvd., Phoenix, AZ, 85054, USA
| | - Julia S Lehman
- Department of Dermatology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
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Youssef S, Bordone LA. Oral tofacitinib effectively treating eruptive and hypertrophic cutaneous lichen planus. JAAD Case Rep 2023; 37:16-20. [PMID: 37332361 PMCID: PMC10275736 DOI: 10.1016/j.jdcr.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023] Open
Affiliation(s)
- Soundos Youssef
- Postdoctoral Research Fellow, Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Lindsey A. Bordone
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
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Anttonen V, Pöykkö E, Kiviniemi E, Jokelainen J, Huilaja L, Sinikumpu S. Characteristics, comorbidities, and treatment practices of lichen planus in Northern Finland: A register-based study among 619 subjects. Health Sci Rep 2023; 6:e1327. [PMID: 37305152 PMCID: PMC10256618 DOI: 10.1002/hsr2.1327] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/03/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023] Open
Abstract
Background and Aims Lichen planus (LP) is a common itching skin disease where lesions appear on the skin and mucous membranes. However, the epidemiology of LP is not yet sufficiently understood. The aim of this study was to retrospectively map out the characteristics, comorbidities and treatments of patients diagnosed with LP. Methods This is a retrospective hospital patient registry-based study performed between 2009 and 2021 in a secondary care hospital (Oulu University Hospital) in Northern Finland. All patients with recorded diagnosis of LP were included in the study. Characteristics, comorbidities, and treatments of LP patients were studied. Results In total, 619 patients were verified from the hospital health records. The mean age of patients was 54.2 years and the majority were female (58.3%). Most of the patients had symptoms in more than two skin areas (mean 2.7 skin areas), lower limbs being the most common site (74.0%). A third of patients (34.7%) had oral LP lesions. Nearly fifth (19.4%) of the subjects had a history of previous LP. Of comorbidities found among LP subjects, obesity (22.5%), malignancies (19.4%), depression (12.8%), and thyroiditis (12.4%) were seen more often than in general Finnish population. The most used form of treatment was topical corticosteroids (97.6%), followed by phototherapy 26.8%. Systemic treatments such as prednisolone and methotrexate had been used in 7.6% and 1.1% of the patients, respectively. Conclusion LP patients had a heightened risk for several comorbidities, which should be considered when managing patients with LP.
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Affiliation(s)
| | - Elia Pöykkö
- Faculty of MedicineUniversity of OuluOuluFinland
| | - Eetu Kiviniemi
- Faculty of Medicine, Northern Finland Birth CohortsArctic Biobank, and Infrastructure for Population StudiesOuluFinland
| | - Jari Jokelainen
- Faculty of Medicine, Research Unit of Clinical Medicine, Northern Finland Birth CohortsArctic Biobank, and Infrastructure for Population Studies, University of OuluOuluFinland
| | - Laura Huilaja
- Department of Dermatology, Finland and Research Unit of Clinical Medicine, Oulu University HospitalUniversity of OuluOuluFinland
| | - Suvi‐Päivikki Sinikumpu
- Department of Dermatology, Finland and Research Unit of Clinical Medicine, Oulu University HospitalUniversity of OuluOuluFinland
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12
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Nguyen B, Perez AG, Elgart GW, Elman SA. Lichen planus after COVID-19 infection and vaccination: A systematic review. J Eur Acad Dermatol Venereol 2023; 37:e278-e281. [PMID: 36385506 DOI: 10.1111/jdv.18752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/09/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Betty Nguyen
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,University of California Riverside School of Medicine, Riverside, California, USA
| | - Alexandra G Perez
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - George W Elgart
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Scott A Elman
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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13
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Treatment of Frontal Fibrosing Alopecia. Dermatol Ther 2023. [DOI: 10.1155/2023/3856674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Introduction. Frontal fibrosing alopecia (FFA) is known as a lymphocytic primary cicatricial alopecia. The main characteristic of FFA is progressive frontotemporal hairline recession. The pathogenesis of FFA is not completely understood. Destructing the stem cells of the epithelial hair follicles causes permanent hair loss and seems to be the main cause of FFA. Studies have reported significantly decreased quality of life in patients with hair loss. On the other hand, late diagnosis and treatment of FFA can decrease the success rate of the treatment. In this regard, different topical and systemic therapies have been developed to resolve the symptoms; however, only a partial response to treatment is usually achieved. We conducted a systematic review of the literature to identify the effectiveness of the available treatment modalities used for FFA patients and the related outcomes. Methods. On April 2022, we made a wide systematic computer-assisted search of PubMed and Google Scholar databases, using “frontal fibrosing alopecia” and “treatment” keywords. We scanned 1,514 articles. All the studies concerning a therapeutic regimen for FFA were included. After removing duplicate studies, 50 studies containing the therapeutic regimen of 1,478 FFA patients were included in this review. Results. The 5-alpha-reductase inhibitors (oral finasteride/dutasteride) were the most used medications (usually prescribed as a combination therapy with other medications). Topical corticosteroids were the second commonly used medication for the treatment of FFA. Systemic corticosteroids seem to be ineffective in improving FFA progression. Oral isotretinoin (or alitretinoin) had the most promising effect on improving facial papules of FFA patients with a 92% rate of facial papule improvement. Conclusion. In our review, intralesional corticosteroid injection and 5-alpha-reductase inhibitors (finasteride/dutasteride) were reported as the most effective treatment modalities. Oral isotretinoin (or alitretinoin) is considered as the most promising treatment for improving facial papules in the context of FFA. However, it had minimal effects on hair regrowth or stabilization of hairline recession in FFA patients.
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Changes in Lipoprotein Particles in the Blood Serum of Patients with Lichen Planus. Metabolites 2023; 13:metabo13010091. [PMID: 36677016 PMCID: PMC9866152 DOI: 10.3390/metabo13010091] [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] [Received: 12/06/2022] [Revised: 12/27/2022] [Accepted: 01/04/2023] [Indexed: 01/07/2023] Open
Abstract
Lichen planus is a chronic inflammatory mucocutaneous disease that belongs to the group of papulosquamous skin diseases among diseases like psoriasis, a widely studied disease in dermatology. The aim of the study was to identify the changes between the blood sera of lichen planus patients and healthy controls to widen the knowledge about the metabolomic aspect of lichen planus and gain a better understanding about the pathophysiology of the disease. We used high-throughput nuclear magnetic resonance (NMR) spectroscopy to measure the levels of blood serum metabolites, lipoproteins and lipoprotein particles. Dyslipidemia has relatively recently been shown to be one of the comorbidities of lichen planus, but the changes in the components of lipoproteins have not been described yet. We found statistically significant changes in the concentrations of 16 markers regarding lipoproteins, which included the components of intermediate-density lipoproteins, low-density lipoproteins and large low-density lipoproteins. We propose that the detected changes may increase the risk for specific comorbidities (e.g., dyslipidemia) and resulting cardiovascular diseases, as the turnover and hepatic uptake of the altered/modified lipoprotein particles are disturbed.
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Ly S, Nedosekin D, Wong HK. Review of an Anti-CD20 Monoclonal Antibody for the Treatment of Autoimmune Diseases of the Skin. Am J Clin Dermatol 2023; 24:247-273. [PMID: 36630066 PMCID: PMC9838371 DOI: 10.1007/s40257-022-00751-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 01/12/2023]
Abstract
Biologic therapies targeting B-cells are emerging as an effective strategy to treat a variety of immune-mediated diseases. One of the most studied B-cell-targeted therapies is rituximab, an anti-CD20 monoclonal antibody that exemplifies B-cell depletion therapy and has served as the prototype for other anti-CD20 monoclonal antibodies and the development of biosimilars. While there are multiple studies on the use of rituximab in dermatology, a comprehensive review of rituximab therapy in autoimmune skin conditions is lacking. In this literature review, we summarize indications, treatment efficacy, and safety of rituximab among common autoimmune diseases of the skin: pemphigus vulgaris, cutaneous lupus erythematous, dermatomyositis, systemic sclerosis, thyroid dermopathy, autoimmune pemphigoid diseases, and cutaneous vasculitis diseases. Existing data on rituximab support the approach of rituximab, biosimilars, and newer B-cell-targeting therapies in immune-mediated cutaneous diseases. Overall, rituximab, which targets CD20, provides an effective alternative or concomitant option to traditional immunosuppressants in the management of various autoimmune diseases of the skin. Further studies are necessary to expand the understanding and possible utility of B-cell-targeted therapies among autoimmune skin diseases.
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Affiliation(s)
- Sophia Ly
- grid.241054.60000 0004 4687 1637College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR USA
| | - Dmitry Nedosekin
- grid.241054.60000 0004 4687 1637College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR USA
| | - Henry K. Wong
- grid.241054.60000 0004 4687 1637Department of Dermatology, University of Arkansas for Medical Sciences, 4301 W. Markham St., Slot #576, Little Rock, AR 72205 USA
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New-Onset Lichen Planus Induced by the Pfizer COVID-19 Vaccine. Case Rep Dermatol Med 2022; 2022:2082445. [PMID: 36164291 PMCID: PMC9509278 DOI: 10.1155/2022/2082445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/24/2022] [Indexed: 11/20/2022] Open
Abstract
Objective Coronavirus disease 2019 (COVID-19) vaccine distribution continues to expand; however, increased cutaneous reactions have been reported. Several recent studies suggest a link between COVID-19 vaccination and the development of various cutaneous complications. Lichen planus is a chronic, immune-mediated, inflammatory dermatological illness with an unclear etiology. In this case report, we assessed the relationship between COVID-19 vaccination (Pfizer) and lichen planus diagnosis and evaluated the link between additional doses of the vaccine and disease progression. Methods Complete clinical, laboratory, and histopathological assessment of a patient was performed with ethical and privacy considerations. Written informed consent for all clinical data, images, and publication was obtained from the patient. Results New-onset lichen planus appeared 48 hours after the first dose of the Pfizer vaccine. The symptoms worsened following the second dose. The patient responded gradually to topical corticosteroids, and lichen planus was controlled within 21 days. Conclusion Our case significantly contributes to the literature by highlighting that additional doses of the Pfizer vaccine can contribute to disease progression. Therefore, reporting the patient's condition associated with COVID-19 vaccination should be considered. Future studies should be performed to investigate the combined onset of lichen planus and multisystem COVID-19 vaccine-related complications.
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Abstract
Annular lichenoid diseases encompass a diverse range of pathologies that present as circular, raised, or flat lesions that may vary in size and number. Examples include annular lichenoid dermatitis of youth, annular lichen planus, erythema dyschromicum perstans, erythema multiforme, fixed drug eruption, lichen sclerosus, neonatal lupus, porokeratosis, subacute cutaneous lupus erythematosus, and lichenoid syphilis. Clinical morphology and histopathology can differentiate these entities.
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18
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Al Khabbaz FA, Ali MM, Al Awadhi A. A Rare Case Report: Five Variants of Lichen Planus in a Young Male Patient. Cureus 2022; 14:e27080. [PMID: 36000123 PMCID: PMC9391065 DOI: 10.7759/cureus.27080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/05/2022] Open
Abstract
Lichen planus is a common dermatological condition. It is described as a chronic inflammatory mucocutaneous disease that has characteristic clinical and histopathological findings. Classical lichen planus lesions occur as purple, pruritic polygonal papules or plaques with a lace-like pattern of whitish markings on the surface. Despite the large number of variants that exist with different clinical manifestations from the classic form, histopathology features are fairly similar among the subtypes and can aid in the diagnosis. Although most cases of lichen planus are often self-limiting with spontaneous resolution expected within one to two years, early diagnosis and treatment are encouraged to control severe pruritus and painful mucosal erosion, but most importantly to minimize the potential for malignant transformation in long-standing lesions. The main objective of this paper is to report the first case of five cutaneous variants of lichen planus occurring simultaneously in a young male patient.
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19
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Pinto D, Calabrese FM, De Angelis M, Celano G, Giuliani G, Rinaldi F. Lichen Planopilaris: The first biopsy layer microbiota inspection. PLoS One 2022; 17:e0269933. [PMID: 35849580 PMCID: PMC9292073 DOI: 10.1371/journal.pone.0269933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 06/01/2022] [Indexed: 11/18/2022] Open
Abstract
Lichen Planopilaris (LPP) is a lymphatic disease affecting the scalp that is characterized by a chronic and destructive inflammation process, named as ‘cicatricial alopecia’ in which the hair follicles are targeted and may involve predominantly lymphocytes or neutrophils. Scalp and biopsy layers have never been used to investigate microbial community composition and its relative taxa abundances in LPP. We sought to examine the significant taxa of this chronic relapsing inflammatory skin disease, together with inspect the existing connections with metabolic pathways featuring this microbial community. We used a multilevel analysis based on 16S rRNA marker sequencing in order to detect OTU abundances in pathologic/healthy samples, real time PCR for measuring the levels of IL-23 interleukin expression and urinary metabolomics to find out volatile organic metabolites (VOMs). By using a linear regression model, we described peculiar taxa that significantly differentiated LPP and healthy samples. We inspected taxa abundances and interleukin mRNA levels and the Microbacteriaceae family resulted negatively correlated with the IL-23 expression. Moreover, starting from 16S taxa abundances, we predicted the metabolic pathways featuring this microbial community. By inspecting microbial composition, sample richness, metabolomics profiles and the relative metabolic pathways in a cohort of LPP and healthy samples we deepened the contribution of significant taxa that are connected to inflammation maintenance and microbiota plasticity in LPP pathology.
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Affiliation(s)
- Daniela Pinto
- Human Advanced Microbiome Project-HMAP, Milan, Italy
- * E-mail: (DP); (FMC)
| | - Francesco Maria Calabrese
- Department of Soil, Plant and Food Science, “Aldo Moro” University, Bari, Bari, Italy
- * E-mail: (DP); (FMC)
| | - Maria De Angelis
- Department of Soil, Plant and Food Science, “Aldo Moro” University, Bari, Bari, Italy
| | - Giuseppe Celano
- Department of Soil, Plant and Food Science, “Aldo Moro” University, Bari, Bari, Italy
| | | | - Fabio Rinaldi
- Human Advanced Microbiome Project-HMAP, Milan, Italy
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20
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Idriss MH, Barbosa N, Chang MB, Gibson L, Baum CL, Vidal NY. Concomitant hypertrophic lichen planus and squamous cell carcinoma: Clinical features and treatment outcomes. Int J Dermatol 2022; 61:1527-1531. [PMID: 35766459 DOI: 10.1111/ijd.16321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 04/17/2022] [Accepted: 06/13/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with hypertrophic lichen planus (HLP) and squamous cell carcinoma (SCC) diagnoses present clinicians with diagnostic and disease management challenges. OBJECTIVE To better define the clinical and treatment outcomes of patients with concomitant diagnoses of HLP and SCC. METHODS AND MATERIALS A retrospective review was performed from January 1, 2008, to July 31, 2015, at Mayo Clinic. Patients with a histologic diagnosis of HLP and SCC were included. Patient demographics, associated comorbidities, histopathologic characteristics, treatment, and outcomes were evaluated. RESULTS Thirty-three patients were identified; 79% were female, and mostly the lower extremities were involved. Most of the SCCs were well-differentiated and in situ with the majority treated with destruction or excision. There were no cases of local recurrence, metastasis, or disease-specific death during the follow-up period (mean 55.8 months). CONCLUSION Patients with diagnoses of both HLP and SCC appear to be a distinct population that is predominantly female with lesion predilection for the lower extremities. However, regardless of treatment modality or tumor size, there were no adverse outcomes. An initial trial of more conservative treatment measures with close follow-up may be reasonable with biopsy of lesions unresponsive to conventional treatment.
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Affiliation(s)
- Munir H Idriss
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Naiara Barbosa
- The University of New Mexico, Department of Dermatology, Albuquerque, New Mexico, USA
| | - Michael B Chang
- The University of New Mexico, Department of Dermatology, Albuquerque, New Mexico, USA.,Dermatology and Skin Cancer Center of New Mexico, Albuquerque, New Mexico, USA
| | - Lawrence Gibson
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Christian L Baum
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Nahid Y Vidal
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
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21
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Association between lichen planus and dyslipidemia: an experience from North India. EUREKA: HEALTH SCIENCES 2022. [DOI: 10.21303/2504-5679.2022.002400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Association between lichen planus (LP) and dyslipidaemia and other cardiovascular risk factors has been reported in many studies in the past, with variable results between studies.
The aim: this study was undertaken to study the association of lichen planus with dyslipidaemia.
Methods: this was a prospective hospital-based case control study conducted over a period of three years, on 105 prospective newly diagnosed male patients of lichen planus and equal number of age and sex matched controls. Fasting serum lipid profile including total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and very low-density lipoprotein cholesterol (VLDL-C) were measured, and comparison done between cases and controls.
Results: dyslipidaemia was found in 44 (41.9 %) lichen planus patients (cases) as compared to 28 (26.7 %) controls, the difference being statistically significance (p 0.020). Triglycerides, total cholesterol, LDL cholesterol and VLDL cholesterol were significantly higher in cases than controls, whereas difference in the values of abdominal circumference and body mass index (BMI), although more in cases than controls was not statistically significant. Similarly, HDL-cholesterol values were less in cases than controls, but without statistical significance.
Conclusion: dyslipidaemia was more common in lichen planus (LP) patients, as compared to controls, suggesting that LP patients are at a higher risk of developing derangements of serum lipids and should be routinely and regularly monitored for dyslipidaemia and other cardiovascular risk factors, to detect cardiovascular diseases well in time. The result of present study strengthens the evidence of association between LP and dyslipidaemia.
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22
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Raccampo L, Sembronio S, Tel A, Cacitti V, Robiony M. Oral Lichen Planus arising after BNT162b2 mRNA COVID-19 Vaccine: report of two cases. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:e54-e57. [PMID: 35851250 PMCID: PMC8995197 DOI: 10.1016/j.oooo.2022.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 03/31/2022] [Accepted: 04/02/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Luca Raccampo
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - Salvatore Sembronio
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - Alessandro Tel
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy
| | - Veronica Cacitti
- Department of Pathology, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | - Massimo Robiony
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medicine, University of Udine, Udine, Italy.
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23
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Alrawashdah HM, Al-Habahbeh O, Naser AY, Abu Serhan H, Hamdan O, Sweiss K, Aldalameh Y. Lichen Planus Eruption Following Oxford-AstraZeneca COVID-19 Vaccine Administration: A Case Report and Review of Literature. Cureus 2022; 14:e22669. [PMID: 35386174 PMCID: PMC8967128 DOI: 10.7759/cureus.22669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2022] [Indexed: 11/05/2022] Open
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Babazadeh A, Miladi R, Barary M, Shirvani M, Ebrahimpour S, Aryanian Z, Mohseni Afshar Z. COVID‐19 vaccine‐related new‐onset lichen planus. Clin Case Rep 2022; 10:e05323. [PMID: 35140945 PMCID: PMC8810943 DOI: 10.1002/ccr3.5323] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 01/07/2022] [Indexed: 01/05/2023] Open
Abstract
Coronavirus disease 2019 (COVID‐19) vaccines significantly impacted world health and well‐being. However, various adverse events have been observed following severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) vaccination. Cutaneous reactions have been prevalent following many vaccines, including COVID‐19 vaccines. Here, we present a case of new‐onset lichen planus in a patient who received the COVID‐19 vaccine at the same time as being infected with SARS‐CoV‐2. A 52‐year‐old woman presented to the clinic with extensive pruritic skin lesions. The eruptions had appeared a week after her second dose of the Sinopharm COVID‐19 vaccine. She mentioned a history of SARS‐CoV‐2 infection approximately 10 days following the first dose of her vaccine, causing a 1‐month delay in getting the second dose. Her past medical history was not significant. On examination, erythematous and squamous papules were demonstrated predominantly on the extremities, including inguinal and axillary folds. Moreover, desquamation of the lips was visible, and buccal lesions were also found. After consultation with a dermatologist, a skin biopsy was indicated for the patient, but she refused to undergo the procedure. Therefore, considering the typical appearance of the eruptions, lichen planus was suspected, for which she was treated with oral antihistamines and topical corticosteroids. Dermatologists should be aware of the probability of new‐onset or exacerbated mucosal skin disorders due to the vast range of cutaneous adverse events following COVID‐19 vaccination and actively monitor susceptible patients.
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Affiliation(s)
- Arefeh Babazadeh
- Infectious Diseases and Tropical Medicine Research Center Health Research Institute Babol University of Medical Sciences Babol Iran
| | - Ronak Miladi
- Clinical Research Development Center Imam Reza Hospital Kermanshah University of Medical Sciences Kermanshah Iran
| | - Mohammad Barary
- Student Research Committee Babol University of Medical Sciences Babol Iran
- Students' Scientific Research Center (SSRC) Tehran University of Medical Sciences Tehran Iran
| | - Maria Shirvani
- Clinical Research Development Center Imam Reza Hospital Kermanshah University of Medical Sciences Kermanshah Iran
| | - Soheil Ebrahimpour
- Infectious Diseases and Tropical Medicine Research Center Health Research Institute Babol University of Medical Sciences Babol Iran
| | - Zeinab Aryanian
- Autoimmune Bullous Diseases Research Center Tehran University of Medical Sciences Tehran Iran
- Department of Dermatology School of Medicine Babol University of Medical Sciences Babol Iran
| | - Zeinab Mohseni Afshar
- Clinical Research Development Center Imam Reza Hospital Kermanshah University of Medical Sciences Kermanshah Iran
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25
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Rasul TF, Anderson J, Bergholz DR, Faiz A, Prasad RR. Gold Dental Implant-Induced Oral Lichen Planus. Cureus 2022; 14:e21852. [PMID: 35273836 PMCID: PMC8901106 DOI: 10.7759/cureus.21852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 02/02/2023] Open
Abstract
Lichen planus is a chronic inflammatory cutaneous and mucosal disease mostly affecting middle-aged individuals. The etiology of lichen planus is unknown, but current literature suggests that it is an altered immune response characterized by dysregulated T-cell activation and subsequent inflammation which can be associated with conditions like allergic contact dermatitis and hepatitis C. Additionally, heavy metals like lead, tin, arsenic, and bismuth can create inflammatory and allergic reactions that can predispose to the formation of lichen planus. This report examines the case of a 64-year-old female with longstanding oral lichenoid lesions with superimposed Wickham's striae, allergic skin reactions to several medications, and a history of receiving gold-containing dental implants. As a result of her history and subsequent allergy testing, she was found to have a gold allergy. The constant mucosal irritation from her dental implants likely was associated with the development of her oral lesions, which were confirmed to be oral lichen planus. She was recommended to apply triamcinolone 0.1% ointment to her oral lesions and to follow up with her dentist for evaluation of her filings. Further, it was recommended she replaces the dental crowns with compounds lacking gold to decrease the persistent irritation. This case represents the first such instance of gold dental fillings directly having an appreciable role in the development of oral lichen planus.
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Affiliation(s)
- Taha F Rasul
- Infectious Diseases, University of Miami Miller School of Medicine, Miami, USA
| | - Jackson Anderson
- Internal Medicine, University of Miami Miller School of Medicine, Miami, USA
| | - Daniel R Bergholz
- Allergy and Immunology, University of Miami Miller School of Medicine, Miami, USA
| | - Arfa Faiz
- Allergy and Immunology, Sutter Medical Center, Sacramento, USA
| | - Rishi R Prasad
- Medical Education, University of Miami Miller School of Medicine, Miami, USA
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Alsharif F, Alotaibi S, Alharithy R, Alkhayal N. Lichen planus after COVID-19 vaccination: A report of two cases. JOURNAL OF DERMATOLOGY & DERMATOLOGIC SURGERY 2022. [DOI: 10.4103/jdds.jdds_15_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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27
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Ren J, Ning X, Zhang D, Zhang Y. Increased Level of Serum Wingless-Type Mouse Mammary Tumor Virus Integration Site Family Member 5a in Patients with Cutaneous Lichen Planus. J Inflamm Res 2022; 15:235-239. [PMID: 35046697 PMCID: PMC8761001 DOI: 10.2147/jir.s341908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/28/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Methods Results Conclusion
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Affiliation(s)
- Jianwen Ren
- Department of Dermatology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xian, Shaanxi Province, People’s Republic of China
| | - Xiaoying Ning
- Department of Dermatology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xian, Shaanxi Province, People’s Republic of China
| | - Dingwei Zhang
- Department of Dermatology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xian, Shaanxi Province, People’s Republic of China
| | - Yanfei Zhang
- Department of Dermatology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xian, Shaanxi Province, People’s Republic of China
- Correspondence: Yanfei Zhang Department of Dermatology, The Second Affiliated Hospital of Xi’an Jiaotong University, 157 Xi Wu Road, Xi’an, 710004, Shaanxi Province, People’s Republic of ChinaTel/Fax +86-29-87679301 Email
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Demystifying Esophageal Lichen Planus: A Comprehensive Review of a Rare Disease You Will See in Practice. Am J Gastroenterol 2022; 117:70-77. [PMID: 34591036 DOI: 10.14309/ajg.0000000000001485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 08/03/2021] [Indexed: 12/11/2022]
Abstract
Lichen planus (LP) is a chronic inflammatory disorder that often affects the skin, hair, nails, and mucus membranes. Although esophageal involvement has traditionally been felt to be rare, recent reports suggest that it is often unrecognized or misdiagnosed. The diagnoses of esophageal lichen planus can be challenging and is suspected based on patients' endoscopic and histologic findings and in the context of their clinical history and physical examination. Physicians must have an index of suspicion, particularly in older white women and in those patients with an atypical esophagitis or stricturing disease, which do not respond to traditional treatment. Currently, there are limited data on esophageal lichen planus patients, and no formal management guidelines for this disease, which all gastroenterologists will see in practice. This article reviews the etiology and histopathology of LP and provides a comprehensive discussion of the clinical features, diagnosis, and management of esophageal disease from the gastroenterologist's perspective. Finally, we address the esophageal complications of LP.
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29
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Rehman F, Krishan K, Latif I, Sudan E, Sultan J, Hassan I. Intra-individual Right-Left Comparative Study of Combined Therapy of Intramatricial Triamcinolone and Platelet-Rich Plasma vs. Intramatricial Triamcinolone Only in Lichen Planus-Associated Nail Dystrophy. J Cutan Aesthet Surg 2021; 14:311-317. [PMID: 34908773 PMCID: PMC8611714 DOI: 10.4103/jcas.jcas_156_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background While intramatricial triamcinolone is the most commonly used treatment option for onychodystrophy due to lichen planus, the role of platelet-rich plasma (PRP) in the treatment of onychodystrophy is not established. So we combined the two treatment modalities to assess the synergistic action on nail dystrophy. Aims and Objectives The aim of this article is to compare the effect of combination of intramatricial triamcinolone and PRP vs. intramatricial triamcinolone alone in the treatment of onychodystrophy. Materials and Methods This study was done in 26 and 25 pairs of symmetrical dystrophic nails in hands and feet, respectively. The patients received intramatricial injection of triamcinolone and PRP on one side of finger and toe nails and triamcinolone on the contralateral side. Results Statistically significant improvements in grades of dystrophy according to the Nail Dystrophy Grading System (NDGS) in the finger and toe nails treated with combined therapy were obtained (P < 0.001 and = 0.002, respectively). According to the physician global assessment, response to combination therapy was statistically significant between the two comparison groups of finger and toe nails (P = 0.001 and = 0.004, respectively). Similarly, according to the patient satisfaction score, statistically significant difference was found between the comparison groups of combination therapy and single therapy (P < 0.001). Conclusion Addition of PRP significantly improved the nail quality. Intramatricial PRP is a safe and effective therapeutic modality in refractory nail dystrophies.
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Affiliation(s)
- Fozia Rehman
- Department of Dermatology, Venereology, and Leprosy, Government Medical College Srinagar, Karan Nagar, Jammu and Kashmir, India
| | - Kewal Krishan
- Department of Dermatology, Venereology, and Leprosy, Government Medical College Srinagar, Karan Nagar, Jammu and Kashmir, India
| | - Insha Latif
- Department of Dermatology, Venereology, and Leprosy, Government Medical College Srinagar, Karan Nagar, Jammu and Kashmir, India
| | - Ekta Sudan
- Department of Dermatology, Venereology, and Leprosy, Government Medical College Srinagar, Karan Nagar, Jammu and Kashmir, India
| | - Javeed Sultan
- Department of Dermatology, Venereology, and Leprosy, Government Medical College Srinagar, Karan Nagar, Jammu and Kashmir, India
| | - Iffat Hassan
- Department of Dermatology, Venereology, and Leprosy, Government Medical College Srinagar, Karan Nagar, Jammu and Kashmir, India
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Sharda P, Mohta A, Ghiya BC, Mehta RD. Development of oral lichen planus after COVID-19 vaccination - a rare case report. J Eur Acad Dermatol Venereol 2021; 36:e82-e83. [PMID: 34606669 PMCID: PMC9088686 DOI: 10.1111/jdv.17718] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/27/2021] [Indexed: 11/30/2022]
Affiliation(s)
- P Sharda
- Department of Dermatology, Venereology and Leprosy, Sardar Patel Medical College, Bikaner, India
| | - A Mohta
- Department of Dermatology, Venereology and Leprosy, Sardar Patel Medical College, Bikaner, India
| | - B C Ghiya
- Department of Dermatology, Venereology and Leprosy, Sardar Patel Medical College, Bikaner, India
| | - R D Mehta
- Department of Dermatology, Venereology and Leprosy, Sardar Patel Medical College, Bikaner, India
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31
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Öncül H, Ayhan E. Evaluation of corneal densitometry changes in patients with lichen planus. Int J Clin Pract 2021; 75:e14234. [PMID: 33872447 DOI: 10.1111/ijcp.14234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 03/01/2021] [Accepted: 04/10/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To investigate the corneal topography and densitometry changes in patients with lichen planus (LP). METHODS Anterior segment parameters and corneal densitometry of patients with LP and age- and gender-matched individuals with healthy eyes were evaluated using Scheimpflug corneal topography. A 12 mm corneal area was divided into 4 annular zones and 3 regions-in-depth anterior, central and posterior-for densitometry evaluation. RESULTS The study included 45 patients with LP and 50 individuals with healthy eyes. The two groups were similar in age and gender, and they showed no significant differences in anterior segment corneal topography parameters. Schirmer's I test results were significantly lower in the patients with LP than in the control group (P ˂ .001). The total corneal densitometry was higher in patients with LP than in the control group (P = .030). The anterior, central and posterior corneal densitometry in the 0-2 mm and 2-6 mm annular zones was higher in the LP group than in the control group. Correlation analysis between disease duration and corneal densitometry values showed a strong positive correlation in the anterior segment and a moderate positive correlation in the central and posterior segments (r = 0.632, P ˂ .001; r = 0.572, P ˂ .001; and r = 0.562, P ˂ .001, respectively). CONCLUSIONS Corneal densitometry values were higher in patients with LP than in individuals with healthy eyes, even if the patients had a clinically transparent cornea. More studies are needed to evaluate the changes that may occur in corneal transparency in patients with LP and other autoimmune dermatologic diseases that may affect the eye.
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Affiliation(s)
- Hasan Öncül
- Department of Ophthalmology, University of Health Scıences Gazi Yaşargil Education Research Hospital, Diyarbakır, Turkey
| | - Erhan Ayhan
- Department of Ophthalmology, University of Health Scıences Gazi Yaşargil Education Research Hospital, Diyarbakır, Turkey
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Hiltun I, Sarriugarte J, Martínez‐de‐Espronceda I, Garcés A, Llanos C, Vives R, Yanguas J. Lichen planus arising after COVID-19 vaccination. J Eur Acad Dermatol Venereol 2021; 35:e414-e415. [PMID: 33724563 PMCID: PMC8250777 DOI: 10.1111/jdv.17221] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 03/09/2021] [Indexed: 02/06/2023]
Affiliation(s)
- I. Hiltun
- Dermatology DepartmentComplejo Hospitalario de NavarraPamplonaSpain
| | - J. Sarriugarte
- Dermatology DepartmentComplejo Hospitalario de NavarraPamplonaSpain
| | | | - A. Garcés
- Ansoain Primary Care CenterPamplonaSpain
| | - C. Llanos
- Pathology DepartmentComplejo Hospitalario de NavarraPamplonaSpain
| | - R. Vives
- Dermatology DepartmentComplejo Hospitalario de NavarraPamplonaSpain
| | - J.I. Yanguas
- Dermatology DepartmentComplejo Hospitalario de NavarraPamplonaSpain
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33
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Chung IY, Wong CC, Rodrigues MA. The importance of dermoscopy in subclinical lichen planus in skin of color. Int J Womens Dermatol 2021; 7:205-206. [PMID: 33937495 PMCID: PMC8072490 DOI: 10.1016/j.ijwd.2020.12.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/29/2020] [Accepted: 12/29/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- In Young Chung
- Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Celestine C Wong
- Department of Dermatology, Monash Medical Centre, Clayton, Victoria, Australia.,Chroma Dermatology, Pigment and Skin of Colour Centre, Melbourne, Victoria, Australia
| | - Michelle A Rodrigues
- Chroma Dermatology, Pigment and Skin of Colour Centre, Melbourne, Victoria, Australia.,Department of Dermatology, Royal Children's Hospital, Parkville, Victoria, Australia
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34
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Xie F, Lehman JS. Nail Lichen Planus. Mayo Clin Proc 2021; 96:1363-1364. [PMID: 33958064 DOI: 10.1016/j.mayocp.2021.02.024] [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] [Received: 02/08/2021] [Accepted: 02/08/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Fangyi Xie
- Department of Dermatology, Mayo Clinic, Rochester, MN
| | - Julia S Lehman
- Department of Dermatology, Mayo Clinic, Rochester, MN; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.
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Hunt KM, Klager S, Kwak YJ, Sami N. Successful systemic treatment outcomes of lichen planus: A single-center retrospective review. Dermatol Ther 2021; 34:e14903. [PMID: 33605044 DOI: 10.1111/dth.14903] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/05/2021] [Accepted: 02/13/2021] [Indexed: 12/15/2022]
Abstract
Lichen planus (LP) affects up to 4% of adults and can cause significant distress and morbidity, especially to those with persistent disease. As many as 20% of patients with LP may exhibit widespread or recalcitrant disease necessitating systemic treatment options. We sought to evaluate the effectiveness of systemic treatments for severe and recalcitrant LP not responsive to topical corticosteroids or calcineurin inhibitors. Over a 10-year period, 374 patients with cutaneous and mucosal LP were evaluated at a major regional tertiary medical center; 94 qualified for inclusion in the study. In all, 26 (28%) patients achieved remission, 52 (55%) experienced stable disease control, and 16 (17%) failed all attempted treatments. Among medications most trialed, intramuscular triamcinolone (IM TAC), hydroxychloroquine, and methotrexate were most successful with 79%, 61%, and 42% respective response rates. In contrast, oral corticosteroids and dapsone were less frequently successful at rates of 24% and 20%. IM TAC represented the highest level of treatment success and was statistically significant compared to other systemic treatments (P < .01). Among adjuvant therapies, intralesional triamcinolone (IL TAC) demonstrated higher success (71%) than oral corticosteroids (29%). Based on this multi-year evaluation, we recommend that clinicians consider IM TAC as a first-line systemic option for severe or refractory LP, with hydroxychloroquine as the steroid-sparing treatment of choice. For patients requiring adjuvant therapy, IL TAC should be considered to hasten response and symptom relief. Patients with severe or widespread disease may benefit from earlier initiation of systemic therapy to prevent significant morbidity and impact on daily function.
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Affiliation(s)
- Katherine M Hunt
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Skylar Klager
- University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Young J Kwak
- Laser Skin Care Center, Long Beach, California, USA
| | - Naveed Sami
- Department of Medicine, University of Central Florida, Orlando, Florida, USA
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36
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Priscilla T, Parlapalli N. Effective treatment option for lichen planus: Steroids or low molecular weight heparins? INDIAN JOURNAL OF DRUGS IN DERMATOLOGY 2021. [DOI: 10.4103/ijdd.ijdd_31_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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37
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Mutalik S, Belgaumkar V, Rasal Y. Current perspectives in the treatment of childhood lichen planus. INDIAN JOURNAL OF PAEDIATRIC DERMATOLOGY 2021. [DOI: 10.4103/ijpd.ijpd_165_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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38
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Rathi S, Joshi A, Manchanda Y. Childhood lichen planus. INDIAN JOURNAL OF PAEDIATRIC DERMATOLOGY 2021. [DOI: 10.4103/ijpd.ijpd_132_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Balani P, Lopez AR, Nobleza CMN, Siddiqui M, Shah PV, Khan S. Can Pioglitazone Safeguard Patients of Lichen Planus Against Homocysteine Induced Accelerated Cardiovascular Aging and Reduced Myocardial Performance: A Systematic Review. Cureus 2020; 12:e12372. [PMID: 33527053 PMCID: PMC7842239 DOI: 10.7759/cureus.12372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Lichen planus (L.P.) is a long-standing mucocutaneous inflammatory condition. A less familiar but essential illness association is increased arterial stiffness, endothelial dysfunction, and advanced atherosclerosis. Enhanced cardiac reconditioning and reduced performance of the heart have been suggested. Thiazolidinediones were commenced to manage hyperglycemia in diabetes mellitus. Recently, the class attained popularity after its action on vascular physiology was discovered. With this review, we attempted to explore whether an antidiabetic drug, pioglitazone (PIO), a peroxisome proliferator‑activated receptor γ (PPAR gamma) agonist, can defend patients of lichen planus against increased arterial stiffness and cardiac changes. We methodically screened numerous databases using focused words and phrases for relevant articles. After a comprehensive exploration, we applied the inclusion and exclusion criteria and performed a quality appraisal. Items retained were exhaustively studied. High homocysteine (HHcy) levels in lichen planus play a significant role in modifying the arteries and leading to their dysfunction. Not only does homocysteine affect the precursor cells, but it also increases the free radical damage. Arterial damage and upraised resistance encountered by the heart reduce its performance. After an exhaustive analysis, in our opinion, pioglitazone works in various miscellaneous ways to mitigate the homocysteine mediated changes. Early inclusion of the drug in managing patients with lichen planus seems promising in minimizing the harmful effects of high homocysteine. Evaluating the risk-benefit ratio, we believe that a trial of pioglitazone could be given to patients without underlying cardiac conditions.
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Affiliation(s)
- Prachi Balani
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Angel R Lopez
- Psychiatry, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Chelsea Mae N Nobleza
- Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Mariah Siddiqui
- Neurology, St. George's University, True Blue, GRD.,Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Parth V Shah
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Safeera Khan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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40
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Daye M, Temiz SA, Isık B. The relationship between lichen planus and metabolic syndrome. J Cosmet Dermatol 2020; 20:2635-2639. [PMID: 33355985 DOI: 10.1111/jocd.13905] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/31/2020] [Accepted: 12/01/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Lichen planus (LP) is an idiopathic, chronic inflammatory disease. Chronic inflammatory diseases can cause metabolic complications. In the literature, data related to the relationship between lichen planus and metabolic syndrome (MS) are limited. We aimed to evaluate the relationship between MS and lichen planus with disease activity. METHODS The patients diagnosed with lichen planus at the dermatology outpatient clinic between January 2018 and January 2020 were retrospectively analyzed. 98 lichen planus cases, age- and sex-matched 99 controls, 197 cases in total were included in the study. RESULTS Of the 98 lichen planus cases included in the study, 60 (61%) were women. The mean age of the patients was 49.3 ± 14.4, and the average disease duration was 33.5 ± 31.4 months. 55 (55%) of the patients in the control group were female, and the mean age of the control group was 50 ± 13.2. The body mass index of LP cases was 29.5 ± 5.8, in the control group was 25.8 ± 3.7. Metabolic syndrome was found in 47 (48%) of 98 cases with lichen planus and 32.3% in the control group. MS in the lichen planus group was significantly higher than the control group (P = .025). Metabolic syndrome was detected in the oral lichen planus at the rate of 60% (12 cases). Although the incidence of MS was more common in the oral lichen planus, it was not statistically significant (P = .29). While no significant relationship was found between oral disease severity and metabolic syndrome (P = .19), a significant correlation was found between cutaneous disease severity and metabolic syndrome (P = .023). DISCUSSION The risk of mucosal malignancy that can occur when following LP cases has been known for a long time. According to our results, caution should be taken in terms of metabolic complications in the follow-up of LP cases, especially oral LP cases.
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Affiliation(s)
- Munise Daye
- Department of Dermatology, Necmettin Erbakan University Meram Medical Faculty, Konya, Turkey
| | | | - Begüm Isık
- Department of Dermatology, Necmettin Erbakan University Meram Medical Faculty, Konya, Turkey
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Genomic Analysis of Oral Lichen Planus and Related Oral Microbiome Pathogens. Pathogens 2020; 9:pathogens9110952. [PMID: 33207582 PMCID: PMC7697643 DOI: 10.3390/pathogens9110952] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/05/2020] [Accepted: 11/12/2020] [Indexed: 12/17/2022] Open
Abstract
Oral lichen planus (OLP) is a common chronic inflammatory disease affecting the oral mucosa. The pathogenesis of OLP is incompletely understood but is thought to be related to the immune system. As the oral cavity is a major reservoir and transmission gateway for bacteria, viruses, and fungi, the microbial composition of the oral cavity could play a role in the pathogenesis of OLP. However, limited by analytic technology and knowledge of the microbial community in the oral cavity, it is not yet clear which pathogens are associated with OLP. Next generation sequencing (NGS) is a powerful tool to identify pathogens for many infectious diseases. In this study, we compared the host cell gene expression profiles and the microbial profiles between OLP patients and matched healthy individuals. We identified the activation of the hepatocyte nuclear factor alpha (HNF4A) network in OLP patients and potential pathogens, including Corynebacterium matruchotii, Fusobacterium periodonticum, Streptococcus intermedius, Streptococcus oralis, and Prevotella denticola. Prevotella denticola is capable of activating the HNF4A gene network. Our findings shed light on the previously elusive association of OLP with various diseases like hepatitis, and indicate that OLP is a T-helper type 17 (Th17) mediated mucosal inflammatory process. The identified molecular pathways and microbes could be used to inform future investigations into OLP pathogenesis and to develop novel therapeutics for OLP treatment.
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42
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Piquero-Casals J, Morgado-Carrasco D, Mir-Bonafé JF, Rozas-Muñoz E, Piquero-Casals V. Clinical and Penile Dermoscopy Evaluation of a Reticulated Pattern on the Penile Glans. Urology 2020; 148:e27-e28. [PMID: 33159921 DOI: 10.1016/j.urology.2020.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/17/2020] [Accepted: 10/25/2020] [Indexed: 11/25/2022]
Abstract
A 32-year-old man visited our clinic for evaluation of a mildly pruritic lesion on the glans. He complained of a recurrent red patch, which had been slowly enlarging over the previous three months. Clinical examination revealed a slightly raised plaque with a reticulated lacy net pattern and white threads on the glans. There was no evidence of skin, nail or other mucosal involvement on physical examination. Laboratory tests, including hepatitis and syphilis serologies, were normal or negative. Penile dermoscopy revealed white reticular and circular lines [Wickham striae] on a red background. Penile dermoscopy should be included as a part of the clinical inspection of genital diseases to support diagnosis, as well as to ideally avoid unnecessary invasive investigation.
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Affiliation(s)
- Jaime Piquero-Casals
- Department of Dermatology, Dermik, Clínica Dermatológica Multidisciplinar, Barcelona, Spain.
| | | | | | | | - Vanesa Piquero-Casals
- Department of Dermatology, Dermik, Clínica Dermatológica Multidisciplinar, Barcelona, Spain
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Uncovering subtle nail involvement in lichen planus with dermoscopy: a prospective, controlled study. Postepy Dermatol Alergol 2020; 37:396-400. [PMID: 32792882 PMCID: PMC7394157 DOI: 10.5114/ada.2020.96298] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 11/05/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction There are very few studies investigating the dermoscopic aspect of nail involvement in lichen planus and these studies described dermoscopic features of only clinically visible nail involvement in lichen planus. Aim To reveal subtle dermoscopic nail findings in patients with lichen planus. Material and methods The study included 40 patients with lichen planus and 40 healthy volunteers. All fingernails of the patients and healthy volunteers were examined by a handheld dermoscope and the findings detected were recorded. The patients were grouped by age, gender, disease duration and extent of the disease. The statistical analysis was performed using Chi square test. Results 82.5% of the patients and 17.5% of the healthy volunteers showed at least one dermoscopic nail finding. The frequency of multiple splinter haemorrhage (p < 0.05), multiple leukonychia (p < 0.05), longitudinal erythronychia (p < 0.05), prominent hyponychial vascular structures (p < 0.05) and onycholysis (p < 0.05) observed in the patients group was statistically significant. The other findings included distal short longitudinal lines, onychorrhexis, solitary splinter haemorrhage and solitary punctate leukonychia and showed no statistically significant differences between the two groups. Conclusions To the best of our knowledge, this is the first study focusing on uncovering subtle nail involvement in lichen planus. The presence of dilated hyponychial vascular structures in lichen planus was first described in the present study. It can be concluded that the frequency of nail involvement in lichen planus is more than known. Dermoscopic imaging of the nails of all patients with lichen planus may help establish early diagnosis and treatment to avoid permanent nail damage.
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Ioannides D, Vakirlis E, Kemeny L, Marinovic B, Massone C, Murphy R, Nast A, Ronnevig J, Ruzicka T, Cooper S, Trüeb R, Pujol Vallverdú R, Wolf R, Neumann M. European S1 guidelines on the management of lichen planus: a cooperation of the European Dermatology Forum with the European Academy of Dermatology and Venereology. J Eur Acad Dermatol Venereol 2020; 34:1403-1414. [DOI: 10.1111/jdv.16464] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 03/31/2020] [Indexed: 12/15/2022]
Affiliation(s)
- D. Ioannides
- Department of Dermatology and Venereology Aristotle University of Thessaloniki Medical School Thessaloniki Greece
| | - E. Vakirlis
- Department of Dermatology and Venereology Aristotle University of Thessaloniki Medical School Thessaloniki Greece
| | - L. Kemeny
- Department of Dermatology and Allergology University of Szeged Szeged Hungary
| | - B. Marinovic
- Department of Dermatology and Venereology University Hospital Center and School of Medicine Zagreb Zagreb Croatia
| | - C. Massone
- Department of Dermatology Medical University of Graz Graz Austria
| | - R. Murphy
- Department of Dermatology Nottingham University Hospital Nottingham UK
| | - A. Nast
- Department of Dermatology, Venereology and Allergy Division of Evidence‐Based Medicine Charité ‐ Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Humboldt‐Universität zu Berlin and Berlin Institute of Health Berlin Germany
| | | | - T. Ruzicka
- Department of Dermatology and Allergology LMU Munich Germany
| | - S.M. Cooper
- Department of Dermatology Oxford University Hospitals NHS Trust and University of Oxford Oxford UK
| | - R.M. Trüeb
- Center for Dermatology and Hair Diseases Wallisellen Switzerland
| | | | - R. Wolf
- Department of Dermatology and Allergology LMU Munich Germany
| | - M. Neumann
- Department of Dermatology Erasmus MC Rotterdam The Netherlands
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45
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Conforti C, Giuffrida R, Di Meo N, Longone M, Vichi S, Colli C, Deinlein T, Vezzoni R, Retrosi C, Errichetti E, Cannavò SP, Zalaudek I, Dianzani C. Benign dermatoses of the male genital areas: A review of the literature. Dermatol Ther 2020; 33:e13355. [PMID: 32239734 DOI: 10.1111/dth.13355] [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: 03/05/2020] [Accepted: 03/26/2020] [Indexed: 11/26/2022]
Abstract
The male genitalia are a common site of dermatoses. Patients with penile diseases often delay or avoid medical care due to anxiety and embarrassment. In this narrative review, we describe some of the main benign dermatoses localized to male genital, focusing on their epidemiology, clinical and dermoscopic features, as well as available therapies.
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Affiliation(s)
- Claudio Conforti
- Dermatology Clinic, University of Trieste, Hospital Maggiore, Trieste, Italy
| | - Roberta Giuffrida
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy
| | - Nicola Di Meo
- Dermatology Clinic, University of Trieste, Hospital Maggiore, Trieste, Italy
| | - Michela Longone
- Dermatology Clinic, University of Trieste, Hospital Maggiore, Trieste, Italy
| | - Silvia Vichi
- Dermatology Clinic, University of Trieste, Hospital Maggiore, Trieste, Italy
| | - Claudia Colli
- Dermatology Clinic, University of Trieste, Hospital Maggiore, Trieste, Italy
| | - Teresa Deinlein
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Roberta Vezzoni
- Dermatology Clinic, University of Trieste, Hospital Maggiore, Trieste, Italy
| | - Chiara Retrosi
- Dermatology Clinic, University of Trieste, Hospital Maggiore, Trieste, Italy
| | - Enzo Errichetti
- Department of Experimental and Clinical Medicine, Institute of Dermatology, University of Udine, Udine, Italy
| | | | - Iris Zalaudek
- Dermatology Clinic, University of Trieste, Hospital Maggiore, Trieste, Italy
| | - Caterina Dianzani
- Department of Plastic Reconstructive and Cosmetic Surgery, Dermatology Section, Campus Bio-Medico University Hospital, Rome, Italy
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Aozasa N, Ota M, Iozumi K. Case of oral lichen planus treated successfully with irsogladine maleate. JOURNAL OF CUTANEOUS IMMUNOLOGY AND ALLERGY 2020. [DOI: 10.1002/cia2.12105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Naohiko Aozasa
- Department of Dermatology Tokyo Metropolitan Police Hospital Tokyo Japan
- Department of Dermatology National Center for Global Health and Medicine Tokyo Japan
| | - Mayumi Ota
- Department of Dermatology Tokyo Metropolitan Police Hospital Tokyo Japan
| | - Ken Iozumi
- Department of Dermatology Tokyo Metropolitan Police Hospital Tokyo Japan
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Luo Y, Kuai L, Chen J, Sun X, Liu L, Luo Y, Ru Y, Xing M, Ding X, Zhou M, Li B, Li X. Efficacy and safety of
Tripterygium wilfordii
Hook. f. for oral lichen planus: Evidence from 18 randomized controlled trials. Phytother Res 2020; 34:2180-2191. [PMID: 32180273 DOI: 10.1002/ptr.6672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 02/06/2020] [Accepted: 03/01/2020] [Indexed: 01/03/2023]
Affiliation(s)
- Yue Luo
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Shanghai University of Traditional Chinese Medicine Shanghai China
- Institute of Dermatology Shanghai Academy of Traditional Chinese Medicine Shanghai China
| | - Le Kuai
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Shanghai University of Traditional Chinese Medicine Shanghai China
- Institute of Dermatology Shanghai Academy of Traditional Chinese Medicine Shanghai China
| | - Jia Chen
- Department of Dermatopathology, Shanghai Dermatology Hospital Tongji University Shanghai China
| | - Xiaoying Sun
- Institute of Dermatology Shanghai Academy of Traditional Chinese Medicine Shanghai China
| | - Liu Liu
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Shanghai University of Traditional Chinese Medicine Shanghai China
| | - Ying Luo
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Shanghai University of Traditional Chinese Medicine Shanghai China
| | - Yi Ru
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Shanghai University of Traditional Chinese Medicine Shanghai China
| | - Meng Xing
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Shanghai University of Traditional Chinese Medicine Shanghai China
| | - Xiaojie Ding
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Shanghai University of Traditional Chinese Medicine Shanghai China
| | - Mi Zhou
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Shanghai University of Traditional Chinese Medicine Shanghai China
| | - Bin Li
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Shanghai University of Traditional Chinese Medicine Shanghai China
- Institute of Dermatology Shanghai Academy of Traditional Chinese Medicine Shanghai China
- Department of Dermatology Shanxi TCM Hospital Xian China
| | - Xin Li
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Shanghai University of Traditional Chinese Medicine Shanghai China
- Institute of Dermatology Shanghai Academy of Traditional Chinese Medicine Shanghai China
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Abstract
Mucocutaneous diseases affecting the oral cavity are predominantly immune mediated or inflammatory. Three of the most common and clinically significant conditions are reviewed in this article: lichen planus, pemphigus vulgaris, and mucous membrane pemphigoid. Because oral manifestations may be the first or only manifestation of mucocutaneous diseases, oral health professionals play a critical role in the early diagnosis and multidisciplinary management of these conditions.
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Solimani F, Pollmann R, Schmidt T, Schmidt A, Zheng X, Savai R, Mühlenbein S, Pickert J, Eubel V, Möbs C, Eming R, Hertl M. Therapeutic Targeting of Th17/Tc17 Cells Leads to Clinical Improvement of Lichen Planus. Front Immunol 2019; 10:1808. [PMID: 31417572 PMCID: PMC6685396 DOI: 10.3389/fimmu.2019.01808] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 07/17/2019] [Indexed: 11/13/2022] Open
Abstract
Lichen planus (LP) is a common, chronic relapsing inflammatory disorder of the skin and mucous membranes which often poses a major therapeutic challenge due to its refractory course. Novel pathogenesis-based therapies are urgently needed. As several studies have shown that IL-17 may contribute to LP pathogenesis, we investigated whether therapeutic targeting of IL-17+ T cells leads to clinical improvement of mucosal and cutaneous LP lesions. A total of five patients with lichen planus were treated in a compassionate use trial with either secukinumab (anti-IL-17; 3 patients with acute and chronic recalcitrant muco-cutaneous LP), ustekinumab (anti-IL-12/IL-23; 1 patient with recalcitrant oral LP) or guselkumab (anti-IL-23; 1 patient with recalcitrant oral LP). The clinical course of the patients was assessed by the Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) reflecting both extent and severity of disease and functional sequelae of oral involvement for at least 12 weeks. The inflammatory infiltrate in lesional and post-lesional skin was analyzed by immunohistochemistry before and after treatment. Furthermore, the cytokine profile of peripheral blood T cells from the treated patients was assessed by flow cytometry and/or ELISpot assay. Treatment with secukinumab induced rapid and prolonged clinical amelioration of muco-cutaneous LP. Clinical improvement was accompanied by a strong reduction of the Th1 and Th17/Tc17 cellular mucosal and cutaneous infiltrate. Moreover, long-term treatment of one patient with recalcitrant oral LP with ustekinumab led to healing of the ulcerative oral lesions and a reduction of peripheral blood and lesional IL-17+ T cells. Finally, treatment with guselkumab led to a marked clinical improvement in a patient with recalcitrant erosive oral LP. These findings show for the first time that therapeutic targeting of Th17/Tc17 cells leads to a pronounced clinical amelioration of mucosal and cutaneous LP and strongly suggests that IL-17-producing T cells are central to disease pathogenesis. Thus, therapeutic targeting of Th17/Tc17 cells opens new therapeutic avenues in the treatment of recalcitrant LP.
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Affiliation(s)
- Farzan Solimani
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Robert Pollmann
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Thomas Schmidt
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Ansgar Schmidt
- Department of Pathology, Philipps-Universität Marburg, Marburg, Germany
| | - Xiang Zheng
- Max Planck Institute for Heart and Lung Research, Member of the German Center for Lung Research (DZL), Member of the Cardio-Pulmonary Institute (CPI), Bad Nauheim, Germany
| | - Rajkumar Savai
- Max Planck Institute for Heart and Lung Research, Member of the German Center for Lung Research (DZL), Member of the Cardio-Pulmonary Institute (CPI), Bad Nauheim, Germany.,Department of Internal Medicine, Member of the DZL, Member of CPI, Justus Liebig University, Giessen, Germany
| | - Stefan Mühlenbein
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Julia Pickert
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Verena Eubel
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Christian Möbs
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Rüdiger Eming
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Michael Hertl
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
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