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Kirtschig G, Kinberger M, Kreuter A, Simpson R, Günthert A, van Hees C, Becker K, Ramakers MJ, Corazza M, Müller S, von Seitzberg S, Boffa MJ, Stein R, Barbagli G, Chi CC, Dauendorffer JN, Fischer B, Gaskins M, Hiltunen-Back E, Höfinger A, Köllmann NH, Kühn H, Larsen HK, Lazzeri M, Mendling W, Nikkels AF, Promm M, Rall KK, Regauer S, Sárdy M, Sepp N, Thune T, Tsiogka A, Vassileva S, Voswinkel L, Wölber L, Werner RN. EuroGuiderm guideline on lichen sclerosus-Treatment of lichen sclerosus. J Eur Acad Dermatol Venereol 2024; 38:1874-1909. [PMID: 38822598 DOI: 10.1111/jdv.20083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/22/2024] [Indexed: 06/03/2024]
Abstract
INTRODUCTION Lichen sclerosus (LS) is an inflammatory skin disease affecting all ages. LS typically involves the anogenital site where it causes itching and soreness; it may lead to sexual and urinary dysfunction in females and males; however, it may be asymptomatic. First signs of LS are usually a whitening of the genital skin, sometimes preceded by redness and oedema; fissuring, scarring, shrinkage and fusion of structures may follow in its course. LS is associated with an increased risk of genital cancer. LS has a huge impact on the quality of life of affected patients, and it is important to raise more awareness of this not uncommon disease in order to diagnose and treat it early. OBJECTIVES The guideline intends to provide guidance on the diagnostic of LS (part 1), highlight important aspects in the care of LS patients, generate recommendations and treatment algorithms (part 2) on topical, interventional and surgical therapy, based on the latest evidence, provide guidance in the management of LS patients during pregnancy, provide guidance for the follow-up of patients with LS and inform about new developments and potential research aspects. MATERIALS AND METHODS The guideline was developed in accordance with the EuroGuiDerm Methods Manual v1.3 https://www.edf.one/de/home/Guidelines/EDF-EuroGuiDerm.html. The wording of the recommendations was standardized (as suggested by the GRADE Working Group). The guideline development group is comprised of 34 experts from 16 countries, including 5 patient representatives. RESULTS Ultrapotent or potent topical corticosteroids in females and males, adults and children remain gold standard of care for genital LS; co-treatment with emollients is recommended. If standard treatment fails in males, a surgical intervention is recommended, complete circumcision may cure LS in males. UV light treatment is recommended for extragenital LS; however, there is limited scientific evidence. Topical calcineurin inhibitors are second line treatment. Laser treatment, using various wave lengths, is under investigation, and it can currently not be recommended for the treatment of LS. Treatment with biologics is only reported in single cases. CONCLUSIONS LS has to be diagnosed and treated as early as possible in order to minimize sequelae like scarring and cancer development. Topical potent and ultrapotent corticosteroids are the gold standard of care; genital LS is often a lifelong disease and needs to be treated long-term.
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Affiliation(s)
- G Kirtschig
- Medbase Health Centre, Frauenfeld, Switzerland
| | - M Kinberger
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - A Kreuter
- Department of Dermatology, Venereology, and Allergology, HELIOS St. Elisabeth Hospital Oberhausen, Oberhausen, Germany
| | - R Simpson
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - A Günthert
- Gynäkologisches Tumorzentrum St. Anna, Lucerne, Switzerland
| | - C van Hees
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - K Becker
- Office for Paediatric Surgery, Bonn, Germany
| | - M J Ramakers
- CenSeRe (Centre for Psychological, Relational, Sexual Health), Voorschoten, The Netherlands
| | - M Corazza
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - S Müller
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | | | - M J Boffa
- Department of Dermatology, Mater Dei Hospital, Msida, Malta
| | - R Stein
- Center for Pediatric, Adolescent and Reconstructive Urology, Medical Faculty Mannheim, University of Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - G Barbagli
- Centro Chirurgico Toscano, Arezzo, Italy
| | - C C Chi
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - J N Dauendorffer
- Department of Dermatology, Centre for Genital and Sexually Transmitted Diseases, University Hospital Saint Louis, Paris, France
| | - B Fischer
- The Swiss Lichen Sclerosus Association, Switzerland/Verein Lichen Sclerosus e.V., Dottikon, Switzerland
| | - M Gaskins
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - E Hiltunen-Back
- Department of Dermatovenereology, Helsinki University Hospital, Helsinki, Finland
| | - A Höfinger
- The Swiss Lichen Sclerosus Association, Switzerland/Verein Lichen Sclerosus e.V., Dottikon, Switzerland
| | - N H Köllmann
- The Swiss Lichen Sclerosus Association, Switzerland/Verein Lichen Sclerosus e.V., Dottikon, Switzerland
| | - H Kühn
- The German Lichen Sclerosus Association, Hamburg, Germany
| | - H K Larsen
- Department of Dermatology and Venereology, Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen, Denmark
| | - M Lazzeri
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - W Mendling
- German Center for Infections in Gynecology and Obstetrics, Helios University Hospital Wuppertal-University Witten/Herdecke, Wuppertal, Germany
| | - A F Nikkels
- Department of Dermatology, University Medical Center of Liège, Liège, Belgium
| | - M Promm
- Department of Paediatric Urology and Clinic St. Hedwig, University Medical Centre of Regensburg, Regensburg, Germany
| | - K K Rall
- Department of Women's Health, Women's University Hospital Tuebingen, Tuebingen, Germany
| | - S Regauer
- Diagnostic and Research Institute of Pathology, Medical University Graz, Graz, Austria
| | - M Sárdy
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - N Sepp
- Department of Dermatology and Venereology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - T Thune
- Department of Dermatology, Haukeland University Hospital, Bergen, Norway
| | - A Tsiogka
- 1st Department of Dermatology-Venereology, Faculty of Medicine, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - S Vassileva
- Department of Dermatology and Venereology, University Hospital "Alexandrovska", Medical University - Sofia, Sofia, Bulgaria
| | - L Voswinkel
- The German Lichen Sclerosus Association, Hamburg, Germany
| | - L Wölber
- Department of Gynaecology, University Medical Centre Hamburg-Eppendorf and Centre for Colposcopy and Vulvovaginal Disease Jersualem Hospital Hamburg, Hamburg, Germany
| | - R N Werner
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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El-Sadek HM, Shaban SSEM, Abdelmaksoud A, Risha BESM, Rageh MA. Choroidal thickness and retinal vascular changes in patients with lichen planus: an inflammatory disease beyond the skin. Ir J Med Sci 2024; 193:2333-2339. [PMID: 38735999 DOI: 10.1007/s11845-024-03699-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 04/27/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Lichen planus (LP) is a common inflammatory condition of unknown etiology that commonly affects the skin and mucous membranes. Optical coherence tomography angiography (OCTA) is a noninvasive technique for identifying early retinal vascular impairment in systemic disease without clinical damage by imaging deep and superficial capillary networks. AIMS To assess the impacts of LP on the choroid and assess vascular changes in retinal capillary density using OCTA. METHODS This single-center prospective case-control study included 30 therapeutic-naïve LP patients and 30 age and sex-matched healthy individuals. All study subjects underwent a complete ophthalmological examination, including best-corrected visual acuity (BCVA) measurement using a Snellen chart, slit-lamp biomicroscopy, intraocular pressure (IOP) measurement, and fundus examination. They were then examined using spectral domain OCT and choroidal thickness was measured. The vessel density of the superficial and deep capillary networks was measured and assessed using OCTA. RESULTS Patients had significantly thicker choroidal and retinal thickness than controls, with subfoveal, nasal, and temporal areas showing a significant difference. A significantly higher vascular density in the superficial capillary plexus, particularly in the nasal perifoveal area, was found compared to the control group. Significantly, higher vascular density in the deep capillary plexus in the parafoveal area compared to controls was reported. Significant correlations were found between visual acuity and IOP, and age, duration of disease, and severity of disease. CONCLUSIONS This study is the first to reveal that LP patients exhibit choroidal changes and retinal vascular alterations compared to healthy controls.
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Affiliation(s)
- Hala M El-Sadek
- Department of Dermatology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | | | - Ayman Abdelmaksoud
- Mansoura Dermatology, Venereology and Leprology Hospital, Mansoura, Egypt
- Department of Dermatology, University of Studies Guglielmo Marconi, Rome, Italy
| | | | - Mahmoud A Rageh
- Department of Dermatology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
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Tekin B, Xie F, Lehman JS. Lichen Planus: What is New in Diagnosis and Treatment? Am J Clin Dermatol 2024; 25:735-764. [PMID: 38982032 DOI: 10.1007/s40257-024-00878-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [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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Reekie IR, Simpson A, Erikitola O, Lyall D, Roberts F. Ocular Lichen Planus: A clinicopathologic review. Eur J Ophthalmol 2024; 34:1318-1327. [PMID: 38304934 DOI: 10.1177/11206721241229128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Lichen planus is a chronic inflammatory dermatosis that can affect the skin, mucous membranes and nails. Cutaneous lichen planus lesions are best described by the "six Ps" - purple pruritic polygonal planar papules and plaques. Mucous membrane lesions are commonly associated with cutaneous lichen planus. Ocular involvement with lichen planus is rare and conjunctival involvement usually predominates, it can however be visually devastating. Ocular lichen planus often progresses to extensive conjunctival scarring which can be impossible to distinguish clinically from other cicatrising conjunctivitis, requiring histopathological confirmation. Here we review the ocular pathology of this condition.
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Affiliation(s)
- Ian R Reekie
- Department of Ophthalmology, Hairmyres Hospital, NHS Lanarkshire, East Kilbride, UK
| | - Alasdair Simpson
- Department of Ophthalmology, Hairmyres Hospital, NHS Lanarkshire, East Kilbride, UK
| | - Ore Erikitola
- Department of Ophthalmology, Hairmyres Hospital, NHS Lanarkshire, East Kilbride, UK
| | - Douglas Lyall
- Department of Ophthalmology, Hairmyres Hospital, NHS Lanarkshire, East Kilbride, UK
| | - Fiona Roberts
- Department of Histopathology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
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Saleh W, Alharbi H, Yue S, Fernandes RP. Lichen planus after COVID-19 infection and vaccination. Oral Dis 2024; 30:3925-3930. [PMID: 38069546 DOI: 10.1111/odi.14834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/24/2023] [Accepted: 11/24/2023] [Indexed: 09/03/2024]
Abstract
BACKGROUND Lichen planus is one of the common adverse reactions after COVID-19 infection and vaccination. Despite it being reported in several case reports, the literature including a large sample of the studied population is lacking. The current study was performed to assess the risk of LP after COVID-19 infection as well as COVID-19 vaccination. METHODS The current study was designed as a retrospective cross-sectional hospital-based study of registered patients at the University of Florida (UF) health centers. The diagnoses of LP, COVID-19 infection, and COVID-19 vaccines were detected. The logistic regression model was used to assess the risk of developing LP after COVID-19 infection and vaccination. RESULTS A total hospital patient of 684,110 attended UF Health centers were included in this study. 181 patients reported LP after COVID-19 vaccination and 24 patients developed LP after COVID-19 infection. The risk of developing LP after COVID-19 vaccination was 1.573 while the risk of developing LP after COVID-19 infection was 1.143. CONCLUSION The odds of getting LP after COVID-19 vaccination are significantly developed. The current study showed that COVID-19 infection and vaccination are associated with LP. So, healthcare practitioners should be aware of this reaction for rapid recognition and treatment.
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Affiliation(s)
- Wafaa Saleh
- Oral Medicine, Periodontology, Diagnosis and Oral Radiology Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Hamad Alharbi
- Department of Oral and Maxillofacial Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sijia Yue
- Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Rui P Fernandes
- Department of Oral and Maxillofacial Surgery, Division of Head and Neck Oncologic Surgery and Microvascular Reconstruction, College of Medicine, University of Florida, Jacksonville, Florida, USA
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Waśkiel-Burnat A, Czuwara J, Blicharz L, Olszewska M, Rudnicka L. Differential diagnosis of red scalp: the importance of trichoscopy. Clin Exp Dermatol 2024; 49:961-968. [PMID: 37935061 DOI: 10.1093/ced/llad366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/17/2023] [Accepted: 10/17/2023] [Indexed: 11/09/2023]
Abstract
Red scalp is a common complaint that may constitute a diagnostic and therapeutic challenge in daily clinical practice. Among the numerous diseases to cause diffuse scalp erythema are psoriasis, seborrhoeic dermatitis, contact dermatitis, diffuse lichen planopilaris, dermatomyositis and scalp rosacea. Accurate diagnosis is crucial for optimal treatment outcomes. Histology most frequently discriminates the underlying condition, but it requires scalp biopsy. In many cases, the combination of clinical examination and trichoscopy is sufficient for establishing the correct diagnosis. The main trichoscopic features of psoriasis are silver-white scaling, regularly distributed dotted (glomerular) vessels or twisted red loops, and punctate haemorrhages. Yellowish-white scaling and thin arborizing vessels are typical features of seborrhoeic dermatitis. Contact dermatitis is characterized by the presence of yellow exudate and polymorphic vessels, while perifollicular scaling and erythema with the lack of follicular openings are typical findings in lichen planopilaris. In scalp dermatomyositis, tortuous and arborizing vessels with interfollicular and perifollicular pigmentation may be detected. The most characteristic features of scalp rosacea are perifollicular scaling and polygonal/arborizing vessels. This review also summarizes histological features and therapeutic options for these conditions.
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Affiliation(s)
| | - Joanna Czuwara
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Leszek Blicharz
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | | | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
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Brown M, Williams A, Chilcott RP, Brady B, Lenn J, Evans C, Allen L, McAuley WJ, Beebeejaun M, Haslinger J, Beuttel C, Vieira R, Guidali F, Miranda M. Topically Applied Therapies for the Treatment of Skin Disease: Past, Present, and Future. Pharmacol Rev 2024; 76:689-790. [PMID: 38914467 DOI: 10.1124/pharmrev.123.000549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 05/31/2024] [Accepted: 06/03/2024] [Indexed: 06/26/2024] Open
Abstract
The purpose of this review is to summarize essential biological, pharmaceutical, and clinical aspects in the field of topically applied medicines that may help scientists when trying to develop new topical medicines. After a brief history of topical drug delivery, a review of the structure and function of the skin and routes of drug absorption and their limitations is provided. The most prevalent diseases and current topical treatment approaches are then detailed, the organization of which reflects the key disease categories of autoimmune and inflammatory diseases, microbial infections, skin cancers, and genetic skin diseases. The complexity of topical product development through to large-scale manufacturing along with recommended risk mitigation approaches are then highlighted. As such topical treatments are applied externally, patient preferences along with the challenges they invoke are then described, and finally the future of this field of drug delivery is discussed, with an emphasis on areas that are more likely to yield significant improvements over the topical medicines in current use or would expand the range of medicines and diseases treatable by this route of administration. SIGNIFICANCE STATEMENT: This review of the key aspects of the skin and its associated diseases and current treatments along with the intricacies of topical formulation development should be helpful in making judicious decisions about the development of new or improved topical medicines. These aspects include the choices of the active ingredients, formulations, the target patient population's preferences, limitations, and the future with regard to new skin diseases and topical medicine approaches.
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Affiliation(s)
- Marc Brown
- MLBT Investments and Consultancy, Aylesbury, United Kingdom (M.Br.); MedPharm Ltd, Guildford, United Kingdom (M.Br., B.B., C.E., J.H., F.G.); Reading School of Pharmacy, Reading, United Kingdom (A.W.); School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom (R.P.C., W.J.M.); MedPharm Ltd, Durham. North Carolina (J.L., L.A., C.B.); Medicine Development and Supply, GlaxoSmithKline R&D, Stevenage, United Kingdom (M.Be.); Department of Dermatology, CUF Tejo Hospital, Lisbon, Portugal (R.V.); Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz School of Health and Science, Monte de Caparica, Portugal (M.M.); and Department of Chemistry, Coimbra Chemistry Center, University of Coimbra, Coimbra, Portugal (M.M.)
| | - Adrian Williams
- MLBT Investments and Consultancy, Aylesbury, United Kingdom (M.Br.); MedPharm Ltd, Guildford, United Kingdom (M.Br., B.B., C.E., J.H., F.G.); Reading School of Pharmacy, Reading, United Kingdom (A.W.); School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom (R.P.C., W.J.M.); MedPharm Ltd, Durham. North Carolina (J.L., L.A., C.B.); Medicine Development and Supply, GlaxoSmithKline R&D, Stevenage, United Kingdom (M.Be.); Department of Dermatology, CUF Tejo Hospital, Lisbon, Portugal (R.V.); Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz School of Health and Science, Monte de Caparica, Portugal (M.M.); and Department of Chemistry, Coimbra Chemistry Center, University of Coimbra, Coimbra, Portugal (M.M.)
| | - Robert P Chilcott
- MLBT Investments and Consultancy, Aylesbury, United Kingdom (M.Br.); MedPharm Ltd, Guildford, United Kingdom (M.Br., B.B., C.E., J.H., F.G.); Reading School of Pharmacy, Reading, United Kingdom (A.W.); School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom (R.P.C., W.J.M.); MedPharm Ltd, Durham. North Carolina (J.L., L.A., C.B.); Medicine Development and Supply, GlaxoSmithKline R&D, Stevenage, United Kingdom (M.Be.); Department of Dermatology, CUF Tejo Hospital, Lisbon, Portugal (R.V.); Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz School of Health and Science, Monte de Caparica, Portugal (M.M.); and Department of Chemistry, Coimbra Chemistry Center, University of Coimbra, Coimbra, Portugal (M.M.)
| | - Brendan Brady
- MLBT Investments and Consultancy, Aylesbury, United Kingdom (M.Br.); MedPharm Ltd, Guildford, United Kingdom (M.Br., B.B., C.E., J.H., F.G.); Reading School of Pharmacy, Reading, United Kingdom (A.W.); School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom (R.P.C., W.J.M.); MedPharm Ltd, Durham. North Carolina (J.L., L.A., C.B.); Medicine Development and Supply, GlaxoSmithKline R&D, Stevenage, United Kingdom (M.Be.); Department of Dermatology, CUF Tejo Hospital, Lisbon, Portugal (R.V.); Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz School of Health and Science, Monte de Caparica, Portugal (M.M.); and Department of Chemistry, Coimbra Chemistry Center, University of Coimbra, Coimbra, Portugal (M.M.)
| | - Jon Lenn
- MLBT Investments and Consultancy, Aylesbury, United Kingdom (M.Br.); MedPharm Ltd, Guildford, United Kingdom (M.Br., B.B., C.E., J.H., F.G.); Reading School of Pharmacy, Reading, United Kingdom (A.W.); School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom (R.P.C., W.J.M.); MedPharm Ltd, Durham. North Carolina (J.L., L.A., C.B.); Medicine Development and Supply, GlaxoSmithKline R&D, Stevenage, United Kingdom (M.Be.); Department of Dermatology, CUF Tejo Hospital, Lisbon, Portugal (R.V.); Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz School of Health and Science, Monte de Caparica, Portugal (M.M.); and Department of Chemistry, Coimbra Chemistry Center, University of Coimbra, Coimbra, Portugal (M.M.)
| | - Charles Evans
- MLBT Investments and Consultancy, Aylesbury, United Kingdom (M.Br.); MedPharm Ltd, Guildford, United Kingdom (M.Br., B.B., C.E., J.H., F.G.); Reading School of Pharmacy, Reading, United Kingdom (A.W.); School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom (R.P.C., W.J.M.); MedPharm Ltd, Durham. North Carolina (J.L., L.A., C.B.); Medicine Development and Supply, GlaxoSmithKline R&D, Stevenage, United Kingdom (M.Be.); Department of Dermatology, CUF Tejo Hospital, Lisbon, Portugal (R.V.); Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz School of Health and Science, Monte de Caparica, Portugal (M.M.); and Department of Chemistry, Coimbra Chemistry Center, University of Coimbra, Coimbra, Portugal (M.M.)
| | - Lynn Allen
- MLBT Investments and Consultancy, Aylesbury, United Kingdom (M.Br.); MedPharm Ltd, Guildford, United Kingdom (M.Br., B.B., C.E., J.H., F.G.); Reading School of Pharmacy, Reading, United Kingdom (A.W.); School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom (R.P.C., W.J.M.); MedPharm Ltd, Durham. North Carolina (J.L., L.A., C.B.); Medicine Development and Supply, GlaxoSmithKline R&D, Stevenage, United Kingdom (M.Be.); Department of Dermatology, CUF Tejo Hospital, Lisbon, Portugal (R.V.); Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz School of Health and Science, Monte de Caparica, Portugal (M.M.); and Department of Chemistry, Coimbra Chemistry Center, University of Coimbra, Coimbra, Portugal (M.M.)
| | - William J McAuley
- MLBT Investments and Consultancy, Aylesbury, United Kingdom (M.Br.); MedPharm Ltd, Guildford, United Kingdom (M.Br., B.B., C.E., J.H., F.G.); Reading School of Pharmacy, Reading, United Kingdom (A.W.); School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom (R.P.C., W.J.M.); MedPharm Ltd, Durham. North Carolina (J.L., L.A., C.B.); Medicine Development and Supply, GlaxoSmithKline R&D, Stevenage, United Kingdom (M.Be.); Department of Dermatology, CUF Tejo Hospital, Lisbon, Portugal (R.V.); Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz School of Health and Science, Monte de Caparica, Portugal (M.M.); and Department of Chemistry, Coimbra Chemistry Center, University of Coimbra, Coimbra, Portugal (M.M.)
| | - Mubinah Beebeejaun
- MLBT Investments and Consultancy, Aylesbury, United Kingdom (M.Br.); MedPharm Ltd, Guildford, United Kingdom (M.Br., B.B., C.E., J.H., F.G.); Reading School of Pharmacy, Reading, United Kingdom (A.W.); School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom (R.P.C., W.J.M.); MedPharm Ltd, Durham. North Carolina (J.L., L.A., C.B.); Medicine Development and Supply, GlaxoSmithKline R&D, Stevenage, United Kingdom (M.Be.); Department of Dermatology, CUF Tejo Hospital, Lisbon, Portugal (R.V.); Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz School of Health and Science, Monte de Caparica, Portugal (M.M.); and Department of Chemistry, Coimbra Chemistry Center, University of Coimbra, Coimbra, Portugal (M.M.)
| | - Jasmin Haslinger
- MLBT Investments and Consultancy, Aylesbury, United Kingdom (M.Br.); MedPharm Ltd, Guildford, United Kingdom (M.Br., B.B., C.E., J.H., F.G.); Reading School of Pharmacy, Reading, United Kingdom (A.W.); School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom (R.P.C., W.J.M.); MedPharm Ltd, Durham. North Carolina (J.L., L.A., C.B.); Medicine Development and Supply, GlaxoSmithKline R&D, Stevenage, United Kingdom (M.Be.); Department of Dermatology, CUF Tejo Hospital, Lisbon, Portugal (R.V.); Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz School of Health and Science, Monte de Caparica, Portugal (M.M.); and Department of Chemistry, Coimbra Chemistry Center, University of Coimbra, Coimbra, Portugal (M.M.)
| | - Claire Beuttel
- MLBT Investments and Consultancy, Aylesbury, United Kingdom (M.Br.); MedPharm Ltd, Guildford, United Kingdom (M.Br., B.B., C.E., J.H., F.G.); Reading School of Pharmacy, Reading, United Kingdom (A.W.); School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom (R.P.C., W.J.M.); MedPharm Ltd, Durham. North Carolina (J.L., L.A., C.B.); Medicine Development and Supply, GlaxoSmithKline R&D, Stevenage, United Kingdom (M.Be.); Department of Dermatology, CUF Tejo Hospital, Lisbon, Portugal (R.V.); Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz School of Health and Science, Monte de Caparica, Portugal (M.M.); and Department of Chemistry, Coimbra Chemistry Center, University of Coimbra, Coimbra, Portugal (M.M.)
| | - Raquel Vieira
- MLBT Investments and Consultancy, Aylesbury, United Kingdom (M.Br.); MedPharm Ltd, Guildford, United Kingdom (M.Br., B.B., C.E., J.H., F.G.); Reading School of Pharmacy, Reading, United Kingdom (A.W.); School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom (R.P.C., W.J.M.); MedPharm Ltd, Durham. North Carolina (J.L., L.A., C.B.); Medicine Development and Supply, GlaxoSmithKline R&D, Stevenage, United Kingdom (M.Be.); Department of Dermatology, CUF Tejo Hospital, Lisbon, Portugal (R.V.); Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz School of Health and Science, Monte de Caparica, Portugal (M.M.); and Department of Chemistry, Coimbra Chemistry Center, University of Coimbra, Coimbra, Portugal (M.M.)
| | - Florencia Guidali
- MLBT Investments and Consultancy, Aylesbury, United Kingdom (M.Br.); MedPharm Ltd, Guildford, United Kingdom (M.Br., B.B., C.E., J.H., F.G.); Reading School of Pharmacy, Reading, United Kingdom (A.W.); School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom (R.P.C., W.J.M.); MedPharm Ltd, Durham. North Carolina (J.L., L.A., C.B.); Medicine Development and Supply, GlaxoSmithKline R&D, Stevenage, United Kingdom (M.Be.); Department of Dermatology, CUF Tejo Hospital, Lisbon, Portugal (R.V.); Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz School of Health and Science, Monte de Caparica, Portugal (M.M.); and Department of Chemistry, Coimbra Chemistry Center, University of Coimbra, Coimbra, Portugal (M.M.)
| | - Margarida Miranda
- MLBT Investments and Consultancy, Aylesbury, United Kingdom (M.Br.); MedPharm Ltd, Guildford, United Kingdom (M.Br., B.B., C.E., J.H., F.G.); Reading School of Pharmacy, Reading, United Kingdom (A.W.); School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom (R.P.C., W.J.M.); MedPharm Ltd, Durham. North Carolina (J.L., L.A., C.B.); Medicine Development and Supply, GlaxoSmithKline R&D, Stevenage, United Kingdom (M.Be.); Department of Dermatology, CUF Tejo Hospital, Lisbon, Portugal (R.V.); Centro de Investigação Interdisciplinar Egas Moniz, Egas Moniz School of Health and Science, Monte de Caparica, Portugal (M.M.); and Department of Chemistry, Coimbra Chemistry Center, University of Coimbra, Coimbra, Portugal (M.M.)
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8
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Chen LC, Chung HJ. Increased risk of allergic contact dermatitis in patients with cutaneous lichen planus and lichen planopilaris, but not cutaneous lupus erythematosus: An all of us database analysis. Arch Dermatol Res 2024; 316:440. [PMID: 38951294 DOI: 10.1007/s00403-024-03175-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 05/13/2024] [Accepted: 06/08/2024] [Indexed: 07/03/2024]
Affiliation(s)
- Li-Chi Chen
- Department of Dermatology, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Hye Jin Chung
- Department of Dermatology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA.
- Department of Dermatology, Harvard Medical School, Boston, MA, USA.
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9
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Marcu (Selaru) CA, Parlatescu I, Tovaru S, Nicolae CL, Costache M, Tovaru M. Lichen Planus of the Lip-Case Series and Review of the Literature. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:987. [PMID: 38929604 PMCID: PMC11205475 DOI: 10.3390/medicina60060987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/08/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024]
Abstract
Background and Objectives: Lichen planus of the lip (LPL) is a chronic inflammatory condition that resembles actinic cheilitis, discoid lupus erythematosus, graft-versus-host disease, and lichenoid reaction to dental materials or drugs. The purpose of this study was to conduct a literature review on lichen planus lip involvement and to report a retrospective observational study that characterises and explores the clinical, histopathological, and evolution of the lesions in a group of patients with unique involvement of LPL. Materials and Methods: Clinical data of patients diagnosed with LPL was retrieved from the medical charts of the patients referred to the Oral Pathology Department of the "Carol Davila" University of Medicine and Pharmacy. A concurrent electronic literature research was carried out using PubMed and Web of Science from 2003 to 2023. Results: Eleven patients diagnosed with unique LPL were analysed (male/female ratio was 1.75, mean age 63.64 years ± 12.52). All patients presented lesions of the lower lip; the clinical forms were atrophic (six cases) and erosive (five cases), and the histopathological exam confirmed the diagnosis. After topical treatment with corticosteroids, most of the patients had complete remission. The literature review revealed 24 studies (sixteen case reports and eight case series) which comprised 84 patients. Isolated lip involvement was reported in 17 studies, and five articles with concomitant oral lichen planus, while two articles did not mention this criterion. Conclusions: Our study brings new data on isolated lichen planus of the lip that primarily affects the lower lip with predominance in male patients. It was reported worldwide in patients between 22 and 75 years old. Topical corticosteroids were the main treatment prescribed and they usually brought remission of the lesions. Lichen planus of the lip is a challenging diagnosis for oral health practitioner providers as well as for dermatologists.
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Affiliation(s)
| | - Ioanina Parlatescu
- Faculty of Dentistry, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (S.T.); (C.L.N.); (M.T.)
| | - Serban Tovaru
- Faculty of Dentistry, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (S.T.); (C.L.N.); (M.T.)
| | - Carmen Larisa Nicolae
- Faculty of Dentistry, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (S.T.); (C.L.N.); (M.T.)
| | - Mariana Costache
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Mihaela Tovaru
- Faculty of Dentistry, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (S.T.); (C.L.N.); (M.T.)
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10
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Reeve MP, Vehviläinen M, Luo S, Ritari J, Karjalainen J, Gracia-Tabuenca J, Mehtonen J, Padmanabhuni SS, Kolosov N, Artomov M, Siirtola H, Olilla HM, Graham D, Partanen J, Xavier RJ, Daly MJ, Ripatti S, Salo T, Siponen M. Oral and non-oral lichen planus show genetic heterogeneity and differential risk for autoimmune disease and oral cancer. Am J Hum Genet 2024; 111:1047-1060. [PMID: 38776927 PMCID: PMC11179409 DOI: 10.1016/j.ajhg.2024.04.020] [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: 02/29/2024] [Revised: 04/23/2024] [Accepted: 04/25/2024] [Indexed: 05/25/2024] Open
Abstract
Lichen planus (LP) is a T-cell-mediated inflammatory disease affecting squamous epithelia in many parts of the body, most often the skin and oral mucosa. Cutaneous LP is usually transient and oral LP (OLP) is most often chronic, so we performed a large-scale genetic and epidemiological study of LP to address whether the oral and non-oral subgroups have shared or distinct underlying pathologies and their overlap with autoimmune disease. Using lifelong records covering diagnoses, procedures, and clinic identity from 473,580 individuals in the FinnGen study, genome-wide association analyses were conducted on carefully constructed subcategories of OLP (n = 3,323) and non-oral LP (n = 4,356) and on the combined group. We identified 15 genome-wide significant associations in FinnGen and an additional 12 when meta-analyzed with UKBB (27 independent associations at 25 distinct genomic locations), most of which are shared between oral and non-oral LP. Many associations coincide with known autoimmune disease loci, consistent with the epidemiologic enrichment of LP with hypothyroidism and other autoimmune diseases. Notably, a third of the FinnGen associations demonstrate significant differences between OLP and non-OLP. We also observed a 13.6-fold risk for tongue cancer and an elevated risk for other oral cancers in OLP, in agreement with earlier reports that connect LP with higher cancer incidence. In addition to a large-scale dissection of LP genetics and comorbidities, our study demonstrates the use of comprehensive, multidimensional health registry data to address outstanding clinical questions and reveal underlying biological mechanisms in common but understudied diseases.
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Affiliation(s)
- Mary Pat Reeve
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland; Broad Institute of MIT and Harvard, Cambridge, MA, USA.
| | - Mari Vehviläinen
- Department of Oral and Maxillofacial Diseases, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Shuang Luo
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Jarmo Ritari
- Finnish Red Cross Blood Service, Helsinki, Finland
| | - Juha Karjalainen
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Javier Gracia-Tabuenca
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Juha Mehtonen
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Shanmukha Sampath Padmanabhuni
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Nikita Kolosov
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland; Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA; Ohio State University College of Medicine, Columbus, OH, USA
| | - Mykyta Artomov
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland; Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA; Ohio State University College of Medicine, Columbus, OH, USA
| | - Harri Siirtola
- TAUCHI Research Center, Tampere University, Tampere, Finland
| | - Hanna M Olilla
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland; Broad Institute of MIT and Harvard, Cambridge, MA, USA; Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Daniel Graham
- Broad Institute of MIT and Harvard, Cambridge, MA, USA; Center for Computational and Integrative Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA; Department of Molecular Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA; Klarman Cell Observatory, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | | | - Ramnik J Xavier
- Broad Institute of MIT and Harvard, Cambridge, MA, USA; Center for Computational and Integrative Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA; Department of Molecular Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA; Klarman Cell Observatory, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Mark J Daly
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland; Broad Institute of MIT and Harvard, Cambridge, MA, USA; Klarman Cell Observatory, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; Analytical and Translational Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Samuli Ripatti
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Tuula Salo
- Research Unit of Population Health, Department of Oral Pathology, University of Oulu and Oulu University Hospital, Oulu, Finland; Medical Research Center, Oulu University Hospital, Oulu, Finland; Department of Oral and Maxillofacial Diseases, and Translational Immunology Program (TRIMM), University of Helsinki, Helsinki, Finland
| | - Maria Siponen
- Institute of Dentistry, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland; Odontology Education Unit, and Oral and Maxillofacial Diseases Clinic, Kuopio University Hospital, Kuopio, Finland
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11
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Jameie M, Amanollahi M, Ahli B, Farahmand G, Magrouni H, Sarraf P. Coexistence of myasthenia gravis and lichen planus: A case report and systematic review of related case reports from 1971 to 2024. Clin Case Rep 2024; 12:e9065. [PMID: 38883218 PMCID: PMC11177179 DOI: 10.1002/ccr3.9065] [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: 03/11/2024] [Revised: 05/03/2024] [Accepted: 05/31/2024] [Indexed: 06/18/2024] Open
Abstract
Key Clinical Message The co-occurrence of myasthenia gravis (MG) and lichen planus (LP) is a rare phenomenon, with only 13 cases reported in the English literature between 1971 and 2024. Patients with MG or LP, regardless of the thymoma status, require close monitoring for other autoimmune diseases. Abstract Myasthenia gravis (MG) is an uncommon autoimmune disease, resulting in fatigable muscle weakness in the ocular, bulbar, and respiratory muscles, as well as muscles of the extremities. Lichen planus (LP) is an autoimmune mucocutaneous disease, presenting with pruritic and violaceous plaques on the skin and mucosal surfaces. So far, MG and LP co-occurrence is only reported in anecdotal individuals. This study reports a patient with MG and LP and systematically reviews the English literature on this rare co-occurrence from 1971 to 2024, indicating only 13 cases with similar conditions. A 67-year-old man presented with ocular and progressive bulbar symptoms, a year after being diagnosed with generalized LP. Laboratory evaluations were normal except for the high anti-AchR-Ab titer and a positive ANA titer. Neurologic examinations revealed asymmetric bilateral ptosis, weakness and fatigability in proximal muscles, and a severe reduction in the gag reflex. He was diagnosed with late-onset, seropositive MG. The treatment included pyridostigmine (60 mg, three times daily), intravenous immunoglobulin (25 g daily for 5 days), and oral prednisolone. There was no evidence of thymoma in the chest x-ray and CT scan without contrast. However, a CT scan with contrast was not performed due to the patient's unstable condition. A common autoimmune mechanism may underlie the unclear pathophysiology of MG and LP co-occurrence, with or without thymoma. Patients with MG, LP, or thymoma require close monitoring and assessment for other possible autoimmune diseases.
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Affiliation(s)
- Melika Jameie
- Iranian Center of Neurological Research, Neuroscience Institute Tehran University of Medical Sciences Tehran Iran
| | - Mobina Amanollahi
- School of Medicine Tehran University of Medical Sciences Tehran Iran
| | - Bahareh Ahli
- School of Medicine Tehran University of Medical Sciences Tehran Iran
| | - Ghasem Farahmand
- Neurology Department, Imam Khomeini Hospital Complex Tehran University of Medical Sciences Tehran Iran
| | - Hana Magrouni
- Neurology Department, Imam Khomeini Hospital Complex Tehran University of Medical Sciences Tehran Iran
| | - Payam Sarraf
- Iranian Center of Neurological Research, Neuroscience Institute Tehran University of Medical Sciences Tehran Iran
- Neurology Department, Imam Khomeini Hospital Complex Tehran University of Medical Sciences Tehran Iran
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12
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Tampa M, Nicolae I, Ene CD, Mitran CI, Mitran MI, Matei C, Georgescu SR. The Interplay between Nitrosative Stress, Inflammation, and Antioxidant Defense in Patients with Lichen Planus. Antioxidants (Basel) 2024; 13:670. [PMID: 38929109 PMCID: PMC11200615 DOI: 10.3390/antiox13060670] [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: 04/28/2024] [Revised: 05/24/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Lichen planus (LP) is a chronic inflammatory skin disease of unelucidated etiology. LP immunopathogenesis is mainly governed by cytotoxic T lymphocytes that mediate an immune response in basal keratinocytes, which may transform into a reservoir of antigens able to initiate an autoimmune reaction. However, other pathogenic pathways complement these mechanisms. Recent studies highlight the involvement of nitrosative stress in the pathogenesis of chronic inflammatory skin diseases. Current data on its role in the pathogenesis of LP are scarce. METHODS In this article, we investigated nitrosative stress in 40 cutaneous LP (CLP) patients compared to 40 healthy subjects using serum markers including nitrosative stress markers-direct nitrite, total nitrite, nitrate and symmetric dimethylarginine (SDMA), total antioxidant status (TAS), and hsCRP, a marker of inflammation, and analyzed the relationship between nitrosative stress, antioxidant defense, and inflammation to offer new insights into the role of the NO pathway in LP pathogenesis. RESULTS We identified significantly higher serum levels of direct nitrite, total nitrite, nitrate, SDMA and hsCRP, and significantly lower levels of TAS in CLP patients versus controls. There were significant negative correlations between the serum levels of TAS and significantl positive correlations between the serum levels of hsCRP and the analyzed nitrosative stress markers in patients with CLP. CONCLUSION Our results indicate an increased level of nitrosative stress in LP patients that correlates with a pro-inflammatory status and altered antioxidant defense.
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Affiliation(s)
- Mircea Tampa
- Department of Dermatology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (M.T.); (S.R.G.)
- Department of Dermatology, ‘Victor Babes’ Clinical Hospital for Infectious Diseases, 030303 Bucharest, Romania;
| | - Ilinca Nicolae
- Department of Dermatology, ‘Victor Babes’ Clinical Hospital for Infectious Diseases, 030303 Bucharest, Romania;
| | - Corina Daniela Ene
- Departments of Nephrology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Nephrology, ‘Carol Davila’ Nephrology Hospital, 010731 Bucharest, Romania
| | - Cristina Iulia Mitran
- Department of Microbiology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.I.M.); (M.I.M.)
| | - Madalina Irina Mitran
- Department of Microbiology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.I.M.); (M.I.M.)
| | - Clara Matei
- Department of Dermatology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (M.T.); (S.R.G.)
| | - Simona Roxana Georgescu
- Department of Dermatology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (M.T.); (S.R.G.)
- Department of Dermatology, ‘Victor Babes’ Clinical Hospital for Infectious Diseases, 030303 Bucharest, Romania;
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13
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Musick AN, Kim DY, Baumrucker SJ. Post-radiation lichen planus: a case report and review of the literature. J Med Case Rep 2024; 18:195. [PMID: 38555437 PMCID: PMC10981816 DOI: 10.1186/s13256-024-04389-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 12/30/2023] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Lichen planus is a T-cell mediated inflammatory disorder of the skin and mucus membranes and is a rare complication of external beam radiation. CASE PRESENTATION 64 year old White male who presented to dermatology with a lesion at the lateral aspect of the right thigh. The lesion was first noted 40 years prior and had grown from 1.5 cm to 6.5 cm in the ensuing years. On examination the lesion was raised, hypopigmented, with pearly borders and central ulceration. Wide excision with lymph node dissection demonstrated invasive squamous cell carcinoma, basaloid type, with negative margins. Patient had radiation therapy of the right inguinal nodes. Patient subsequently noted a "blister" on the right upper thigh, which progressed over time to flat, polygonal, intensely pruritic lesions that covered the right lateral thigh from just distal to the hip to the distal third of the femur (Figs. 1, 2). Skin biopsy was positive for lichen planus. He was started on topical triamcinolone with salutary effects on appearance and pruritus. Fig. 1 Lichen planus, right thigh Fig. 2 Closeup, lichen planus, right thigh, demonstrating polygonal papules CONCLUSION: Once more biopsy-proven cases of post-radiation lichen planus are reported, hopefully the exact mechanism can be elucidated. This may identify risk factors and aid in treatment, with the goal of limiting radiation toxicity and palliation of symptoms that may affect the quality of daily life.
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Affiliation(s)
- Adam N Musick
- MSIV, ETSU Quillen College of Medicine, Johnson City, TN, USA
| | - Do Young Kim
- Department of Oncology, ETSU-Quillen College of Medicine, Johnson City, TN, USA
| | - Steven J Baumrucker
- MSIV, ETSU Quillen College of Medicine, Johnson City, TN, USA.
- Department of Palliative Medicine, Ballad Health System, Johnson City, TN, USA.
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14
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Elmasry MF, Mosaad RA, Azzam OA, Rashed LA, Fahim A. Assessment of PD-1 and PD-L1 tissue expression levels in lichen planus patients: a case-control study. Arch Dermatol Res 2024; 316:97. [PMID: 38430309 PMCID: PMC10908618 DOI: 10.1007/s00403-024-02838-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: 11/25/2023] [Revised: 01/23/2024] [Accepted: 02/06/2024] [Indexed: 03/03/2024]
Abstract
Programmed cell death protein-1 (PD-1) is an immune checkpoint protein, PD-1 interaction with PD ligand-1 (PD-L1) is essential for maintaining immunological tolerance. The study aimed to study and compare the levels of PD-1 and PD-L1 in lesional and nonlesional skin of lichen planus (LP) patients and compare these levels to normal healthy controls to assess their role in the pathogenesis of LP. This case-control study involved 30 patients with LP and 30 healthy age-and sex-matched controls. After clinical assessment of the severity by LP severity index score (LPSI), skin biopsies were taken from lesional and nonlesional skin of LP patients and from normal skin in healthy controls for assessment of the tissue levels of PD-1 and PD-L1 by ELISA. The tissue levels of both PD-1 and PD-L1 were significantly higher in healthy controls than in both lesional and nonlesional skin of LP patients (P < 0.001). Also, significantly higher PD-l and PD-L1 levels in nonlesional skin than in lesional skin of LP patients were reported (P < 0.001). No significant correlations were found between lesional and nonlesional PD-1, PD-L1 levels, or LPSI score. Based on the fact that PD-1/PD-L1 interaction is important to maintain tolerance and protection against autoimmune diseases, in addition to our study results that revealed lower levels of PD-1/PD-L1 in LP skin than in healthy skin, we can conclude that PD-1/PDL-1 may be incriminated in the pathogenesis of LP. ClinicalTrials.govID: NCT04892381.
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Affiliation(s)
- Maha Fathy Elmasry
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Rana Ahmed Mosaad
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Omar Ahmed Azzam
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Laila Ahmed Rashed
- Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Aya Fahim
- Dermatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Mathur M, Thakur N, Jaiswal S, Das G, Shah S, Maharjan S, Paudel S, Shrestha A, Upadhyay HP. Metabolic syndrome in patients with lichen planus: A case-control study. SKIN HEALTH AND DISEASE 2024; 4:e315. [PMID: 38312252 PMCID: PMC10831556 DOI: 10.1002/ski2.315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/09/2023] [Accepted: 11/09/2023] [Indexed: 02/06/2024]
Abstract
Background Lichen Planus (LP) is a chronic dermatosis affecting the skin and mucous membranes. Chronic inflammation and oxidative stress in patients with LP is a trigger predisposing to Metabolic Syndrome. Objectives To study the association of Metabolic Syndrome in patients with LP. Materials and Methods A hospital-based prospective case-control study was conducted from April 2021 to January 2023 including 75 histopathologically confirmed patients with LP and 82 age and sex-matched controls according to the inclusion and exclusion criteria. Metabolic Syndrome was diagnosed using Modified National Cholesterol Education Programme Adult Treatment Panel III criteria. Statistical analysis of the data was performed using Statistical Package for the Social Sciences software, version 26. The chi-square test was used for data analysis. Results The majority (30.6%) of the patients belonged to the age group 31-40 years. The mean age of patients with LP was 46.13 ± 14.9 years. Female predominance (69.3%) was observed in our study. Patients with classic LP (54.6%) were predominantly observed. Metabolic Syndrome was significantly prevalent in LP patients than in controls (32% vs. 13.4%, p = 0.005, OR 3.037) and was significantly associated with morphology (only oral mucosal involvement, 61.5%, p 0.027, OR 3.9), severity (severe LP, 58.6%, p < 0.001, OR 7.79), and duration of the disease (≥6 months, 55.5%, p 0.001, OR 5.42). 71% of Metabolic Syndrome was observed in females (p 0.847). Among patients with metabolic syndrome, the majority belonged to the age group between 31 and 40 years (37.5%, p 0.378). Systolic and Diastolic Blood Pressure values (≥130/85 mm of Hg), Serum Triglycerides (≥150 mg/dl), and Low-Density Lipoprotein (>130 mg/dl) were significantly elevated, and High-Density Lipoprotein (<40 mg/dl) was significantly low in LP than in controls (p < 0.05). Conclusion The study showed a significant association of Metabolic Syndrome in patients with LP. Thus, patients with LP need to be screened to avoid complications associated with Metabolic Syndrome that is, Diabetes Mellitus, Cardiovascular Disease, colorectal cancer, and stroke.
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Affiliation(s)
- Mahesh Mathur
- Department of Dermatology, Venereology and LeprologyCollege of Medical Sciences and Teaching HospitalBharatpurNepal
| | - Neha Thakur
- Department of Dermatology, Venereology and LeprologyCollege of Medical Sciences and Teaching HospitalBharatpurNepal
| | - Sunil Jaiswal
- Department of Dermatology, Venereology and LeprologyCollege of Medical Sciences and Teaching HospitalBharatpurNepal
| | - Gautam Das
- Department of Dermatology, Venereology and LeprologyCollege of Medical Sciences and Teaching HospitalBharatpurNepal
| | - Swati Shah
- Department of Dermatology, Venereology and LeprologyCollege of Medical Sciences and Teaching HospitalBharatpurNepal
| | - Srijana Maharjan
- Department of Dermatology, Venereology and LeprologyCollege of Medical Sciences and Teaching HospitalBharatpurNepal
| | - Supriya Paudel
- Department of Dermatology, Venereology and LeprologyCollege of Medical Sciences and Teaching HospitalBharatpurNepal
| | - Anjali Shrestha
- Department of Dermatology, Venereology and LeprologyCollege of Medical Sciences and Teaching HospitalBharatpurNepal
| | - Hari Prasad Upadhyay
- Department of Community MedicineCollege of Medical Sciences and Teaching HospitalBharatpurNepal
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16
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Hwang A, Kechter J, Do T, Hughes A, Zhang N, Li X, Wasikowski R, Brumfiel C, Patel M, Boudreaux B, Bhullar P, Nassir S, Yousif M, DiCaudo DJ, Fox J, Gharaee-Kermani M, Xing X, Zunich S, Branch E, Kahlenberg JM, Billi AC, Plazyo O, Tsoi LC, Pittelkow MR, Gudjonsson JE, Mangold AR. Oral Baricitinib in the Treatment of Cutaneous Lichen Planus. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.09.24300946. [PMID: 38260663 PMCID: PMC10802654 DOI: 10.1101/2024.01.09.24300946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Background Cutaneous lichen planus (LP) is a recalcitrant, difficult-to-treat, inflammatory skin disease characterized by pruritic, flat-topped, violaceous papules on the skin. Baricitinib is an oral Janus kinase (JAK) 1/2 inhibitor that interrupts the signaling pathway of interferon (IFN)-γ, a cytokine implicated in the pathogenesis of LP. Methods In this phase II trial, twelve patients with cutaneous LP received baricitinib 2 mg daily for 16 weeks, accompanied by in-depth spatial, single-cell, and bulk transcriptomic profiling of pre-and post-treatment samples. Results An early and sustained clinical response was seen with 83.3% of patients responsive at week 16. Our molecular data identified a unique, oligoclonal IFN-γ, CD8+, CXCL13+ cytotoxic T-cell population in LP skin and demonstrate a rapid decrease in interferon signature within 2 weeks of treatment, most prominent in the basal layer of the epidermis. Conclusion This study demonstrates the efficacy and molecular mechanisms of JAK inhibition in LP. Trial Registration Number : NCT05188521.
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17
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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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18
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He J, Weng T, Zhu W, Yang Y, Li C. Alleviation of isolated nail lichen planus by the JAK1/2 inhibitor Baricitinib: a case report. J DERMATOL TREAT 2023; 34:2274816. [PMID: 37919960 DOI: 10.1080/09546634.2023.2274816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 10/19/2023] [Indexed: 11/04/2023]
Affiliation(s)
- Juan He
- Department of Dermatology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Tengyu Weng
- Department of Dermatology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Wenwei Zhu
- Department of Dermatology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yi Yang
- Department of Dermatology, The Third Medical Center of the Chinese People's Liberation Army, Beijing, China
| | - Chengxin Li
- Department of Dermatology, First Medical Center of Chinese PLA General Hospital, Beijing, China
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19
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Luo Q, Cao Q, Guo J, Chang S, Wu Y. Genetically predicted levels of circulating cytokines and the risk of six immune skin diseases: a two-sample Mendelian randomization study. Front Immunol 2023; 14:1240714. [PMID: 37954607 PMCID: PMC10637377 DOI: 10.3389/fimmu.2023.1240714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/12/2023] [Indexed: 11/14/2023] Open
Abstract
Background Circulating cytokines play a crucial role in the onset and progression of immune skin diseases. However, the causal relationships and the direction of causal effects require further investigation. Methods Two-sample Mendelian randomization (MR) analyses were conducted to assess the causal relationships between 41 circulating cytokines and six immune skin diseases including alopecia areata, chloasma, hidradenitis suppurativa (HS), lichen planus (LP), seborrheic dermatitis, and urticaria, using summary statistics from genome-wide association studies. Reverse MR analyses was performed to test for the reverse causation. Pleiotropy and heterogeneity tests were conducted to assess the robustness of the findings. Results Twelve unique cytokines showed a suggestive causal relationship with the risk of six immune skin diseases. Among them, the causal effects between 9 unique cytokines and immune skin diseases have strong statistical power. Additionally, the concentrations of six cytokines might be influenced by LP and urticaria. After Bonferroni correction, the following associations remained significant: the causal effect of beta-nerve growth factor on HS (odds ratio [OR] = 1.634, 95% confidence interval [CI] = 1.226-2.177, p = 7.97e-04), interleukin (IL)-6 on LP (OR = 0.615, 95% CI = 0.481-0.786, p = 1.04e-04), IL-4 on LP (OR = 1.099. 95% CI = 1.020-1.184, p = 1.26e-02), and IL-2 on urticaria (OR = 0.712, 95% CI = 0.531-0.955, p = 2.33e-02). Conclusion This study provides novel perspectives on the relationship between circulating cytokines and immune skin diseases, potentially providing valuable insights into their etiology, diagnostic approaches, and treatment.
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Affiliation(s)
- Qinghua Luo
- Department of Anorectal Surgery, Jiangmen Wuyi Hospital of Traditional Chinese Medicine, Jiangmen, China
| | - Qiurui Cao
- Department of Anorectal Surgery, Jiangmen Wuyi Hospital of Traditional Chinese Medicine, Jiangmen, China
| | - Jinyan Guo
- Department of Anorectal Surgery, Jiangmen Wuyi Hospital of Traditional Chinese Medicine, Jiangmen, China
| | - Shuangqing Chang
- Department of Anorectal Surgery, Jiangmen Wuyi Hospital of Traditional Chinese Medicine, Jiangmen, China
| | - Yunxiang Wu
- Department of Anorectal Surgery, Affiliated Hospital of Jiangxi University of Chinese Medicine, Nanchang, China
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20
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García-Pola M, Rodríguez-Fonseca L, Suárez-Fernández C, Sanjuán-Pardavila R, Seoane-Romero J, Rodríguez-López S. Bidirectional Association between Lichen Planus and Hepatitis C-An Update Systematic Review and Meta-Analysis. J Clin Med 2023; 12:5777. [PMID: 37762719 PMCID: PMC10531646 DOI: 10.3390/jcm12185777] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/21/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023] Open
Abstract
Lichen planus (LP) is a chronic, inflammatory mucocutaneous disorder associated with systemic diseases such as hepatitis C (HCV). The objective of this study is to evaluate the association between LP and HCV bidirectionally through a systematic review and meta-analysis. A comprehensive search of studies published was performed in the databases of PubMed, Embase, and Web of Science. Out of 18,491 articles, 192 studies were included. The global prevalence of HCV positive (HCV+) in LP patients registered from 143 studies was 9.42% [95% confidence interval (CI), 7.27-11.58%], and from these, 84 studies showed HCV+ 4-fold more frequent in LP than a control group (OR, 4.48; 95% CI, 3.48-5.77). The global prevalence of LP in patients HCV+ recorded from 49 studies was 7.05% (95% CI, 4.85-9.26%), and from these, 15 registered a 3-fold more LP in HCV (OR, 3.65; 95% CI, 2.14-6.24). HCV+ in LP patients showed great geographic variability (OR, 2.7 to 8.57), and the predominantly cutaneous location was higher (OR, 5.95) than the oral location (OR, 3.49). LP in HCV+ patients was more frequent in the Eastern Mediterranean (OR, 5.51; 95% CI, 1.40-15.57). There is a higher prevalence of HCV+ in LP and vice versa than in the control group, especially in certain geographical areas that should be taken into consideration when doing screening in countries with an upper prevalence of HCV among the general population.
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Affiliation(s)
- María García-Pola
- Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine and Health Sciences, University of Oviedo, 33004 Oviedo, Spain; (L.R.-F.); (C.S.-F.); (R.S.-P.); (S.R.-L.)
| | - Lucia Rodríguez-Fonseca
- Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine and Health Sciences, University of Oviedo, 33004 Oviedo, Spain; (L.R.-F.); (C.S.-F.); (R.S.-P.); (S.R.-L.)
| | - Carlota Suárez-Fernández
- Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine and Health Sciences, University of Oviedo, 33004 Oviedo, Spain; (L.R.-F.); (C.S.-F.); (R.S.-P.); (S.R.-L.)
| | - Raquel Sanjuán-Pardavila
- Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine and Health Sciences, University of Oviedo, 33004 Oviedo, Spain; (L.R.-F.); (C.S.-F.); (R.S.-P.); (S.R.-L.)
| | - Juan Seoane-Romero
- Department of Surgery and Medical-Surgical Specialties, School of Medicine and Dentistry, University of Santiago de Compostela, 15780 Santiago de Compostela, Spain;
| | - Samuel Rodríguez-López
- Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine and Health Sciences, University of Oviedo, 33004 Oviedo, Spain; (L.R.-F.); (C.S.-F.); (R.S.-P.); (S.R.-L.)
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21
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Mahon-Smith A, Clifford M, Batish A, Sharp R, Panter C, Naujoks C, Schruf E, Compagno N, Moreno SG. Patient Experience of Lichen Planus: A Qualitative Exploration of Signs, Symptoms, and Health-Related Quality of Life Impacts. Dermatol Ther (Heidelb) 2023; 13:2001-2017. [PMID: 37505393 PMCID: PMC10442305 DOI: 10.1007/s13555-023-00968-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/14/2023] [Indexed: 07/29/2023] Open
Abstract
INTRODUCTION Lichen planus (LP) is an inflammatory skin disorder that can present in various forms across the body, including lesions on the skin (cutaneous LP [CLP]), scalp (lichen planopilaris [LPP]), and mucosal regions (mucosal LP [MLP]). Qualitative exploration of the patient experience of LP, notably symptoms and impacts on health-related quality of life (HRQoL), is limited. A scarcity of research was also identified relating to emotional wellbeing impacts of CLP patients. Two qualitative studies were conducted with LP patients to address these gaps. METHODS Study 1 consisted of exit interviews conducted with a subset of adult patients with MLP (n = 5), CLP (n = 4), and LPP (n = 4) enrolled in an LP clinical study in the United States (US) to explore the patient experience. Study 2 consisted of independent qualitative interviews conducted with adult CLP patients (n = 13) from the US and Germany to further explore impacts on emotional wellbeing. RESULTS Exit interviews found that itch , pain, and skin lesions were most frequently reported as signs/symptoms of LP. Itch and skin lesions were experienced across all LP subtypes, while pain was only reported by CLP and MLP patients. These signs/symptoms impacted HRQoL including emotional wellbeing (frustration, embarrassment), daily activities (oral hygiene, clothing options), social functioning (intimacy, social activities), and physical functioning (chewing/swallowing, opening/moving mouth). Impacts on activities of daily living (ADL) and physical functioning were mostly experienced by MLP patients. Independent qualitative interviews, which further explored impacts of CLP on patients' emotional wellbeing, identified frustration, worry, sadness, embarrassment, and depression as the most frequently experienced. CONCLUSION The findings contribute to the literature by providing qualitative insights into signs/symptoms and HRQoL impacts of LP, from the adult patient perspective. The findings also highlight the importance of considering assessment of HRQoL impacts in future clinical LP research, particularly impacts on emotional wellbeing when selecting instruments for assessment of HRQoL in the CLP population. TRIAL REGISTRATION NCT04300296.
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Affiliation(s)
- Aoife Mahon-Smith
- Patient-Centered Outcomes, Adelphi Values Ltd, Bollington, Cheshire, UK.
| | - Molly Clifford
- Patient-Centered Outcomes, Adelphi Values Ltd, Bollington, Cheshire, UK
| | - Anjali Batish
- Patient-Centered Outcomes, Adelphi Values Ltd, Bollington, Cheshire, UK
| | - Rosie Sharp
- Patient-Centered Outcomes, Adelphi Values Ltd, Bollington, Cheshire, UK
| | - Charlotte Panter
- Patient-Centered Outcomes, Adelphi Values Ltd, Bollington, Cheshire, UK
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22
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Bieber T. Disease modification in inflammatory skin disorders: opportunities and challenges. Nat Rev Drug Discov 2023; 22:662-680. [PMID: 37443275 DOI: 10.1038/s41573-023-00735-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/15/2023]
Abstract
Progress in understanding of the mechanisms underlying chronic inflammatory skin disorders, such as atopic dermatitis and psoriasis vulgaris, has led to new treatment options with the primary goal of alleviating symptoms. In addition, this knowledge has the potential to inform on new strategies aimed at inducing deep and therapy-free remission, that is, disease modification, potentially impacting on associated comorbidities. However, to reach this goal, key areas require further exploration, including the definitions of disease modification and disease activity index, further understanding of disease mechanisms and systemic spillover effects, potential windows of opportunity, biomarkers for patient stratification and successful intervention, as well as appropriate study design. This Perspective article assesses the opportunities and challenges in the discovery and development of disease-modifying therapies for chronic inflammatory skin disorders.
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Affiliation(s)
- Thomas Bieber
- Department of Dermatology and Allergy, University Hospital, Bonn, Germany.
- Christine Kühne - Center for Allergy Research and Education, Davos, Switzerland.
- Davos Biosciences, Davos, Switzerland.
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23
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Gajraj FA, Zahir J, Adereti C, Gajraj MH. A Case Report and Literature Review of the Role of Dupilumab in the Management of Lichen Planus: Cause or Treatment? Cureus 2023; 15:e41274. [PMID: 37533618 PMCID: PMC10392291 DOI: 10.7759/cureus.41274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2023] [Indexed: 08/04/2023] Open
Abstract
Lichen planus (LP) is a chronic inflammatory skin condition characterized by the six Ps (ie. purple, planar, polygonal, pruritic, plaques, and papules) often causing physical, emotional, and psychological stress for the person affected. Drug-induced LP has been described after the administration of drugs like antihypertensives, non-steroidal anti-inflammatory drugs (NSAIDs), and biologics like adalimumab and etanercept. Currently, there is a dearth of studies discussing the association between LP and dupilumab. Here, we present the case of a young adult female who developed LP 24 months after treatment with dupilumab for severe atopic dermatitis. We also conducted a review of the literature discussing the association between LP and dupilumab.
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Affiliation(s)
| | - Jamal Zahir
- Surgery, Ross University School of Medicine, Miramar, USA
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24
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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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25
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Fetter T, de Graaf DM, Claus I, Wenzel J. Aberrant inflammasome activation as a driving force of human autoimmune skin disease. Front Immunol 2023; 14:1190388. [PMID: 37325658 PMCID: PMC10266227 DOI: 10.3389/fimmu.2023.1190388] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/09/2023] [Indexed: 06/17/2023] Open
Abstract
Autoimmune skin diseases are understood as conditions in which the adaptive immune system with autoantigen-specific T cells and autoantibody-producing B cells reacting against self-tissues plays a crucial pathogenic role. However, there is increasing evidence that inflammasomes, which are large multiprotein complexes that were first described 20 years ago, contribute to autoimmune disease progression. The inflammasome and its contribution to the bioactivation of interleukins IL-1β and IL-18 play an essential role in combating foreign pathogens or tissue damage, but may also act as a pathogenic driver of myriad chronic inflammatory diseases when dysfunctionally regulated. Inflammasomes containing the NOD-like receptor family members NLRP1 and NLRP3 as well as the AIM2-like receptor family member AIM2 have been increasingly investigated in inflammatory skin conditions. In addition to autoinflammatory diseases, which are often associated with skin involvement, the aberrant activation of the inflammasome has also been implied in autoimmune diseases that can either affect the skin besides other organs such as systemic lupus erythematosus and systemic sclerosis or are isolated to the skin in humans. The latter include, among others, the T-cell mediated disorders vitiligo, alopecia areata, lichen planus and cutaneous lupus erythematosus as well as the autoantibody-driven blistering skin disease bullous pemphigoid. Some diseases are characterized by both autoinflammatory and autoimmune responses such as the chronic inflammatory skin disease psoriasis. Further insights into inflammasome dysregulation and associated pathways as well as their role in forming adaptive immune responses in human autoimmune skin pathology could potentially offer a new field of therapeutic options in the future.
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Affiliation(s)
- Tanja Fetter
- Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany
| | | | - Isabelle Claus
- Institute of Human Genetics, University of Bonn, School of Medicine and University Hospital Bonn, Bonn, Germany
| | - Joerg Wenzel
- Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany
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26
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Dopytalska K, Czaplicka A, Szymańska E, Walecka I. The Essential Role of microRNAs in Inflammatory and Autoimmune Skin Diseases-A Review. Int J Mol Sci 2023; 24:ijms24119130. [PMID: 37298095 DOI: 10.3390/ijms24119130] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023] Open
Abstract
The etiopathogenesis of autoimmune skin diseases is complex and still not fully understood. The role of epigenetic factors is emphasized in the development of such diseases. MicroRNAs (miRNAs), a group of non-coding RNAs (ncRNAs-non-coding RNAs), are one of the important post-transcriptional epigenetic factors. miRNAs have a significant role in the regulation of the immune response by participating in the process of the differentiation and activation of B and T lymphocytes, macrophages, and dendritic cells. Recent advances in research on epigenetic factors have provided new insights into the pathogenesis and potential diagnostic and therapeutic targets of many pathologies. Numerous studies revealed a change in the expression of some microRNAs in inflammatory skin disorders, and the regulation of miRNA expression is a promising therapeutic goal. This review presents the state of the art regarding changes in the expression and role of miRNAs in inflammatory and autoimmune skin diseases, including psoriasis, atopic dermatitis, vitiligo, lichen planus, hidradenitis suppurativa, and autoimmune blistering diseases.
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Affiliation(s)
- Klaudia Dopytalska
- Department of Dermatology, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland
- Department of Dermatology, The National Institute of Medicine of the Ministry of the Interior and Administration, 02-507 Warsaw, Poland
| | - Anna Czaplicka
- Department of Dermatology, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland
- Department of Dermatology, The National Institute of Medicine of the Ministry of the Interior and Administration, 02-507 Warsaw, Poland
| | - Elżbieta Szymańska
- Department of Dermatology, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland
- Department of Dermatology, The National Institute of Medicine of the Ministry of the Interior and Administration, 02-507 Warsaw, Poland
| | - Irena Walecka
- Department of Dermatology, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland
- Department of Dermatology, The National Institute of Medicine of the Ministry of the Interior and Administration, 02-507 Warsaw, Poland
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27
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Sriram S, Hasan S, Alqarni A, Alam T, Kaleem SM, Aziz S, Durrani HK, Ajmal M, Dawasaz AA, Saeed S. Efficacy of Platelet-Rich Plasma Therapy in Oral Lichen Planus: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040746. [PMID: 37109704 PMCID: PMC10146996 DOI: 10.3390/medicina59040746] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023]
Abstract
Background and Objectives: Oral lichen planus (OLP) is an autoimmune, mucocutaneous, oral potentially malignant disorder (OPMD), which characteristically manifests with chronic, recalcitrant lesions, with frequent flare-ups and remissions. The precise etiopathogenesis of OLP is still debatable, although it is believed to be a T-cell-mediated disorder of an unidentified antigen. Despite the availability of various treatments, no cure for OLP exists due to its recalcitrant nature and idiopathic etiology. Platelet-rich plasma (PRP) has antioxidant, anti-inflammatory, and immunomodulatory properties, in addition to its regulatory action on keratinocyte differentiation and proliferation. These salient properties substantiate the possible role of PRP in the treatment of OLP. Our systematic review focuses on assessing the therapeutic potential of PRP as a treatment modality in OLP. Materials and Methods: We conducted a detailed literature search for studies assessing PRP as a therapeutic regimen in OLP, using the Google Scholar and PubMed/MEDLINE search engines. The search was limited to studies published from January 2000 to January 2023 and included a combination of Medical Subject Heading (MeSH) terms. ROBVIS analysis was carried out for the assessment of publication bias. Descriptive statistics were performed using Microsoft Excel. Results: This systematic review included five articles that met the inclusion criteria. Most of the included studies demonstrated that PRP treatment considerably ameliorated both objective and subjective symptoms in OLP subjects, with comparable efficacy to the standard corticosteroid treatment. Further, PRP therapy offers the added benefit of minimal adverse effects and recurrences. Conclusion: This systematic review suggests that PRP has significant therapeutic potential for treating OLP. However, further research with larger sample sizes is imperative to corroborate these findings.
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Affiliation(s)
- Shyamkumar Sriram
- Department of Social and Public Health, Ohio University, Athens, OH 45701, USA
| | - Shamimul Hasan
- Department of Oral Medicine and Radiology, Faculty of Dentistry, Jamia Millia Islamia, New Delhi 110025, India
| | - Abdullah Alqarni
- Department of Diagnostic Dental Sciences and Oral Biology, College of Dentistry, King Khalid University, Abha 62529, Saudi Arabia
| | - Tanveer Alam
- Department of Diagnostic Dental Sciences and Oral Biology, College of Dentistry, King Khalid University, Abha 62529, Saudi Arabia
| | - Sultan Mohammed Kaleem
- Department of Diagnostic Dental Sciences and Oral Biology, College of Dentistry, King Khalid University, Abha 62529, Saudi Arabia
| | - Shahid Aziz
- Department of Medicine, College of Medicine, King Khalid University, Abha 62529, Saudi Arabia
| | - Humayoun Khan Durrani
- Department of Medicine, College of Medicine, King Khalid University, Abha 62529, Saudi Arabia
| | - Muhammed Ajmal
- Department of Diagnostic Dental Sciences and Oral Biology, College of Dentistry, King Khalid University, Abha 62529, Saudi Arabia
| | - Ali Azhar Dawasaz
- Department of Diagnostic Dental Sciences and Oral Biology, College of Dentistry, King Khalid University, Abha 62529, Saudi Arabia
| | - Shazina Saeed
- Amity Institute of Public Health & Hospital Administration, Amity University, Noida 201303, India
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Gleave A, Granville DJ. Granzyme B in Autoimmune Skin Disease. Biomolecules 2023; 13:388. [PMID: 36830757 PMCID: PMC9952967 DOI: 10.3390/biom13020388] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
Autoimmune diseases often present with cutaneous symptoms that contribute to dysfunction, disfigurement, and in many cases, reduced quality-of-life. Unfortunately, treatment options for many autoimmune skin diseases are limited. Local and systemic corticosteroids remain the current standard-of-care but are associated with significant adverse effects. Hence, there is an unmet need for novel therapies that block molecular drivers of disease in a local and/or targeted manner. Granzyme B (GzmB) is a serine protease with known cytotoxic activity and emerging extracellular functions, including the cleavage of cell-cell junctions, basement membranes, cell receptors, and other structural proteins. While minimal to absent in healthy skin, GzmB is markedly elevated in alopecia areata, interface dermatitis, pemphigoid disease, psoriasis, systemic sclerosis, and vitiligo. This review will discuss the role of GzmB in immunity, blistering, apoptosis, and barrier dysfunction in the context of autoimmune skin disease. GzmB plays a causal role in the development of pemphigoid disease and carries diagnostic and prognostic significance in cutaneous lupus erythematosus, vitiligo, and alopecia areata. Taken together, these data support GzmB as a promising therapeutic target for autoimmune skin diseases impacted by impaired barrier function, inflammation, and/or blistering.
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Affiliation(s)
- Anna Gleave
- British Columbia Professional Firefighters’ Burn and Wound Healing Laboratory, International Collaboration On Repair Discoveries (ICORD) Centre, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - David J. Granville
- British Columbia Professional Firefighters’ Burn and Wound Healing Laboratory, International Collaboration On Repair Discoveries (ICORD) Centre, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z7, Canada
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Hundt JE, Hoffmann MH, Amber KT, Ludwig RJ. Editorial: Autoimmune pre-disease. Front Immunol 2023; 14:1159396. [PMID: 36865538 PMCID: PMC9971971 DOI: 10.3389/fimmu.2023.1159396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 02/16/2023] Open
Affiliation(s)
- Jennifer E. Hundt
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Markus H. Hoffmann
- Department of Dermatology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Kyle T. Amber
- Division of Dermatology, Rush University Medical Center, Chicago, IL, United States
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Ralf J. Ludwig
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
- Department of Dermatology, University Medical Center Schleswig-Holstein, Lübeck, Germany
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30
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Vičić M, Hlača N, Kaštelan M, Brajac I, Sotošek V, Prpić Massari L. Comprehensive Insight into Lichen Planus Immunopathogenesis. Int J Mol Sci 2023; 24:ijms24033038. [PMID: 36769361 PMCID: PMC9918135 DOI: 10.3390/ijms24033038] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/08/2023] Open
Abstract
Lichen planus is a chronic disease affecting the skin, appendages, and mucous membranes. A cutaneous lichen planus is a rare disease occurring in less than 1% of the general population, while oral illness is up to five times more prevalent; still, both forms equally impair the patient's quality of life. The etiology of lichen planus is not entirely understood. Yet, immune-mediated mechanisms have been recognized since environmental factors such as hepatitis virus infection, mechanical trauma, psychological stress, or microbiome changes can trigger the disease in genetically susceptible individuals. According to current understanding, lichen planus immunopathogenesis is caused by cell-mediated cytotoxicity, particularly cytotoxic T lymphocytes, whose activity is further influenced by Th1 and IL-23/Th-17 axis. However, other immunocytes and inflammatory pathways complement these mechanisms. This paper presents a comprehensive insight into the actual knowledge about lichen planus, with the causal genetic and environmental factors being discussed, the immunopathogenesis described, and the principal effectors of its inflammatory circuits identified.
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Affiliation(s)
- Marijana Vičić
- Department of Dermatovenereology, Medical Faculty, University of Rijeka, Clinical Hospital Center Rijeka, Krešimirova 42, 51000 Rijeka, Croatia
| | - Nika Hlača
- Department of Dermatovenereology, Medical Faculty, University of Rijeka, Clinical Hospital Center Rijeka, Krešimirova 42, 51000 Rijeka, Croatia
| | - Marija Kaštelan
- Department of Dermatovenereology, Medical Faculty, University of Rijeka, Clinical Hospital Center Rijeka, Krešimirova 42, 51000 Rijeka, Croatia
| | - Ines Brajac
- Department of Dermatovenereology, Medical Faculty, University of Rijeka, Clinical Hospital Center Rijeka, Krešimirova 42, 51000 Rijeka, Croatia
| | - Vlatka Sotošek
- Department of Anesthesiology, Reanimation and Intensive Care, Medical Faculty, University of Rijeka, Clinical Hospital Center Rijeka, Tome Strižića 3, 51000 Rijeka, Croatia
| | - Larisa Prpić Massari
- Department of Dermatovenereology, Medical Faculty, University of Rijeka, Clinical Hospital Center Rijeka, Krešimirova 42, 51000 Rijeka, Croatia
- Correspondence:
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31
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Muacevic A, Adler JR, Alsehli T, Altukhaim F. Rare Association Between Lichen Planus and Vogt-Koyanagi-Harada Syndrome: A Case Report. Cureus 2023; 15:e35464. [PMID: 36855585 PMCID: PMC9968211 DOI: 10.7759/cureus.35464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2023] [Indexed: 02/27/2023] Open
Abstract
Vogt-Koyanagi-Harada syndrome (VKHS) is a rare inflammatory autoimmune condition that affects tissues with high melanocyte concentrations such as the skin, inner ears, eyes, and central nervous system. VKHS has previously been reported to be associated with various autoimmune diseases, but we have observed the first known co-occurrence of VKHS and lichen planus (LP). In this report, we examine the similarities between these two diseases and discuss how they relate to each other.
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32
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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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Halonen M, Siponen M. Lichenoid lesions of the upper labial mucosa: a systematic review and a report of a new case with extensive follow-up. Acta Odontol Scand 2023; 81:29-39. [PMID: 35609206 DOI: 10.1080/00016357.2022.2077983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The paper reports the demographic characteristics of patients with lichenoid lesions affecting only the upper labial mucosa, with or without associated lesions in the maxillary anterior gingiva, alongside the lesions' clinical and histopathological features, treatment, follow-up and prognosis. Also, a new case with lengthy follow-up is presented. MATERIALS AND METHODS A systematic review was performed in line with PRISMA guidelines. The literature search sources were PubMed, Scopus and Web of Science. RESULTS In all, 26 patients (21 women, 5 men) were included in the review. 80.8% (n = 21) of the labial lesions were clinically erythematous and 19.2% (n = 5) were accompanied by white striations. The gingiva was affected in 46.2% of cases. All patients (100%, n = 24) reported symptoms. All of the lesions presented histological features of lichenoid inflammation. Granulomas were noted in 65.4% (n = 17) of the lesions. Topical corticosteroid was the most frequent therapy (89.5%, n = 17). CONCLUSIONS Lichenoid lesions found solely in the upper labial mucosa, with or without adjacent gingival lesions, are rarely reported in the literature, and the reporting is often incomplete. A definitive aetiology could not be established for the lesions. Likewise, there is little information about this condition's long-term prognosis.
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Affiliation(s)
- Maisa Halonen
- Faculty of Health Sciences, School of Medicine, Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
| | - Maria Siponen
- Faculty of Health Sciences, School of Medicine, Institute of Dentistry, University of Eastern Finland, Kuopio, Finland.,Oral Health Teaching Clinic and Oral and Maxillofacial Diseases Clinic, Kuopio University Hospital, Kuopio, Finland
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34
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Burden, Outcome, and Comorbidities of Extrahepatic Manifestations in Hepatitis C Virus Infection. BIOLOGY 2022; 12:biology12010023. [PMID: 36671716 PMCID: PMC9855523 DOI: 10.3390/biology12010023] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/06/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
Hepatitis C virus (HCV) is a significant cause of chronic liver diseases worldwide and is associated with negative consequences, including cirrhosis, hepatic decompensation, hepatocellular carcinoma, and increased risk of mortality. In addition to liver-related morbidities, HCV is also associated with several extrahepatic manifestations, including mixed cryoglobulinemia, diabetes mellitus, cardiocerebrovascular disease, lymphoma, and autoimmune diseases. These non-liver-related complications of HCV increase the complexity of this disease and can contribute to the economic burden, morbidity, quality of life, and mortality throughout the world. Therefore, understanding how this virus can contribute to each extrahepatic manifestation is worth investigating. Currently, the advancement of HCV treatment with the advent of direct-acting anti-viral agents (DAAs) has led to a high cure rate as a result of sustained virologic response and tremendously reduced the burden of extrahepatic complications. However, HCV-associated extrahepatic manifestations remain a relevant concern, and this review aims to give an updated highlight of the prevalence, risk factors, associated burdens, and treatment options for these conditions.
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35
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Lu H, He R, Yang S, Ma L, Zhang B. Successful treatment of pediatric lichen planus with topical Crisaborole. Dermatol Ther 2022; 35:e15893. [PMID: 36194005 DOI: 10.1111/dth.15893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/01/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Hongzheng Lu
- Department of Dermatology, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China
- Henan Clinical Research Center of Childhood Diseases, Henan Children's Hospital Zhengzhou Children's Hospital, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Rui He
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University (National Center for Children's Health, China), Beijing, China
| | - Siyan Yang
- Department of Dermatology, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China
- Henan Clinical Research Center of Childhood Diseases, Henan Children's Hospital Zhengzhou Children's Hospital, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Lin Ma
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University (National Center for Children's Health, China), Beijing, China
| | - Bin Zhang
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University (National Center for Children's Health, China), Beijing, China
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36
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Hong S, Fan R, Cohen JM. Lichen planus is associated with depression and anxiety: a cross-sectional study in the All of Us research program. Arch Dermatol Res 2022; 315:1417-1419. [DOI: 10.1007/s00403-022-02459-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 11/03/2022] [Indexed: 11/21/2022]
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37
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Fromme M, Schneider CV, Schlapbach C, Cazzaniga S, Trautwein C, Rader DJ, Borradori L, Strnad P. Comorbidities in lichen planus by phenome-wide association study in two biobank population cohorts. Br J Dermatol 2022; 187:722-729. [PMID: 35819183 DOI: 10.1111/bjd.21762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/05/2022] [Accepted: 07/09/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Lichen planus (LP) is a relatively frequent mucocutaneous inflammatory disease affecting the skin, skin appendages and mucosae, including oral mucosae, and less frequently the anogenital area, conjunctivae, oesophagus or larynx. OBJECTIVES To estimate the association of LP, with emphasis on dermatological and gastrointestinal conditions, in two large independent population cohorts. MATERIALS AND METHODS We performed a phenome-wide association study (PheWAS) and examined conditions associated with LP in two unrelated cohorts, i.e. the multicentre, community-based UK Biobank (UKB: 501 381 controls; 1130 LP subjects) and the healthcare-associated Penn Medicine BioBank (PMBB; 42 702 controls; 764 LP subjects). The data were analysed in 2021. The 'PheWAS' R package was used to perform the PheWAS analyses and Bonferroni correction was used to adjust for multiple testing. Odds ratios (ORs) were adjusted for age, sex and body mass index. RESULTS In the UKB, PheWAS revealed 133 phenome codes (PheCodes) significantly associated with LP and most of them were confirmed in PMBB. Dermatological and digestive PheCodes were the most abundant: 29 and 34 of these disorders, respectively, were significantly overrepresented in LP individuals from both cohorts. The 29 dermatological and 12 oral disorders were often highly enriched, whereas hepatic, gastric, oesophageal and intestinal PheCodes displayed ORs in the range of 1·6-4·5. Several autoimmune disorders also exhibited OR > 5 in both cohorts. CONCLUSIONS PheWAS in two large unrelated cohorts identified previously unknown comorbidities and may support clinical counselling of patients with LP. What is already known about this topic? Lichen planus (LP) is known to affect the skin, skin appendages and mucosae, including oral mucosae, and less frequently the anogenital area, conjunctivae, oesophagus or larynx. What does this study add? Our data provide the most comprehensive collection of associated dermatological, digestive and autoimmune disorders to date. Our findings are expected to be useful for the evaluation and management of patients with LP.
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Affiliation(s)
- Malin Fromme
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Carolin V Schneider
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.,The Institute for Translational Medicine and Therapeutics, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Christoph Schlapbach
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simone Cazzaniga
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Centro Studi GISED, Bergamo, Italy
| | - Christian Trautwein
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Dan J Rader
- The Institute for Translational Medicine and Therapeutics, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Luca Borradori
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pavel Strnad
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
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38
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Oral Papillomatosis: Its Relation with Human Papilloma Virus Infection and Local Immunity—An Update. Medicina (B Aires) 2022; 58:medicina58081103. [PMID: 36013570 PMCID: PMC9415166 DOI: 10.3390/medicina58081103] [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: 06/18/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 11/16/2022] Open
Abstract
Oral papilloma lesions may appear as a result of HPV infection, or not, and only special molecular methods could differentiate them. Low-risk and high-risk HPV types could induce oral HPV papillomatosis with different natural evolution, clearance and persistence mechanisms. The pathogenic mechanisms are based on the crosstalk between the oral epithelial and immune cells and this very efficient virus. HPV acts as a direct inducer in the process of transforming a benign lesion into a malignant one, the cancerization process being also debated in this paper. According to the degree of malignity, three types of papillomatous lesions can be described in the oral cavity: benign lesions, potential malign disorders and malignant lesions. The precise molecular diagnostic is important to identify the presence of various virus types and also the virus products responsible for its oncogenicity. An accurate diagnostic of oral papilloma can be established through a good knowledge of etiological and epidemiological factors, clinical examination and laboratory tests. This review intends to update the pathogenic mechanisms driving the macroscopic and histological features of oral papillomatosis having HPV infection as the main etiological factor, focusing on its interreference in the local immunity. In the absence of an accurate molecular diagnostic and knowledge of local immunological conditions, the therapeutic strategy could be difficult to decide.
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39
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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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40
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Ujiie H, Rosmarin D, Schön MP, Ständer S, Boch K, Metz M, Maurer M, Thaci D, Schmidt E, Cole C, Amber KT, Didona D, Hertl M, Recke A, Graßhoff H, Hackel A, Schumann A, Riemekasten G, Bieber K, Sprow G, Dan J, Zillikens D, Sezin T, Christiano AM, Wolk K, Sabat R, Kridin K, Werth VP, Ludwig RJ. Unmet Medical Needs in Chronic, Non-communicable Inflammatory Skin Diseases. Front Med (Lausanne) 2022; 9:875492. [PMID: 35755063 PMCID: PMC9218547 DOI: 10.3389/fmed.2022.875492] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/09/2022] [Indexed: 12/15/2022] Open
Abstract
An estimated 20-25% of the population is affected by chronic, non-communicable inflammatory skin diseases. Chronic skin inflammation has many causes. Among the most frequent chronic inflammatory skin diseases are atopic dermatitis, psoriasis, urticaria, lichen planus, and hidradenitis suppurativa, driven by a complex interplay of genetics and environmental factors. Autoimmunity is another important cause of chronic skin inflammation. The autoimmune response may be mainly T cell driven, such as in alopecia areata or vitiligo, or B cell driven in chronic spontaneous urticaria, pemphigus and pemphigoid diseases. Rare causes of chronic skin inflammation are autoinflammatory diseases, or rheumatic diseases, such as cutaneous lupus erythematosus or dermatomyositis. Whilst we have seen a significant improvement in diagnosis and treatment, several challenges remain. Especially for rarer causes of chronic skin inflammation, early diagnosis is often missed because of low awareness and lack of diagnostics. Systemic immunosuppression is the treatment of choice for almost all of these diseases. Adverse events due to immunosuppression, insufficient therapeutic responses and relapses remain a challenge. For atopic dermatitis and psoriasis, a broad spectrum of innovative treatments has been developed. However, treatment responses cannot be predicted so far. Hence, development of (bio)markers allowing selection of specific medications for individual patients is needed. Given the encouraging developments during the past years, we envision that many of these challenges in the diagnosis and treatment of chronic inflammatory skin diseases will be thoroughly addressed in the future.
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Affiliation(s)
- Hideyuki Ujiie
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - David Rosmarin
- Department of Dermatology, Tufts Medical Center, Boston, MA, United States
| | - Michael P. Schön
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
- Lower Saxony Institute of Occupational Dermatology, University Medical Center Göttingen, Göttingen, Germany
| | - Sonja Ständer
- Center for Chronic Pruritus, Department of Dermatology, University Hospital Muenster, Muenster, Germany
| | - Katharina Boch
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Martin Metz
- Institute for Allergology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Marcus Maurer
- Institute for Allergology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Diamant Thaci
- Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany
| | - Enno Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - Connor Cole
- Division of Dermatology, Rush University Medical Center, Chicago, IL, United States
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Kyle T. Amber
- Division of Dermatology, Rush University Medical Center, Chicago, IL, United States
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Dario Didona
- Department of Dermatology and Allergology, Philipps-Universität, Marburg, Germany
| | - Michael Hertl
- Department of Dermatology and Allergology, Philipps-Universität, Marburg, Germany
| | - Andreas Recke
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Hanna Graßhoff
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Alexander Hackel
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Anja Schumann
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Gabriela Riemekasten
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Katja Bieber
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - Gant Sprow
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States
| | - Joshua Dan
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States
| | - Detlef Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Tanya Sezin
- Department of Dermatology, Columbia University Medical Center, New York, NY, United States
| | - Angela M. Christiano
- Department of Dermatology, Columbia University Medical Center, New York, NY, United States
| | - Kerstin Wolk
- Psoriasis Research and Treatment Centre, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Interdisciplinary Group Molecular Immunopathology, Dermatology/Medical Immunology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Robert Sabat
- Psoriasis Research and Treatment Centre, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Interdisciplinary Group Molecular Immunopathology, Dermatology/Medical Immunology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Khalaf Kridin
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Victoria P. Werth
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States
| | - Ralf J. Ludwig
- Department of Dermatology, University of Lübeck, Lübeck, Germany
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
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41
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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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