Oral Dis . Lichen planus - interface dermatitis with apoptotic bodies. Sign out FORESKIN, CIRCUMCISION: - SKIN WITH PATCHY MILD NONSPECIFIC INFLAMMATION. Lichenoid keratosis (LK) is a common benign skin growth that typically presents as an evolving single discrete papule on the trunk or upper extremities of adults (Figure 1). Annular atrophic lichen planus (AALP) is a rare variant of lichen planus that was first described by Friedman and Hashimoto1 in 1991. Lichen planus (LP) is a chronic mucocutaneous disorder of the stratified squamous epithelium that affects oral and genital mucous membranes, skin, nails, and scalp. For cases with no specific clinical and histologic characteristics, or with . The first choice for treatment of lichen planus is usually a prescription corticosteroid cream or ointment. Individualizing treatment and choice of medication in lichen planus: a step by step approach. Classical dermoscopic criteria for LP diagnosis are missing, diagnosis is therefore challenging, and histological evaluation is needed [ 1 ]. Lichen planus (LP) is a chronic inflammatory mucocutaneous disease, which affects 1-2% of the general population (1). It is one of the causes of atypical solar lentigo. These challenges may include: Limited information about the disease and treatment Financial and economic difficulties It is normal for patients, their families, and caregivers to experience a variety of stresses that may change over time. Lichen planus and diabetes mellitus: systematic review and meta-analysis. Verhoeff-van Gieson staining for elastic fibers was performed on both biopsies, which revealed destruction of elastic fibers in the central papillary dermis and upper reticular dermis of the lesional biopsy (Figure 3A). It is characterized by oval or irregularly-shaped brown to gray-brown macules and patches on the skin. Saving You Time. He denied any new medications, recent illnesses, or sick contacts. Cutaneous amyloidosis - classically has "cracked" appearance. An initial punch biopsy was consistent with a nonspecific lichenoid dermatitis (Figure 2), and the patient was prescribed triamcinolone ointment 0.1% for the trunk and extremities and tacrolimus ointment 0.1% for the groin and genital region. . LP can involve the skin or mucous membranes including the oral, vulvovaginal, esophageal, laryngeal, and conjunctival mucosa. Atrophic (large lichen palnus plaques with central atrophy) Hypertrophic (thick, hyperkeratotic plaques) Actinic (young adults or children with lichen planus on sun exposed areas occurring during the spring and summer seasons) Pigmentosus (lesions are brown, on the face and neck, more common in South Asia, frequent intertriginous involvement) In: James WD, Berger TG, Elston DM, eds. Elastic fibers had been destroyed in the papillary dermis both in the border and in the center of the lesion, resulting in an atrophic appearance of the lesion. The lesions were annular with raised borders and central depigmented atrophic scarring (Figure 1B). Dr. Dahiya is from the Department of Pathology, Edward Hines Jr. VA Hospital, Hines, Illinois. Many of the diseases listed below that are histologically lichenoid are not clinically lichenoid. On the other hand, Vega et al. Sugashima Y, Yamamoto T. Annular atrophic lichen planus of the lip. Vulvar lichen sclerosus[TI] free full text[SB], J Eur Acad Dermatol Venereol 2010;24:1031, HPV independent vulvar intraepithelial neoplasia (VIN), Immune mediated chronic fibroinflammatory condition of vulvar skin, Most commonly postmenopausal at onset; rarely can occur in children, Lichenoid interface inflammatory reaction, Hyalinization and homogenization of the superficial dermal collagen with displacement of inflammatory cells downward, below the abnormal collagen layer, Associated with other autoimmune disorders (, Typically does not involve vaginal mucosa but focal extension from vulvar skin onto the adjacent mucosa may be seen, Cell mediated immune response with associated degenerative changes of the basal keratinocytes, Secondary fibrosis of the superficial dermis, leading to a subepithelial hypocellular band of homogenous appearing collagen, Associated with increased risk of developing human papillomavirus (HPV) independent vulvar intraepithelial neoplasia (VIN) and squamous cell carcinoma (, Vulvar skin becomes thinned (cigarette paper appearance), with destruction of normal anatomic landmarks as the disease progresses, Characteristic clinical findings are highly suggestive but a biopsy can provide a definitive diagnosis if there is diagnostic uncertainty and also rule out neoplasia (e.g., VIN or Paget disease), Early diagnosis and treatment may prevent disease progression, 44 year old woman with bullous lichen sclerosus (, 50 year old woman with lichen sclerosus undergoing treatment with nivolumab (, 60 and 61 year old women with lichen sclerosus with vaginal involvement (, 66 year old woman with lichen sclerosus after treatment for vulvar squamous cell carcinoma (, Topical corticosteroids (first line), with topical calcineurin inhibitor therapy as second line (, Diagnosis is made based on small biopsy specimens, May be an incidental finding in a resection specimen (e.g., for vulvar squamous cell carcinoma), Vacuolar interface reaction pattern in conjunction with dermal sclerosis (homogenized and hyalinized eosinophilic collagen bundles) of any thickness intervening between inflammatory infiltrate and epithelium or vessel walls (, Early lesions show only the inflammation and no or minimal fibrosis (inflammatory phase); the histopathological findings at this stage of disease development are not diagnostic, Severe hyperkeratosis; thin epidermis, loss of rete pegs, basal cell degeneration, homogenized band of dense fibrosis at papillary dermis, upper dermal edema, band-like chronic inflammation, In early stages, findings are subtle and often more prominent in adnexal structures than in interfollicular skin; adnexal structures show acanthosis, luminal hyperkeratosis and hypergranulosis, Early dermal changes are homogenized collagen and wide ectatic capillaries in dermal papillae immediately beneath basement membrane, Superficial dermal collagen may be wire-like with lymphocyte entrapment (, Lymphocytic infiltrate can be sparse or dense, lichenoid or interstitial with epidermal lymphocyte exocytosis. Subepithelial band-like inflammatory infiltrate is directly under the . [ 4] The examination also revealed several large hypopigmented atrophic patches and plaques in the right inguinal region and on the dorsal aspect of the penile shaft and buttocks as well as a single atrophic plaque on the scalp. Although most authors consider LPLK to be a distinct lesion, surgical pathologists are often unfamiliar with it. The clinical presentation and histopathological findings confirmed a diagnosis of AALP. Thompson DF, Skaehill PA Drug-induced lichen planus. In atrophic LP, specifically, affected people develop pale papules or plaques with an atrophic (broken down tissue) center. Ponce-Olivera RM, Tirado-Snchez A, Montes-de-Oca-Snchez G, et al. Lichen planus and related conditions. We report a case of AALP in a 69-year-old black man. [34] reviewed 20 cases of AD and 11 cases of LPP in 1992. Lichen planus (LP) is a chronic inflammatory mucocutaneous disease. Hydroxychloroquine 400 mg once daily was administered, which initially resulted in some thinning of the plaques on the trunk; however, further progression of the disease was noted after 3 months. This section is currently in development. The most common ages for symptoms of a disease to begin is called age of onset. National Center for Advancing Translational Sciences, UMLSVocabulary Standards and Mappings Downloads, Access aggregated data from Orphanet at Orphadata, National Center for Biotechnology Information's, Newborn Screening Coding and Terminology Guide, Improving newborn screening laboratory test ordering and result reporting using health information exchange, Health Literacy Online: A Guide for Simplifying the User Experience, U.S. Department of Health & Human Services, National Center for Advancing Translation Sciences. Core tip: Oral Lichen planus (OLP) is frequently encountered by the dermatologists and oral physician. Who gets lichenoid keratosis? Our patient showed early signs of improvement with hydroxychloroquine and acitretin, suggesting a role for systemic therapy in the treatment of AALP. However, we cannot answer medical or research questions or give advice. This could be the oral, esophageal, vaginal mucosa as well as the skin. Pinkus [31, 32] included ashy dermatosis and atrophic lichen planus in the same section of his classification of "lichenoid tissue patterns" because of their histologic similarities. Reticulate, lace-like and white keratotic lesions; rarely bullous or ulcerated. Kim BS, Seo SH, Jang BS, et al. Annular atrophic lichen planus with well-demarcated, hyperpigmented, violaceous annular plaques on the left posterior thigh (A) and posterior trunk (B) with elevated borders and central depigmented atrophic scarring. Many GARD web pages are still in development. [] The first case was reported in 1948, attributed to the intake of quinacrine hydrochloride, the second case in 1991, and the third in 1994.2 Atrophic lichen planus (LP) is a rare form of lichen planus, which is a condition that affects the skin and/or mouth. We welcome suggestions or questions about using the website. Atrophic lesions are often asymptomatic, although a portion of patients may experience pruritus. Common side effects of topical corticosteroids include skin irritation or thinning where the cream is applied . Syphilis - plasma cells. This website is intended for pathologists and laboratory personnel but not for patients. 2015;1(3): 140-149. Atrophic lichen planus (LP) is a rare form of lichen planus, which is a condition that affects the skin and/or mouth. Overview. Figure 2. Annular atrophic lichen planus (AALP) is a rare variant of lichen planus. The patient continued to develop new annular atrophic skin lesions over the next several months. Sunlight seems to be a triggering factor in most cases. Reticular lichen planus Symmetrical white lace-like pattern on buccal mucosa (inner aspects of cheeks) There may be no symptoms or discomfort and soreness. Histopathologic findings generally reveal a lichenoid dermatitis in active lesions with a distinct loss of elastic fibers in the center of the lesions. Annular atrophic lichen planus (AALP) is a rare variant of lichen planus. Clinical findings include hyperpigmented, brown to gray-brown macules and patches in sun-exposed areas, typically on the head and neck. LK occurs almost always as a solitary skin growth; however, two or three lesions can occasionally be present. Lichenoid keratosis generally develops in fair-skinned patients aged 30-80 years. Eyler and Swan are from the Division of Dermatology, and Dr. Garib is from the Department of Pathology. Downs SM, van Dyck PC, Rinaldo P, et al. We report a unique case of AALP, which highlights the chronicity of the eruption. Repeat punch biopsies of lesional and uninvolved perilesional skin from the trunk were obtained for histopathologic confirmation and special staining. Subacute to chronic mucocutaneous disorder of unknown etiology. This website is intended for pathologists and laboratory personnel but not for patients. Punch biopsy from the left posterior thigh showed compact hyperkeratosis, hypergranulosis, Civatte bodies, and focal acanthosis with an underlying lichenoid dermatitis composed of a lymphohistiocytic infiltrate partially obscuring the dermoepidermal junction (H&E, original magnification 40). Lesions most frequently occur on cutaneous and oral surfaces (40%) or are . [] Research published in 2015 also suggests that osteopontin, CD44, and survivin may be involved in the pathogenesis of oral lichen planus. Since it is . 4,6 There is thought to be a correlation with emotional factors, like anxiety and stress, and the presentation of oral lichen planus lesions. Oral lichen planus is a chronic inflammatory disease of unknown etiology or pathogenesis with varied disease severity that waxes and wanes over a long period of time. Evaluating the Clinical and Demographic Features of Extrafacial Granuloma Faciale, Telmisartan-Induced Lichen Planus Eruption Manifested on Vitiliginous Skin, Lichen Planus Pemphigoides Associated With Pregnancy Mimicking Pemphigoid Gestationis, Oral Lichen Planus With Malignant Transformation to Invasive Squamous Cell Carcinoma, Expert Insights in Hidradenitis Suppurativa, Treating Patients with Acne by Telemedicine in the Era of COVID-19, Nurse Practitioners / Physician Assistants. Glassy, reticulated, white papules and plaques, See what's new this week at PathologyOutlines.com on, Copyright PathologyOutlines.com, Inc. Click, 30100 Telegraph Road, Suite 408, Bingham Farms, Michigan 48025 (USA). Although these papules can be found anywhere on the body, they most commonly affect the trunk and/or legs on skin areas previously affected by classic lichen planus. Int J Womens Dermatol. Histopathologic findings generally reveal a lichenoid dermatitis in active lesions with a distinct loss of elastic fibers in the center of the lesions. Hypertrophic lesions are extremely pruritic. [15,16] many studies have been focused on the identification of several predictive variables of the dysplastic changes of the disease. A 69-year-old black man with a history of hepatitis C virus infection and hypothyroidism presented to the dermatology clinic with a pruritic rash on the trunk, extremities, groin, and scalp of 4 months' duration. Figure 3. It has features of both annular and atrophic LP. Several clinical morphologic patterns have been described, and multiple therapies with variable results have been used. Pruritus is common in lichen planus but varies in severity depending on the type of lesion and the extent of involvement. Lichenoid keratosis is also known as benign lichenoid keratosis, solitary lichen planus, lichen planus-like keratosis and involuting lichenoid plaque. The authors report no conflict of interest. Manousaridis I, Manousaridis K, Peitsch WK, et al. Many rare diseases have limited information. If that doesn't help and your condition is severe or widespread, your doctor might suggest a corticosteroid pill or injection. Annular atrophic lichen planus. Overlap can occur where superficial and deep changes co-exist. Lichen planus actinicus is a photodistributed variant of lichen planus that most often occurs in individuals with dark complexions. See our Other Publications. Copyright 2022Frontline Medical Communications Inc., Newark, NJ, USA. Often, it is found only in the oral cavity. Even though, lot of research is carried out on this disease, still the precise etiopathogenesis and treatment is controversial. The prominent histopathologic features consisted of an interface dermatitis characterized by coarse vacuolar degeneration of the basal cell layer, a mid-dermal perivascular predominantly lymphocytic inflammatory cell infiltrate, and a significant degree of pigment incontinence. For other diseases, symptoms may begin any time during a person's life. The common ages for symptoms to begin in this disease are shown above by the colored icon(s). Negative for dysplasia or malignancy. May affect tongue or gums May ulcerate Atrophic / erosive lichen planus Red lesions often with a whitish border My cause erosions (superficial ulceration) Other terminology: differentiated VIN (dVIN), differentiated exophytic vulvar intraepithelial lesion (DEVIL), vulvar acanthosis with altered differentiation (VAAD), vulvar altered maturation (VAM), Shows epithelial hyperplasia and loss of normal maturation; often shows significant basal atypia and may show mutant pattern, Clinically, the presence of erosions, oral involvement, a burning sensation or a hyperkeratotic lesional margin favor a diagnosis of lichen planus over lichen sclerosus (, Typically involves mucosa or nonhair bearing skin, Subepithelial band-like inflammatory infiltrate is directly under the squamous epithelium, without a separating area of fibrosis / sclerosis, Pointed rete ridges are more common in lichen planus, while the presence of epidermal atrophy or basal lamina thickening favor lichen sclerosus (, Early lesions of lichen sclerosus, before the fibrosis becomes established, can be difficult or impossible to distinguish from lichen planus; such cases can be signed out descriptively, indicating that follow up, with or without rebiopsy, should allow for definitive diagnosis, Lichen planus can coexist with lichen sclerosus (, Epidermal hyperplasia is present, rather than atrophic changes, with no degenerative changes of the basal epithelial layer and no superficial subepidermal sclerosis, Excoriation is common and may lead to subepidermal scarring but with variably sized collagen bundles and not the homogenized sclerotic band of lichen sclerosis, Spongiosis / spongiotic dermatitis may be present but is not necessary for diagnosis (, High grade squamous intraepithelial lesion (HSIL / VIN3), Human papillomavirus (HPV) independent vulvar intraepithelial neoplasia (VIN).
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