A clinical and histopathological study of lichen planus. Cureus hypertrophic lichen planus mimicking verrucous. However, histopathological examination of lp and lpvariant lesions reveal. Involvement of the oral cavity may present with white wickhams striae or as erosive painful lesions figure 68. Annular atrophic lichen planus aalp is a rare variant of lichen planus. Lichen planus lp is derived from the greek leichen meaning tree moss and the latin planus meaning flat lichens are primitive plants composed of symbiotic algae and fungi planus in latin for flat. The two types of lichen planus, which are most relevant to the tropical physician, are hypertrophic lichen planus and actinic lichen planus. It is one of the most common dermatological conditions involving the oral cavity. Varying numbers of apoptotic keratinocytes may be appreciated. Lichen planus lp usually develops in middle age between 30 and 60 years and shows a slight female preponderance. There is irregular epidermal hyperplasia forming a characteristic sawtooth appearance with wedgeshaped hypergranulosis. However, histopathological examination of lp and lpvariant lesions reveal similar. Hypertrophic lichen planus versus prurigo nodularis. There are several variants of lichen planus whose clinical, dermoscopic and histological appearance varies from one subtype to another.
Lichen planus is an uncommon disorder of unknown cause that most commonly affects middleaged adults. Pathogenesis thought to be an auto immune process with unknown trigger if the trigger is known then it is called lichenoid reaction exposure to medicines, dyes, other chemicals as gold, antimalarials, antibiotics. Histopathology demonstrated epidermal acanthosis, wedgeshaped hypergranulosis, a sawtooth rete ridge pattern with necrosis of the basal layer, and a bandlike lymphoid infiltrate, findings consistent with a diagnosis of hypertrophic lichen planus figure 4. Lichen planus is characterized by lichenoid, polygonal papules with fine white. Hypertrophic lichen planus hlp classically involves shin and ankles and is characterized by hyperkeratotic plaques and nodules. Hypertrophic lichen planus lp is a variant of lp favoring the lower extremities and showing prominent epidermal hyperplasia and hyperorthokeratosis. Pathogenesis immunologically mediated antigen cell surface alteration. Lichen planus is a chronic recurrent skin disease of unknown cause with no established cure lichen planus generally affects adults and can involve any portion of the skin and lining tissue mucous membranes of the mouth andor vagina, but it has a predilection for. In our study, generalised lichen planus was the most common type of lp. At present, studies on hypertrophic lichen planus hlp and prurigo nodularis pn are limited. Cutaneous lichen planus typically presents as papules that are planar, polygonal, pruritic, and purple. Light microscopy of the a ected skin biopsy samples. Pdf lichen planus lp is an inflammatory skin condition with characteristic clinical and histopathological findings.
Systemic corticosteroids should be considered for severe, widespread lichen planus involving oral, cutaneous, or genital sites. This case underscores how increased awareness of subtle. Atrophic lichen planus is a rare variant usually observed on. Squamous cell carcinoma arising in hypertrophic lichen planus. Learn the basic features of the hypertrophic variant of lichen planus. Wilson as an inflammatory disorder of the stratified squamous epithelia with an unknown etiology. Subtypes of lichen planus include actinic, annular, atrophic, eruptive, follicular, hypertrophic, inverse, linear, palmoplantar, pemphigoides, pigmentosus, ulcerative, vesiculobullous. Hypertrophic lichen planus mistaken for squamous cell.
The differential diagnoses included lichen simplex chronicus, hypertrophic discoid lupus erythematosus, hypertrophic lichen planus, tinea corporis and nummular eczema. Dermographic, clinical and histopathological prole. Histopathological findings may not have the typical features of lichen planus and can mimic squamous cell carcinoma scc. It has been suggested that true lichen planus may respond to stress, where lesions may present on the mucosa or skin during times of stress in those with the disease. According to type of lichen planus out of 87 cases of lichen planus most common was classical lp with 4450. The aim of this study was to compare the dermoscopic features of hlp and pn and to determine the role of dermoscopy in the differential diagnosis of both the conditions. Complicationspermanent hair loss carcinomatous change in. Oral lichenplanus clinical features, histopathology. Two patients 75 and 69 years presented with lesions diagnosed as scc on biopsy, which developed after 39 months on icb therapy.
Term suggests flat fungal condition current evidence indicates immunologicaly mediated mucocutaneous disorder. Atypical case of hypertrophic lichen planus recognized by. Hypertrophic lichen planus hlp and squamous cell carcinoma scc share many clinical and histopathologic characteristics, making them difficult to distinguish. Introduction lichen planus lp is an inflammatory disease that affects the skin, the mucous membranes, the genitalia, the nails, and the scalp. Direct immunofluorescence examination is an important technique in the diagnosis of cutaneous inflammatory disorders including lichen planus, especially in clinically and histopathological doubtful cases. Mucosal lichen planus was seen in 10% of our cases with oral mucosal involvement in 8% of cases and genital mucosal involvement in 2% of cases. Lichen planus and lichenoid reactions as a systemic. Ppt lichen planus lp powerpoint presentation free to. Cutaneous lichen planus clp most commonly involves the flexor surfaces of the extremities and presents as small itchy violaceous papules in. Twice malignant transformation of hypertrophic lichen planus. The disease has a chronic course, and it is often resistant to local and systemic. Scanning power view of lichen planus shows a lichenoid reaction pattern figure 1 characterised by the combination of degeneration of the basal layer of the epidermis and a band like lymphocytic infiltrate obscuring the dermoepidermal junction. Differentiating hypertrophic lichen planus lp from welldifferent iated squamous cell carcinoma scc is a histological challenge given the numerous histopathologic similarities between scc and pseudoepitheliomatous hyperplasia peh arising in the setting of hypertrophic lp. Histopathology two types of hle lesions have been described.
Your story matters citation levandoski, katherine a. Hypertrophic lichen planus with histological features of. They are one of the causes of atypical solar lentigo. Objective to critically appraise the body of literature concerning treatment of lichen planus lp. The condition may cause continuous itching and scaling of the skin, which creates skin moistness, providing a suitable environment for bacteria and fungi to grow and thrive. Role of dermoscopy in the diagnosis of hypertrophic lichen. Acitretin soriatane is a retinoid that may be used for lichen sclerosus unresponsive to topical steroids and in some cases lichen planus. Clinical and histopathological spectrum of lichen planus. The objective of this article is to highlight hypertrophic lichen planus hlp with histological features diagnosed as squamous cell carcinoma scc, which is a potential cutaneous reaction to icb. Lichen planus is a chronic, inflammatory, autoimmune disease that affects the skin, oral mucosa, genital mucosa, scalp, and nails.
What are the possible complications of hypertrophic lichen planus. Clinical features, histopathology and immunofluorescence. Histopathology and cytology laboratory, public health laboratory centre, department of health. Hypertrophic lichen planus was the next most common type accounting for 14% of cases.
Pdf update on lichen planus and its clinical variants researchgate. Harvard medical school and the department of pathology. The complications of hypertrophic lichen planus may include. Lichen planus lp is a chronic disease that involves the skin, scalp, mucous membranes, and nails. Acitretin for hypertrophic lichen planuslike reaction in. Definition lichen planus is a relatively common chronic inflammatory disease of the oral mucosa and skin etiology although the cause is not well known, t cellmediated autoimmune phenomena are involved in the pathogenesis.
Histopathology in such lesions shows marked hyperkeratosis, acanthosis. The study group comprised of clinical diagnosed 87 cases of lichen planus. Contrary to dogma that eosinophils are rare in lp and variants, we noticed that some cases of hypertrophic lp have eosinophils in the absence of drug history. Lichen planus lp is a chronic inflammatory and immune mediated disease that affects the skin, nails, hair, and mucous membranes. View enhanced pdf access article on wiley online library html view. Histopathology of hlp and pn demonstrate epidermal hyperplasia, hypergranulosis, and compact hyperkeratosis.
A complicated case of recalcitrant lichen planus with. Prurigo nodularis pn is a chronic neurodermatitis that presents with intensely pruritic nodules. Clinical features white papules that usually coalesce, forming a network of lines wickmans striae, are the characteristic oral lesions of the disease. Lichen planus, particularly of the oral cavity, 7,8 and hypertrophic lichen planus 9 may be complicated by squamous cell carcinoma.
Histopathological findings in oral lichen planus and their correlation. Lichen planus classically presents on the wrists and ankles. Hypertrophic lichen planus mayo clinic clinical photographs used with permission citation ends. Update on lichen planus and its clinical variants sciencedirect. Hypertrophic lichen planus hlp is a chronic tcellmediated inflammatory disease characterised by pruritic hypertrophic or verrucous plaques on the lower limbs.
Some histopathologic hallmarks of ls were seen chiefly. Lichen planus is a chronic inflammatory disease that affects the skin and mucosa. Wilson probably referred to the condition that was originally described by herba as lichen ruber 3, 4. Genital lichen planus, which may cause lesions on the glans penis or skin of the scrotum in males, and the vulva or vagina in females. Lp greek leichen tree moss, latin planus flat, even was first explained in 1869 by dr. Histopathologic findings generally reveal a lichenoid dermatitis in active lesions with a distinct loss of elastic fibers in the center of the lesions. Hypertrophic lichen planus is a less common form of lichen planus. Lichenoid keratosis generally develops in fairskinned patients aged 3080 years. Symptoms may include lower urinary tract symptoms associated with stenosis of the urethra, painful sexual intercourse, and itching. Lichenoid keratosis is also known as benign lichenoid keratosis, solitary lichen planus, lichen planus like keratosis and involuting lichenoid plaque. Lichen planus lesions are described using the six ps.
Lichen planus may affect the skin cutaneous lichen planus, oral cavity oral lichen planus, genitalia penile or vulvar lichen planus, scalp lichen planopilaris, nails, or esophagus. A study of clinical and histopathological correlation of lichen planus. The importance of clinicopathologic correlation the harvard community has made this article openly available. The significance of eosinophils in hypertrophic lichen planus. Hypertrophic lichen planus mimicking squamous cell. Hypertrophic lichen planus mimicking squamous cell carcinoma.
Apply to skin qhs with gradual decrease to two to three times a week. Only four of the patients initially ontacted refused the interview. Lichen planus has been reported as a complication of chronic hepatitis c virus infection and can be a sign of chronic graftversushost disease of the skin. However, the development of skin cancers usually occurs in longstanding chronic disease and contrasts with the short history of the hypertrophic lichenoid lesions seen in. Hypertrophic lichen planus versus welldifferentiated. Pdf hypertrophic lichen planus a case report researchgate. It was originally named lichen ruber planus and lichen.
A dermoscope is an office tool used in the diagnosis of various disorders. Hlp may undergo malignant transformation, leading to the development of scc within hlp. We report a case of an 87yearold woman with a 12year history of hlp on both lower legs presenting with malignant transformation of one lesion into a squamous cell carcinoma scc. The clinical presentation of aalp shows distinct atrophic plaques with elevated borders on the trunk and extremities. We present a case of hlp that mimicked scc and was referred for surgical intervention. Diagnosis is often made clinically and confirmed on biopsy. Lichen planus is chronic mucocutaneous disease of autoimmune origin, affecting around 0. To study the diagnostic utility of intensity, number, and subtypes of positive immunoreactants found in lichen planus. Lichen planus is an inflammatory skin condition that can affect the hair, mucous membranes, nails, and skin.
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