Pdf hypertrophic lichen planus a case report researchgate. Dermographic, clinical and histopathological prole. Clinical features, histopathology and immunofluorescence. Lichenoid keratosis generally develops in fairskinned patients aged 3080 years. Wilson probably referred to the condition that was originally described by herba as lichen ruber 3, 4.
Light microscopy of the a ected skin biopsy samples. Atypical case of hypertrophic lichen planus recognized by. Prurigo nodularis pn is a chronic neurodermatitis that presents with intensely pruritic nodules. Objective to critically appraise the body of literature concerning treatment of lichen planus lp. Diagnosis is often made clinically and confirmed on biopsy. The two types of lichen planus, which are most relevant to the tropical physician, are hypertrophic lichen planus and actinic lichen planus.
Hlp may undergo malignant transformation, leading to the development of scc within hlp. Cureus hypertrophic lichen planus mimicking verrucous. The significance of eosinophils in hypertrophic lichen planus. Hypertrophic lichen planus was the next most common type accounting for 14% of cases. Cutaneous lichen planus typically presents as papules that are planar, polygonal, pruritic, and purple. Subtypes of lichen planus include actinic, annular, atrophic, eruptive, follicular, hypertrophic, inverse, linear, palmoplantar, pemphigoides, pigmentosus, ulcerative, vesiculobullous.
Lichen planus lesions are described using the six ps. The study group comprised of clinical diagnosed 87 cases of lichen planus. The clinical presentation of aalp shows distinct atrophic plaques with elevated borders on the trunk and extremities. 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. There is irregular epidermal hyperplasia forming a characteristic sawtooth appearance with wedgeshaped hypergranulosis. Complicationspermanent hair loss carcinomatous change in.
A study of clinical and histopathological correlation of lichen planus. Lichen planus classically presents on the wrists and ankles. Atrophic lichen planus is a rare variant usually observed on. Lichen planus, particularly of the oral cavity, 7,8 and hypertrophic lichen planus 9 may be complicated by squamous cell carcinoma. Histopathologic findings generally reveal a lichenoid dermatitis in active lesions with a distinct loss of elastic fibers in the center of the lesions. Lichen planus and lichenoid reactions as a systemic. Clinical and histopathological spectrum of lichen planus. Lichen planus lp usually develops in middle age between 30 and 60 years and shows a slight female preponderance. Histopathological findings may not have the typical features of lichen planus and can mimic squamous cell carcinoma scc. Histopathology and cytology laboratory, public health laboratory centre, department of health. In our study, generalised lichen planus was the most common type of lp. Hypertrophic lichen planus lp is a variant of lp favoring the lower extremities and showing prominent epidermal hyperplasia and hyperorthokeratosis. The importance of clinicopathologic correlation the harvard community has made this article openly available. It is one of the most common dermatological conditions involving the oral cavity.
Hypertrophic lichen planus mistaken for squamous cell. 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. A dermoscope is an office tool used in the diagnosis of various disorders. Hypertrophic lichen planus mimicking squamous cell carcinoma.
Involvement of the oral cavity may present with white wickhams striae or as erosive painful lesions figure 68. They are one of the causes of atypical solar lentigo. However, histopathological examination of lp and lpvariant lesions reveal. To study the diagnostic utility of intensity, number, and subtypes of positive immunoreactants found in lichen planus. However, histopathological examination of lp and lpvariant lesions reveal similar. Pathogenesis immunologically mediated antigen cell surface alteration. Lichen planus is a chronic, inflammatory, autoimmune disease that affects the skin, oral mucosa, genital mucosa, scalp, and nails. Introduction lichen planus lp is an inflammatory disease that affects the skin, the mucous membranes, the genitalia, the nails, and the scalp. 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 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 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.
Squamous cell carcinoma arising in hypertrophic lichen planus. This case underscores how increased awareness of subtle. The complications of hypertrophic lichen planus may include. Histopathology two types of hle lesions have been described. Oral lichenplanus clinical features, histopathology. Acitretin soriatane is a retinoid that may be used for lichen sclerosus unresponsive to topical steroids and in some cases lichen planus. 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. Lichen planus lp is a chronic inflammatory and immune mediated disease that affects the skin, nails, hair, and mucous membranes. Two patients 75 and 69 years presented with lesions diagnosed as scc on biopsy, which developed after 39 months on icb therapy.
Only four of the patients initially ontacted refused the interview. Hypertrophic lichen planus with histological features of. Varying numbers of apoptotic keratinocytes may be appreciated. According to type of lichen planus out of 87 cases of lichen planus most common was classical lp with 4450. Ppt lichen planus lp powerpoint presentation free to. 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. Hypertrophic lichen planus mimicking squamous cell. Lichenoid keratosis is also known as benign lichenoid keratosis, solitary lichen planus, lichen planus like keratosis and involuting lichenoid plaque. Cutaneous lichen planus clp most commonly involves the flexor surfaces of the extremities and presents as small itchy violaceous papules in. 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. A good example of the lichenoid dermatitis pattern. 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. M ultiple reports have shown that scc can arise from hypertrophic lp not infrequently, but that the lptoscc. Lichen planus lp is a chronic disease that involves the skin, scalp, mucous membranes, and nails.
Apply to skin qhs with gradual decrease to two to three times a week. Hypertrophic lichen planus hlp and squamous cell carcinoma scc share many clinical and histopathologic characteristics, making them difficult to distinguish. Wilson as an inflammatory disorder of the stratified squamous epithelia with an unknown etiology. 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. 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. 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. Hypertrophic lichen planus hlp is a chronic tcellmediated inflammatory disease characterised by pruritic hypertrophic or verrucous plaques on the lower limbs.
Hypertrophic lichen planus versus welldifferentiated. Harvard medical school and the department of pathology. Role of dermoscopy in the diagnosis of hypertrophic lichen. View enhanced pdf access article on wiley online library html view. Twice malignant transformation of hypertrophic lichen planus. It was originally named lichen ruber planus and lichen. Annular atrophic lichen planus aalp is a rare variant of lichen planus. Learn the basic features of the hypertrophic variant of lichen planus. Clinical features white papules that usually coalesce, forming a network of lines wickmans striae, are the characteristic oral lesions of the disease. Histopathology of hlp and pn demonstrate epidermal hyperplasia, hypergranulosis, and compact hyperkeratosis. Symptoms may include lower urinary tract symptoms associated with stenosis of the urethra, painful sexual intercourse, and itching. Lichen planus is an inflammatory skin condition that can affect the hair, mucous membranes, nails, and skin.
Hypertrophic lichen planus hlp classically involves shin and ankles and is characterized by hyperkeratotic plaques and nodules. 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. Hypertrophic lichen planus mayo clinic clinical photographs used with permission citation ends. Systemic corticosteroids should be considered for severe, widespread lichen planus involving oral, cutaneous, or genital sites. Clinical variants of lichen planus wiley online library. Hypertrophic lichen planus is a less common form of lichen planus. The differential diagnoses included lichen simplex chronicus, hypertrophic discoid lupus erythematosus, hypertrophic lichen planus, tinea corporis and nummular eczema. A clinical and histopathological study of lichen planus.
Direct immunofluorescence examination is an important technique in the diagnosis of cutaneous inflammatory disorders including lichen planus, especially in clinically and histopathological doubtful cases. Lichen planus is a chronic inflammatory disease that affects the skin and mucosa. The disease has a chronic course, and it is often resistant to local and systemic. Term suggests flat fungal condition current evidence indicates immunologicaly mediated mucocutaneous disorder. There are several variants of lichen planus whose clinical, dermoscopic and histological appearance varies from one subtype to another. Lichen planus is chronic mucocutaneous disease of autoimmune origin, affecting around 0. Hypertrophic lichen planus versus prurigo nodularis. Lichen planus is an uncommon disorder of unknown cause that most commonly affects middleaged adults. 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. Lichen planus is characterized by lichenoid, polygonal papules with fine white. At present, studies on hypertrophic lichen planus hlp and prurigo nodularis pn are limited.
Lp greek leichen tree moss, latin planus flat, even was first explained in 1869 by dr. 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. Update on lichen planus and its clinical variants sciencedirect. Pdf update on lichen planus and its clinical variants researchgate. Pdf lichen planus lp is an inflammatory skin condition with characteristic clinical and histopathological findings. Lichen planus is an autoimmune mucocutaneous inflammatory disorder.
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. 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. We present a case of hlp that mimicked scc and was referred for surgical intervention. The hypertrophic variant of lp, also called lichen planus verrucous or lichen.
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