DOCSLIB.ORG

Concise Review of Lichen Planus and Lichenoid Dermatoses

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text

Load more

Resident CoRneR Concise Review of Lichen Planus and Lichenoid Dermatoses Amanda Pickert, MD ichenoid dermatoses are named after lichen, a surface CD95L (FasL) on the CTLs to keratinocyte composite organism consisting of a fungus and CD95 (Fas) to activate apoptosis; (2) CTL and natu- Lphotosynthetic partner engaged in a symbiotic ral killer cell secretion of granzyme B, which enters relationship. In Latin, the word leichen means tree keratinocytes via cell membrane pores from perforin, moss and the word planus means flat. Lichenoid der- leading to apoptosis; and (3) lymphocyte secretion of matoses are a heterogeneous group of diseases with tumor necrosis factor a–inducing matrix metallopro- varying clinical presentations. Immune-mediated teinase 9, which can disrupt the basement membrane basal cell keratinocyte damage is a key finding on zone and promote keratinocyte apoptosis through histology. Herein, I will giveCUTIS a basic overview of deprivation of basement membrane zone–derived cell lichenoid dermatoses with a focus on classic lichen survival signals. Although lichenoid dermatoses have planus (LP) and its variants. Residents should be repeatedly been proposed as contributory, there has familiar with this disease and its variants and should been no conclusive evidence linking LP and LP variants be able to recognize these sometimes overlooked der- to syphilis, human herpesvirus 2, human immunode- matoses that can pose a diagnostic challenge. I will ficiency virus, chronic bladder infections, hepatitis C not be discussing oral (erosive) LP, lichen planopila- virus, Helicobacter pylori, or human papillomavirus.4 ris, andDo nail LP, as these are broadNot topics. However, Copy screening for hepatitis C virus infection is recommended, as case-control studies have shown an Pathophysiology of Lichen Planus association of hepatitis C virus and LP.5 The pathophysiology of LP and LP variants is unclear. However, LP is classified as a cell-mediated immune Lichen Planus reaction perpetuated by activated CD81 cytotoxic The prototypic lichenoid dermatosis of LP often is T lymphocytes (CTLs) and natural killer cells.1 described by the 4 p’s: purple, polygonal, pruritic pap- Although the antigen has yet to be identified, basal ules. Papules are grouped and tend to coalesce. Thin, keratinocyte presentation of an unspecified agent transparent, adherent scales known as Wickham (eg, autoreactive peptide, altered protein, drug reac- striae give lesions a reticulated appearance. The visu- tion, contact allergen, hapten, and viral or infectious alization of Wickham striae can be enhanced with oil agents) on a class I major histocompatibility complex or water and use of a contact dermatoscope, which is molecule is believed to activate a CTL-inciting dis- a helpful clinical pearl. Wickham striae are thought ease.2 The subsequent immune cascade causes effector to correlate with the focal thickening of the stratum CTLs and natural killer cells to accumulate at the granulosum epidermidis, which is appreciated on his- dermoepidermal junction and keratinocyte apoptosis tology.6 Spots usually start as erythematous macules (Civatte bodies).3 The immune system can cause that evolve to the characteristic purplish papules over keratinocyte apoptosis via several mechanisms: several weeks’ duration. Initial lesions are symmetric; (1) the caspase cascade, which requires the binding of more commonly present on the lower extremities than the upper extremities; and favor the flexural From Mayo Clinic Arizona, Scottsdale. areas of the wrists, arms, and legs. In approximately The author reports no conflict of interest. one-third of cases, generalization can occur within a WWW.CUTIS.COM VOLUME 90, SEPTEMBER 2012 E1 Copyright Cutis 2012. No part of this publication may be reproduced, stored, or transmitted without the prior written permission of the Publisher. Resident Corner few months of the initial outbreak.6 Spots usually heal regions. Patients also may have classic LP at other with hyperpigmentation. The duration of LP is vari- anatomic locations. Hyperpigmented macules and able but oral (erosive), hypertrophic, and nail vari- patches usually are present on clinical presentation. ants of LP tend to be more recalcitrant. Ulcerative Histopathology can show evidence of epidermal atro- lesions usually present on the mucous membranes, phy and pigment incontinence. glans penis, and vulva. Oral (erosive) LP, anogenital LP, and vulvovaginal LP are special forms of LP. Atro- Hypertrophic LP phic LP is common on the lower extremities and may Hypertrophic LP most commonly presents on the represent a resolving phase of LP. extremities (eg, shins). The disease is extremely pruritic and is associated with chronic venous insuf- Familial LP ficiency. Hypertrophic LP often is confused both There are fewer than 200 cases of familial LP reported clinically and histologically with squamous cell carci- in the literature.7-9 Oftentimes this disease is more noma. The clinical course of hypertrophic LP is more severe and protracted and presents with erosive, lin- chronic than other LP variants. ear, or ulcerative patterns, usually affecting several family members. Familial LP has been associated Vesiculobullous LP with HLA-B7, HLA-A3, HLA-B18, and HLA-Cw8, Vesiculobullous LP is a rare variant of LP. It pres- though there have been mixed results.7-9 The exis- ents with vesicles or bullae within lesions caused by tence of familial LP has purported to support the intense inflammation, and it is the clinical equivalent hypothesis that genetic factors are of etiologic impor- of Max-Joseph spaces, which is a subepidermal cleft tance in LP. formed by acantholysis or hydropic degeneration of basal keratinocytes on histology.6 Vesiculobullous Lichen Nitidus LP should not arise from healthy-appearing skin and Lichen nitidus has a predilection for children and must be differentiated from LP pemphigoides, an usually presents in the upper extremities, chest, LP-pemphigoid overlap syndrome. abdomen, and male genitalia.6 Lichen nitidus has its own unique picturesque histology,CUTIS often described as Lichen Planus Pigmentosus ball-and-claw pattern. Generalized lichen nitidus is Lichen planus pigmentosus most commonly occurs rare and has been reported in association with genetic in individuals with Fitzpatrick skin types III and syndromes, such as Down syndrome.10 IV. Usual presentation includes brown to gray mac- ules in sun-exposed areas of the face and neck with Lichen Striatus subsequent generalization and potential involve- Lichen striatus is described as a benign self-limited ment of intertriginous areas. Both histologically and dermatosis,Do primarily affecting Not adolescent children. clinically, Copy LP pigmentosus often appears similar to Classically, it arises suddenly as crops of pink-tan erythema dyschromicum perstans (ashy dermatosis); papules often on the extremities and along the lines however, the former may be differentiated by its pre- of Blaschko.6 Digital involvement may be associated dilection for sun-exposed skin, intertriginous areas, with a nail dystrophy. A deep perivascular and periec- and older age of onset (40–50 years).6 crine infiltrate with granulomatous inflammation on histology is not uncommon. Actinic LP Actinic LP also is referred to as LP subtropicus, LP Annular LP tropicus, summertime actinic lichenoid eruption, Annular LP is a rarely reported variant of LP seen in LP actinicus, LP atrophicus annularis, and lichenoid approximately 10% of cases.6 There often is an arcu- melanodermatitis. This variant of LP is more com- ate grouping of papules or rings with central clearing mon in the Middle East and most commonly occurs and hyperpigmentation. This dermatosis more com- in young adults in the spring and summer months. monly presents in darker skin types and on the penis It presents as hyperpigmented to red-brown papules and/or scrotum. I have seen several pediatric patients with an annular configuration and develops on sun- with generalized dramatic disease. Postinflammatory exposed surfaces including the face, dorsal hands, and hyperpigmentation can be notable and is difficult arms.6 The clinical differential diagnosis may be simi- to treat. lar to melasma. I have never seen a case of actinic LP. Inverse LP Lichenoid Drug Eruptions Inverse LP is a clinical variant of LP with lesions There can be a long latency between drug initiation appearing in the axillae, groin, and inframammary and drug eruption involving the onset of a lichenoid E2 CUTIS® WWW.CUTIS.COM Copyright Cutis 2012. No part of this publication may be reproduced, stored, or transmitted without the prior written permission of the Publisher. Resident Corner drug eruption. Halevy and Shai11 reported an average RANTES/CCL5 and IP-10/CXCL10 in their cytolytic latency period of up to 12 months. Additionally, the granules: a potential self-recruiting mechanism. Am J eruption may appear similar to LP; however, there Pathol. 2003;163:261-268. are key differences between the 2 variants. In classic 2. Sugerman PB, Savage NW, Walsh LJ, et al. The patho- LP, generalized or photodistributed sites are spared. genesis of oral lichen planus. Crit Rev Oral Biol Med. In lichenoid drug eruptions, Wickham striae are not 2002;13:350-365. present, there are larger monomorphic lesions with 3. Prpi´c Massari L, Kastelan M, Gruber F, et al. Perforin a psoriasiform appearance, and desquamation with expression in peripheral blood lymphocytes and skin- crusting is present. The presence of eosinophils, infiltrating cells
Recommended publications
  • Pediatrics-EOR-Outline.Pdf

    Pediatrics-EOR-Outline.Pdf

    DERMATOLOGY – 15% Acne Vulgaris Inflammatory skin condition assoc. with papules & pustules involving pilosebaceous units Pathophysiology: • 4 main factors – follicular hyperkeratinization with plugging of sebaceous ducts, increased sebum production, Propionibacterium acnes overgrowth within follicles, & inflammatory response • Hormonal activation of pilosebaceous glands which may cause cyclic flares that coincide with menstruation Clinical Manifestations: • In areas with increased sebaceous glands (face, back, chest, upper arms) • Stage I: Comedones: small, inflammatory bumps from clogged pores - Open comedones (blackheads): incomplete blockage - Closed comedones (whiteheads): complete blockage • Stage II: Inflammatory: papules or pustules surrounded by inflammation • Stage III: Nodular or cystic acne: heals with scarring Differential Diagnosis: • Differentiate from rosacea which has no comedones** • Perioral dermatitis based on perioral and periorbital location • CS-induced acne lacks comedones and pustules are in same stage of development Diagnosis: • Mild: comedones, small amounts of papules &/or pustules • Moderate: comedones, larger amounts of papules &/or pustules • Severe: nodular (>5mm) or cystic Management: • Mild: topical – azelaic acid, salicylic acid, benzoyl peroxide, retinoids, Tretinoin topical (Retin A) or topical antibiotics [Clindamycin or Erythromycin with Benzoyl peroxide] • Moderate: above + oral antibiotics [Minocycline 50mg PO qd or Doxycycline 100 mg PO qd], spironolactone • Severe (refractory nodular acne): oral
  • Hyperkeratotic and Hypertrophic Lichen Nitidus

    Hyperkeratotic and Hypertrophic Lichen Nitidus

    Volume 23 Number 10 | October 2017 Dermatology Online Journal || Case Presentation 23 (10): 15 Hyperkeratotic and hypertrophic lichen nitidus Jonathan D Ho1,2 MBBS DSc Dip.Dermpath, Ali Al-Haseni1 MD MSC, Michael T Rosenbaum1 MD, Lynne J Goldberg1,2 MD Affiliations:1 Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts 2Section of Dermatopathology, Boston University School of Medicine, Boston, Massachusetts Corresponding Author: Ali Al-Haseni MD, 609 Albany Street, Boston MA 02118, Email: [email protected] Abstract interphalangeal joints of the fingers on both hands (Figure 1A). Biopsy demonstrated marked Lichen nitidus typically presents as shiny pin- orthokeratosis, hypergranulosis, and lichen simplex head sized papules on the trunk and extremities, chronicus-like irregular epidermal hyperplasia. A often affecting children and young adults. In this multifocal lichenoid lymphohistiocytic infiltrate prototypical form, it rarely presents a diagnostic expanding one or two dermal papillae with overlying challenge being characterized by distinctive clinical parakeratosis, associated focal hypogranulosis, and and histopathologic findings. We describe a rare occasional individually necrotic keratinocytes were variant of lichen nitidus, which we term “hyperkeratotic noted (Figure 2). These findings were diagnostic and hypertrophic lichen nitidus.” of lichen nitidus. Unusually, the histopathologic and clinically correlated epidermal changes were Keywords: lichen nitidus, hyperkeratosis, somewhat exuberant
  • ORIGINAL ARTICLE a Clinical and Histopathological Study of Lichenoid Eruption of Skin in Two Tertiary Care Hospitals of Dhaka

    ORIGINAL ARTICLE a Clinical and Histopathological Study of Lichenoid Eruption of Skin in Two Tertiary Care Hospitals of Dhaka

    ORIGINAL ARTICLE A Clinical and Histopathological study of Lichenoid Eruption of Skin in Two Tertiary Care Hospitals of Dhaka. Khaled A1, Banu SG 2, Kamal M 3, Manzoor J 4, Nasir TA 5 Introduction studies from other countries. Skin diseases manifested by lichenoid eruption, With this background, this present study was is common in our country. Patients usually undertaken to know the clinical and attend the skin disease clinic in advanced stage histopathological pattern of lichenoid eruption, of disease because of improper treatment due to age and sex distribution of the diseases and to difficulties in differentiation of myriads of well assess the clinical diagnostic accuracy by established diseases which present as lichenoid histopathology. eruption. When we call a clinical eruption lichenoid, we Materials and Method usually mean it resembles lichen planus1, the A total of 134 cases were included in this study prototype of this group of disease. The term and these cases were collected from lichenoid used clinically to describe a flat Bangabandhu Sheikh Mujib Medical University topped, shiny papular eruption resembling 2 (Jan 2003 to Feb 2005) and Apollo Hospitals lichen planus. Histopathologically these Dhaka (Oct 2006 to May 2008), both of these are diseases show lichenoid tissue reaction. The large tertiary care hospitals in Dhaka. Biopsy lichenoid tissue reaction is characterized by specimen from patients of all age group having epidermal basal cell damage that is intimately lichenoid eruption was included in this study. associated with massive infiltration of T cells in 3 Detailed clinical history including age, sex, upper dermis. distribution of lesions, presence of itching, The spectrum of clinical diseases related to exacerbating factors, drug history, family history lichenoid tissue reaction is wider and usually and any systemic manifestation were noted.
  • Down's Syndrome with Lichen Nitidus and Segmental Vitiligo

    Down's Syndrome with Lichen Nitidus and Segmental Vitiligo

    Letters to the Editor and liver manifestations. Retinoids are useful in the and pitryiasis rubra pilaris. We describe a four-year- treatment of skin and muscle manifestations.[2] old girl with Down’s syndrome, with segmental vitiligo and lichen nitidus. Tzanck smear may provide important information in a patient with suspected DCS. A four-year-old female child with Down’s syndrome [Figure 1] presented to us with white patches on the MMuraturat DDurdu,urdu, FFahrettinahrettin AAkaykay1, TTevevÞ k AAlperlper2, right waist and inguinal area for the last one month. SSerkanerkan YYaaşaarr ÇÇelikelik3 She also had asymptomatic papules on the legs for Başkent University Faculty of Medicine, Department of Dermatology, the same duration. She did not have any systemic Adana Hospital, Adana/Turkey, Department of 1Ophthalmology, complaints. On examination, she had segmental vitiligo 2Internal Medicine, 3Pathology, Diyarbakõr Military Hospital, [Figure 2] on the right waist. The vitiliginous macule Diyarbakõr, Turkey had an irregular border and leucotrichia. She also had AAddressddress fforor ccorrespondenceorrespondence: Dr. Murat Durdu, multiple, discrete, flat, round, smooth, skin-colored- Başkent University Faculty of Medicine, to-slightly pink papules of 1 to 2 mm size, distributed Department of Dermatology, Adana Hospital, 01250, symmetrically over the extensors of both the legs and Adana/Turkey. E-mail: [email protected] thighs [Figure 3]. The rest of the skin, hair, and nails DOI: 10.4103/0378-6323.57737 - PMID: 19915256 were normal. Manifestations of Down’s Syndrome RREFERENCESEFERENCES in our case were hypertelorism, depressed nose, epicanthal folds, high-arched palate, flat occiput, low- 1. Ben Selma Z, Yilmaz S, Schischmanoff PO, Blom A, Ozogul C, set ears, hypotonia, sandle toe, flat feet, clinodactyly, Laroche L, et al.
  • Immunologic Adverse Reactions of Β-Blockers and the Skin (Review)

    Immunologic Adverse Reactions of Β-Blockers and the Skin (Review)

    EXPERIMENTAL AND THERAPEUTIC MEDICINE 18: 955-959, 2019 Immunologic adverse reactions of β-blockers and the skin (Review) ALIN LAURENTIU TATU1, ALINA MIHAELA ELISEI1, VALENTIN CHIONCEL2, MAGDALENA MIULESCU3 and LAWRENCE CHUKWUDI NWABUDIKE4 1Medical and Pharmaceutical Research Unit/Competitive, Interdisciplinary Research Integrated Platform ‘Dunărea de Jos’, ReForm-UDJG; Research Centre in the Field of Medical and Pharmaceutical Sciences, Faculty of Medicine and Pharmacy, Department of Pharmaceutical Sciences, ‘Dunărea de Jos’ University of Galați, 800010 Galati; 2Department of Cardio-Thoracic Pathology, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Phamacy, 050474 Bucharest; 3Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos University’ of Galati, 800010 Galati; 4Department of Diabetic Foot Care, ‘Prof. N. Paulescu’ National Institute of Diabetes, 011233 Bucharest, Romania Received September 11, 2018; Accepted November 16, 2018 DOI: 10.3892/etm.2019.7504 Abstract. β-Blockers are a widely utilised class of medica- use, as well as possible therapeutic approaches to these. This tion. They have been in use for a variety of systemic disorders short review will focus on those dermatoses resulting from including hypertension, heart failure and intention tremors. β-blocker use, which have an immunologic basis. Their use in dermatology has garnered growing interest with the discovery of their therapeutic effects in the treatment of haemangiomas, their potential positive effects in wound Contents healing, Kaposi sarcoma, melanoma and pyogenic granuloma, and, more recently, pemphigus. Since β-blockers are deployed 1. Introduction in a variety of disorders, which have cutaneous co-morbidities 2. Cutaneous side - effects of β-blockers such as psoriasis, their pertinence to dermatologists cannot be 3.
  • Simultaneous Occurrence of Lichen Nitidus and Morphea

    Simultaneous Occurrence of Lichen Nitidus and Morphea

    Yonago Acta Medica 2021;**(*):***–*** doi: 10.33160/yam.2021.05.006 Patient Report Simultaneous Occurrence of Lichen Nitidus and Morphea Yuko Ehara,* Yuichi Yoshida,* Kazunari Sugita* and Osamu Yamamoto* *Division of Dermatology, Department of Medicine of Sensory and Motor Organs, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan ABSTRACT plaques (Fig. 1b). Dermoscopically, the papules were Lichen nitidus and morphea are common diseases, but shown to be well-defined circular hypopigmented an associated localization of both lesions is rare. Here, structures (Fig. 1c). Clinical differential diagnosis we describe the first case of lesions distributed along included atrophoderma, morphea and ashy dermatosis. Blaschko’s lines. A 24-year-old Japanese woman was Histopathologically, there was sclerosis in the lower referred to our clinic for evaluation of band-like plaques half of the dermis (Fig. 1d) and perivascular lympho- of 18-months history on the right lateral side of her ab- plasmacytic infiltration near the eccrine glands (Fig. domen. In addition, multiple milky-white papules were 1e). In addition, we observed well-circumscribed, seen within the plaques. Histopathological examination dense, papillary dermal lymphohistiocytic aggregations showed there was sclerosis in the lower half of the showing a so-called”claw clutching a ball”pattern (Fig. dermis and well-circumscribed, dense, papillary dermal 1f). Immunohistochemically, these aggregations were lymphohistiocytic aggregations showing a so-called mainly composed of CD4+ and CD8+ lymphocytes and “claw clutching a ball.” Immunohistochemical analysis some CD68+ cells (Figs. 1g, h, and i). In addition, the revealed that the morphea and lichen nitidus had similar aggregations also contained S-100 protein+ and CD1a+ characteristics.
  • Linear Lichen Planus: Two Case Reports

    Linear Lichen Planus: Two Case Reports

    ANATOL J FAMILY MED Case Report The Anatolian Journal of Family Medicine DOI: 10.5505/anatoljfm.2018.25633 Anatol J Family Med 2019;2(1):41–4 Linear Lichen Planus: Two Case Reports Gülhan Gürel,1 Sevinç Şahin,2 Emine Çölgeçen1 1Department of Dermatology, Bozok University School of Medicine, Yozgat, Turkey 2Department of Pathology, Bozok University School of Medicine, Yozgat, Turkey ABSTRACT Lichen planus (LP) is an idiopathic inflammatory skin disease which affects the skin, mucosa, nails, and hairs of middle-aged individuals. Linear lichen planus (LLP) is a rare variant of LP characterized by pruritic, lichenoid appearance, violaceous-color papules in a linear pattern. About 0.24 to 0.62% of patients with LP have been reported to have LLP. In cases with LP, linear lesions can be post-traumatically seen as widespread generalized eruptions (Koebner phenomenon) and as zosteriforms on herpes infection as the Wolf’s isotopic response. However, LLP indicates the presence of spontaneous LLP lesions which follow Blaschko’s lines without any previous association with trauma or herpes infection. Herein, we present two cases with LLP and emphasize the rarity of these cases and the importance of linear lesions in the differential diagnosis. Keywords: Dermatosis, lichen planus, skin diseases INTRODUCTION Lichen planus (LP) was first described in 1869 by Erasmus Wilson.[1] It is mostly seen in adults aged 30 to 60 years and affects 0.14 to 0.8% of the population. LP is classified according to the location, distribution, and morphology of the lesion and nearly 20 clinical forms have been described as eruptive, localized, annular, linear, hypertrophic, nodular, atrophic, bullous, ero- Please cite this article as: [2] Gürel G, Şahin S, Çölgeçen E.
  • A ABCD, 19, 142, 152 ABCDE, 19, 142 Abramowitz Sign, 3, 5

    A ABCD, 19, 142, 152 ABCDE, 19, 142 Abramowitz Sign, 3, 5

    Index A Atopic dermatitis, 2, 18, 19, 20, 30, ABCD, 19, 142, 152 61, 81, 82, 84, 86, 99 ABCDE, 19, 142 Atrophie blanche, 173, 177 Abramowitz sign, 3, 5 Atrophy, crinkling, 143, 160 Acanthosis nigricans, 105, 106, 132 Atypical nevus, 144, 145, 163, 164 Addison disease (primary adrenal eclipse, 144, 164 insufficiency), 137 ugly duckling, 144, 163 Albright (McCune–Albright Auspitz sign, 3, 5, 6, 18, 104 syndrome), 83, 93 All in different stages, 33, 34, 40 All in same stage, 33, 34, 38 B Alopecia, 57, 77, 94, 105, 106, 111, Bamboo hair, 84, 99, 171, 172 117, 119, 127, 133, 171, 172, Basal cell carcinoma, 17, 104, 140, 182, 184 151, 162, 170 Alopecia areata, 105, 106, 127, 171 Bioterrorism, 33, 38 Amyloid, 107, 119 Black dot (tinea capitis), 37, 57 Angiofibroma, 89 Blue angel (see Tumors, painful) Angiokeratoma, 3, 79, 81, 85 Blue rubber bleb nevus, 144, Angiolipoma, 142, 155 154, 168 Angioma, spider, 107, 109, 134 angiolipioma, 142, 155 Angiomatosis, leptomeningeal, 90 neurilemmoma, 142, 156 Anticoagulant, lupus, 108, 121 glomus tumor, 142, 157 Antiphospholipid syndrome eccrine spiradenoma, 142, 158 (APLS), 19, 107, 108, 121 leiomyoma, 142, 159 Apocrine hidrocystoma, 144, Blue cyst (apocrine hidrocystoma), 166, 168 144, 166, 168 Apple jelly, 36, 37, 47 Blue nose (purpura fulminans), 19, Ash leaf macule (confetti macule), 108, 122 82, 89 Blue papule (blue nevus), 1, 144, Asymmetry, 19, 118, 136, 152 166, 167, 168 187 188 Index Blue rubber bleb nevus, 144, 154, 168 Coast of California, 82, 83, 91 Border Coast of Maine, 83, 93 irregular, 83,
  • Lesions' Pattern Helps Line up Diagnosis

    Lesions' Pattern Helps Line up Diagnosis

    DERMADIAGNOSIS Lesions’ Pattern Helps Line Up Diagnosis ix months ago, a 6-year-old records provided by his primary boy developed asymptom- care provider’s office. Satic lesions on his elbows, The lesions are particularly then his knees. They slowly spread numerous over the extensor sur- to other areas, including his fore- faces of the legs—especially the arms. One primary care provider knees—but are also seen on the diagnosed probable warts; an- extensor forearms and elbows. other, molluscum. The prescribed The lesions are exquisitely dis- treatments—liquid nitrogen and crete, identical, tiny white pin- tretinoin, respectively—had no point papules, all with flat tops. effect. None are umbilicated. In several The boy’s mother became areas of the arms, linear collec- alarmed when the lesions started tions of lesions, some extending to form in long lines on his arms. as long as 6 cm, are noted. The At that point, she decided to bring rest of his exposed type V skin is him to dermatology for evalua- unremarkable. tion. Aside from his skin condi- The most likely diagnostic ex- tion, the child is healthy, accord- planation for these lesions is ing to both his mother and the a) Molluscum contagiosum b) Lichen nitidus Joe R. Monroe, c) Warts MPAS, PA, practices d) Lichen planus at Dawkins Dermatology Clinic in Oklahoma City. ANSWER He is also the The correct answer is lichen niti- founder of the dus (choice “b”), a harmless, self- Society of Dermatology limited condition of unknown Physician Assistants. origin. The lesions’ flat-topped 10 Clinician Reviews • FEBRUARY 2015 clinicianreviews.com (planar) surfaces and tendency best way to highlight it is with ent in this manner are psoriasis, to form in linear configurations a short blast of liquid nitrogen.
  • Imatinib-Induced Lichenoid Eruption: a Case Report and a Review of Literature

    Imatinib-Induced Lichenoid Eruption: a Case Report and a Review of Literature

    Vol.33 No.4 Case report 329 Imatinib-induced lichenoid eruption: A case report and a review of literature. Thiraphong Mekwilaiphan MD, Natta Rajatanavin MD. ABSTRACT: MEKWILAIPHAN T, RAJATANAVIN N. IMATINIB-INDUCED LICHENOID ERUPTION: A CASE REPORT AND A REVIEW OF LITERATURE. THAI J DERMATOL 2017;33: 329-335. DIVISION OF DERMATOLOGY, DEPARTMENT OF MEDICINE, FACULTY OF MEDICINE, RAMATHIBODI HOSPITAL, MAHIDOL UNIVERSITY, BANGKOK, THAILAND. Imatinib is the first generation tyrosine kinase inhibitor which consisted of bcr-abl, c-kit, and platelet-derived growth factor receptors (PDGFRs). Its tolerability in the treatment of malignancies is higher than the conventional chemotherapy. However, various adverse cutaneous reactions are the most common side effect of imatinib. Nevertheless, lichenoid eruption is an uncommon cutaneous reaction from imatinib. The clinical manifestation is violaceous, flat-topped papules or plaques involving mainly trunk and extremities. Oral and genital mucosal involvement is a distinctive feature. There were no specific histopathological findings, but usually not a typical characteristic of lichen planus. Due to high prevalence of cutaneous rash, the pathogenesis may be related to pharmacological effect than hypersensitivity reaction. Dosage decrement of imatinib is a choice of treatment, or switch to the second or third generation tyrosine kinase inhibitors. Acitretin was successfully used to treat imatinib-induced lichenoid eruption in our patient and enabling the continuation of the high imatinib dosage for her hematologic malignancy. Key words: Imatinib, lichenoid eruption, tyrosine kinase inhibitor From: Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University Corresponding author: Thiraphong Mekwilaiphan MD., email: [email protected] 330 Mekwilaiphan T et al Thai J Dermatol, October-December, 2017 บทคัดยอ: ธีรพงษ เมฆวิไลพันธุ, ณัฏฐา รัชตะนาวิน รายงานการเกิดผื่นชนิดไลเคนนอยด ในผูปวยที่ไดรับยาอิมมาทินิบ และ การทบทวนวรรณกรรม วารสารโรคผิวหนัง 2560; 33: 329-335.
  • Dermatological Indications of Disease - Part II This Patient on Dialysis Is Showing: A

    Dermatological Indications of Disease - Part II This Patient on Dialysis Is Showing: A

    “Cutaneous Manifestations of Disease” ACOI - Las Vegas FR Darrow, DO, MACOI Burrell College of Osteopathic Medicine This 56 year old man has a history of headaches, jaw claudication and recent onset of blindness in his left eye. Sed rate is 110. He has: A. Ergot poisoning. B. Cholesterol emboli. C. Temporal arteritis. D. Scleroderma. E. Mucormycosis. Varicella associated. GCA complex = Cranial arteritis; Aortic arch syndrome; Fever/wasting syndrome (FUO); Polymyalgia rheumatica. This patient missed his vaccine due at age: A. 45 B. 50 C. 55 D. 60 E. 65 He must see a (an): A. neurologist. B. opthalmologist. C. cardiologist. D. gastroenterologist. E. surgeon. Medscape This 60 y/o male patient would most likely have which of the following as a pathogen? A. Pseudomonas B. Group B streptococcus* C. Listeria D. Pneumococcus E. Staphylococcus epidermidis This skin condition, erysipelas, may rarely lead to septicemia, thrombophlebitis, septic arthritis, osteomyelitis, and endocarditis. Involves the lymphatics with scarring and chronic lymphedema. *more likely pyogenes/beta hemolytic Streptococcus This patient is susceptible to: A. psoriasis. B. rheumatic fever. C. vasculitis. D. Celiac disease E. membranoproliferative glomerulonephritis. Also susceptible to PSGN and scarlet fever and reactive arthritis. Culture if MRSA suspected. This patient has antithyroid antibodies. This is: • A. alopecia areata. • B. psoriasis. • C. tinea. • D. lichen planus. • E. syphilis. Search for Hashimoto’s or Addison’s or other B8, Q2, Q3, DRB1, DR3, DR4, DR8 diseases. This patient who works in the electronics industry presents with paresthesias, abdominal pain, fingernail changes, and the below findings. He may well have poisoning from : A. lead. B.
  • The Lichenoid Reaction Pattern M Ramaml, Asha Kubba'?

    The Lichenoid Reaction Pattern M Ramaml, Asha Kubba'?

    The lichenoid reaction Pattern M Ramaml, Asha Kubba'? Sri Lanka lournal of Dermatology, 2002, 6,20-26 There is some confusion about the origin of the It is easier to bring these diverse conditions term lichen to describe skin diseases but it appears to together based on the histopathological appearance. characteristic of lichenoid have been a popular name for many conditions. An Histologically, the defining cell damage2-3. The damage impressive list of dermatoses that begin with the term tissue reactions is basal or liquefactive degeneration, Iichen or lichenoid could be colled from the index of a occurs by apoptosis processes that appear to be mediated by different major textbook (Table 1)1. It is difficult to conceive of a pathogenetic mechanisms. Apoptosis, a special type way to unify atl these conditions but there are some of single cell death, consists of the condensation features that some of these diseases share. These fea- of single cells followed by active budding and tures are also shared by diseases that do not have fragmentationa. Unlike necrosis, cell membranes and lichen in their names. Briefly, the common clinical organelles remain intact till late in the apoptosis. On denominator is the presence of small papules, purple light microscopy, apoPtotic keratinocytes appear as and histologically, damage to the or skin coloured, pink, shrunken globules (known as Civatte bodies) basal keratinocytes. which may show pyknotic nuclear remnants. The Civatte bodies may be phagocytosed by other keratinocytes and macrophages or may drop down into the papillary dermis as colloid bodies. Liquefac- Table 1. tive degeneration leads to keratinocyte damage by the Lichen amyloidosus accumulation of fluid within basal cells.