An unusual variant of lupus erythematosus or lichen planus
TL;DR: Clinically, patients with a similar eruption of distinct livid plaques were difficult to diagnose as either lichen planus or lupus erythematosus, but certain laboratory findings and the clinical course were suggestive of lupu ery thematicus.
Abstract: Summary
Four patients with a similar eruption of distinct livid plaques are presented. Clinically, the lesions were difficult to diagnose as either lichen planus or lupus erythematosus. However, histological studies with standard and immunofluorescence staining methods were more consistent with lichen planus. In contrast, certain laboratory findings and the clinical course were suggestive of lupus erythematosus.
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TL;DR: Based on the observed increased risk of malignant development, OLP patients should be offered regular follow-up examination from two to four times annually and asked to report any changes in their lesions and/or symptoms.
Abstract: Lichen planus (LP) is a relatively common disorder of the stratified squamous epithelia, which is, in many ways, an enigma. This paper is the consensus outcome of a workshop held in Switzerland in 1995, involving a selection of clinicians and scientists with an interest in the condition and its management. The oral (OLP) eruptions usually have a distinct clinical morphology and characteristic distribution, but OLP may also present a confusing array of patterns and forms, and other disorders may clinically simulate OLP. Lesions may affect other mucosae and/or skin. Lichen planus is probably of multifactorial origin, sometimes induced by drugs or dental materials, often idiopathic, and with an immunopathogenesis involving T-cells in particular. The etiopathogenesis appears to be complex, with interactions between and among genetic, environmental, and lifestyle factors, but much has now been clarified about the mechanisms involved, and interesting new associations, such as with liver disease, have emerged. T...
515 citations
TL;DR: Of the many immunological changes described in LP several may be epiphenomena although a cell-mediated immune response to unidentified antigens or antigenic changes clearly is involved.
Abstract: Lichen planus (LP) is a common oral disorder which may represent the manifestation of a mucosal reaction to a variety of aetiological factors. Of the many immunological changes described in LP several may be epiphenomena although a cell-mediated immune response to unidentified antigens or antigenic changes clearly is involved. Associations with drugs or systemic disorders are well-defined in some patients but may, in others, be aleatoric. Finally, the prognosis of oral LP not only differs from that of cutaneous LP but there is little doubt that in a few instances LP is a premalignant condition.
406 citations
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130 citations
TL;DR: A 43‐year‐old white man presented with a generalized eruption of lichen planus and tense blisters within the lichenoid lesions and also on clinically normal skin, which may indicate a possible link between the pathology in the junctional zone in lichenPlanus and the appearance of antibasement membrane zone antibodies and bullous lesions.
Abstract: A 43-year-old white man presented with a generalized eruption of lichen planus and tense blisters within the lichenoid lesions and also on clinically normal skin. Direct immunofluorescence (IF) studies revealed immunological and histopathological characteristics of lichen planus in the lichenoid lesions and of bullous pemphigoid in the bullous lesions, and indirect IF studies showed that the patient had circulating antibasement membrane antibodies. The coexistence of both disorders may indicate a possible link between the pathology in the junctional zone in lichen planus and the appearance of antibasement membrane zone antibodies and bullous lesions, respectively.
114 citations
TL;DR: In the present immunofluorescence study, the occurrence of fibrin or related substances and of IgM in the upper part of the dermis in all forty lichen planus lesions examined is reported.
Abstract: SUMMARY
In the present immunofluorescence study we report the occurrence of fibrin or related substances and of IgM in the upper part of the dermis in all forty lichen planus lesions examined. Different amounts of various complement components and fragments were located in the epidermal basement zone, and in the colloid bodies. IgG, IgM, IgA and fibrin were also found in the colloid bodies, sometimes together with albumin.
The earliest pathological change, which was seen in perilesional skin and in clinically normal skin from sites of predilection, was the presence of colloid bodies and pigment containing macrophages in the upper dermis. Deposition of fibrin appeared to be another early sign, as it was discernible in areas devoid of inflammatory infiltrate. The possible significance of these findings is discussed.
110 citations