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Antimicrobial activity in some lichens from south Spain has been studied. Some lichenical substances are also identified. A very hight activity has been observed in lichens with usnic acid.
A case of a 54-year old man with lichen mucosae and Sjögren's syndrome was reported. Clinical and histopathological analysis was made on the presence of sicca features in 6 patients with lichen mucosae. All patients complained either xerophthalmia or xerostomia and 5 out of 6 cases showed specific lymphocytic foci seen in Sjögren's syndrome in addition to lichenoid tissue reaction in the specimen obtained from buccal mucosae. Objective keratoconjunctivitis sicca was demonstrated in 3 cases. Immunologically, abnormal laboratory findings were observed in 5 cases (4 cases with a positive ANA and 3 cases with a positive anti microsome antibody). These findings suggest that lichen mucosae might develop in a close association with Sjögren's syndrome and relationship between these two disease was discussed in this article.
We report on two typical cases of lichen planus and lichen pigmentosus appearing after gold therapy. The characteristics of lichen planus induced by drugs are emphasized, and the literature is reviewed.
Lichen planus is a common disorder affecting the skin, oral and genital epithelium, hair and nails. It is said to account for approximately 1% of new patient referrals to skin clinics (Samman, 1979). It is, therefore, an important entity to the dermatologist. However, lichen planus and lichen-planus-like reactions have been described in a number of clinical situations which may bring them first to the attention of doctors practising in other specialties.
Using a highly sensitive polymerase chain reaction (PCR) technique, based on general GP5+/GP6+ PCR primers covering 34 different human papillomavirus (HPV) types, the presence of HPV DNA was studied in paraffin-embedded penile biopsies from 20 men treated topically with corticosteroids. Clobetasol propionate was applied for 2-16 (mean 7) weeks by 19 men (age 18-73; mean 40) with lichen sclerosus. High-risk HPV was detected prior to therapy in three patients (16%) who lacked clinical or histopathological signs of HPV infection. Following therapy high-risk HPV was detected in biopsies from four men (21%), of whom three also exhibited clinical and/or light microscopic signs of HPV infection. Low-risk HPV DNA was not detected in any of these samples. Four biopsies were collected during a 5-year period from a 51-year-old man who was treated repeatedly with topical mild-moderate potent corticosteroids at intervals of up to 10 weeks for penile erosive lichen planus, followed by nine clinical outbreaks of typical condylomas that consistently showed the presence of low-risk HPV DNA only. These observations indicate that long-lasting topical corticosteroid therapy occasionally may be associated with opportunistic reactivation of a latent high- and low-risk mucosotrophic HPV type infection. The importance of clinical follow-up is underlined.
Lichen sclerosus (LS) and lichen planus (LP) are two conditions frequently affecting genital skin whose clinical and histologic distinction can be difficult. Both diseases can feature solitary genital lesions with bandlike lymphocytic infiltrates. We reviewed 68 cases of vulvar LS to find sections that contained a transition from a lichenoid interface reaction to pathognomonic LS (i.e., marked papillary dermal sclerosis or edema), and in these nine cases we studied routinely and specially stained sections, as well as sections stained with a panel of antisera to lymphoid antigens, and compared the findings with those in six cases of genital LP. We assumed that changes at the periphery of a lesion of LS mirror findings seen in early lesions. The features that we found more commonly in the inflammatory phase of LS included a psoriasiform lichenoid pattern (100% LS, 0% LP), basilar epidermotropism (78% LS, 0% LP), loss of papillary dermal elastic fibers (100% LS, 33% LP), basement membrane thickening (44% LS, 0% LP), and epidermal atrophy (33% LS, 0% LP). Features found more commonly in LP included many cytoid bodies (0% LS, 100% LP), wedge-shaped hypergranulosis (11% LS, 100% LP), basal squamatization (22% LS, 100% LP), and pointed rete ridges (11% LS, 83% LP). We did not detect any significant differences in the immunohistochemical features of the infiltrates. Taken together, these histologic features comprise light microscopic criteria for the diagnosis of early vulvar LS and its differentiation from LP.
A 54-year-old Japanese man with ulcerative lichen planus is reported. He had a painful erythema with ulcers on his soles and nail dystrophy. Mucous involvement was present on his lip. His hairs were intact. Histopathological findings confirmed the diagnosis of lichen planus.
BACKGROUND: Lichen planus (LP) is a mucocutaneous inflammatory dermatosis that frequently involves the oral and genital mucosae. Patients with LP affecting these sites are often seen by oral medicine specialists or gynaecologists who work in isolation and depend heavily on histopathologists to help them in confirming the diagnosis. There are few studies in the literature combining the experiences of these specialists who share the care of patients with both oral and genital LP. OBJECTIVES: To estimate the prevalence of vulval LP (VLP) in a cohort of patients with histologically confirmed oral LP (OLP). METHODS: The study group consisted of 42 women histologically diagnosed with OLP. The mean age was 60.5 years (range 27-81). They underwent genital examination, colposcopy and vulvoscopy. For the histological confirmation of clinical VLP biopsies were performed whenever a clinical lesion was found. Oral and genital biopsy specimens were processed through histological and immunohistochemical staining. Histological diagnoses of LP were made according to the modified World Health Organization histopathological criteria proposed by van der Meij and van der Waal for the diagnosis of OLP, and extended to VLP. Patients with clinical evidence, but without the histological confirmation of OLP and VLP, were excluded from the study group. RESULTS: Thirty-two vulval and one vaginal biopsy specimens were obtained. Histological diagnoses were confirmed in 24 of 32 (75%) patients who underwent a vulval biopsy: these represent 57% (24 of 42) of the study group. Of the 12 patients free of symptoms such as itching, burning and dyspareunia, but with clinical vulval lesions, 11 (92%) had histological confirmation of VLP. Vulval lichen sclerosus was ascertained in five of 32 (16%) cases. CONCLUSIONS: This study showed a 57% prevalence of VLP in selected patients with OLP. The high prevalence of VLP of 92% in the women who were free of vulval symptoms confirmed the usefulness of this careful integrated approach.
A wide variety of cutaneous manifestations have been described in association with Crohn's disease (CD). We describe a patient with a 2-year history of CD who developed both lichen planus (LP) and lichen nitidus (LN) in addition to erythema nodosum (EN) lesions. The clinical course of EN reflected the activity of the bowel disease, whereas LP and LN appeared to persist independently of the ongoing disease activity. Immunohistochemical studies of the infiltrates in these cutaneous and intestinal lesions showed that the majority of the infiltrates were T cells expressing T cell receptor (TCR)-alpha beta. Analyses of TCR V gene expression in these infiltrating T cells demonstrated a different pattern of V beta expression that provides an explanation for the difference in the clinical courses of these lesions. LP and LN lesions are likely to be mediated by T cells with antigen specificity distinct from those that cause EN and intestinal lesions.
Extracts were prepared from lichen planus lesions and from healthy epidermis of normal controls. Their effect on the migration and lymphocyte transformation of autologous leukocytes was studied. On the whole, the ranges of variation and mean values of the autologous leukocyte migration indices obtained in the presence of LP skin extract or sediment from 10 LP patients did not significantly differ from those recorded in the presence of similar extracts prepared from the epidermis of 12 normal controls. Two assays with LP skin sediment antigen and one assay with LP supernatant antigen, however, fell within the range of significant changes in migration. Lymphocyte transformation, as indicated by increased thymidine uptake, was significantly stimulated by LP epidermis in 1 case of 5 LP patients. Extracts from normal epidermis did not affect the transformation of autologous lymphocytes. The phytohemagglutinin response of lymphocytes from LP patients was the same as that of normal controls. The results do not indicate that cell-mediated immunity toward epidermal antigens play any significant role in the etiopathogenesis of lichen planus.
The metal binding properties of a phenolic lichen substance usnic acid (UA) and its acetyl and enamine derivatives 9-O-acetylusnic acid (MAUA), 7,9-di-O-acetylusnic acid (DAUA), Delta(2,11)-enaminousnic acid (EUA), and N-substituted Delta(2,11)-enaminousnic acids have been studied by synthetic and spectroscopic methods, and the structures of copper(II) and palladium(II) complexes have been established by the X-ray diffraction method. Cu(II) reacted with UA and DAUA to give the binary complexes Cu(UA)(2) x H(2)O and Cu(DAUA)(2), respectively, and Cu(bpy) (bpy=2,2'-bipyridine) formed ternary complexes with UA and DAUA. Pd(II) also reacted with UA, DAUA, EUA, and N-substituted Delta(2,11)-enaminousnic acids to give the corresponding binary complexes. All the isolated complexes are insoluble in water and soluble in most organic solvents. They exhibited very strong absorption and circular dichroism spectral peaks in the UV region. The (1)H-NMR spectrum in CDCl(3) of the Pd(II) complex of N-phenyl-Delta(2,11)-enaminousnic acid (PEUA), Pd(PEUA)(2) x C(6)H(6), showed that the C(4)-proton signal suffered a large upfield shift (0.86 ppm) due to the ring current effect of the N-phenyl moiety. X-Ray crystal structure analysis has been performed for Cu(bpy)(UA)(ClO(4)) x CH(3)OH, Pd(MEUA)(2) x C(6)H(6), and Pd(PEUA)(2) x C(6)H(6). Cu(bpy)(UA)(ClO(4)) x CH(3)OH has a square-pyramidal structure with the two nitrogen atoms of bpy and the two oxygen atoms of the mono-deprotonated B ring of UA in the equatorial positions, while Pd(II) binds with two molecules of MEUA or PEUA in the trans configuration through the nitrogen and oxygen atoms with deprotonation. The N-phenyl ring of PEUA in Pd(PEUA)(2).C(6)H(6) was revealed to be located close to the C(4) proton as indicated by (1)H-NMR. Isolation of Cu(2)(bpy)(2)(UA)(NO(3))(2) x 2H(2)O suggests that UA has two metal binding sites that can form polymeric complexes. The present results substantiate the metal binding ability and the structures of the complexes of usnic acid and other substances from lichens as biomonitors of environmental metal ions.
A 39-year-old woman with coexistent lichen planus, lichen sclerosus, and generalized morphea with ulcerations is described. Three additional cases were found in the files of the Mayo Clinic from 1950 to 1983, and these are summarized. Eight cases reviewed in the literature are also summarized. Coexistent lichenoid and sclerodermatous eruptions in graft-versus-host disease after bone marrow transplantation are noted as a model for this combined inflammatory and sclerotic dermatosis.
OBJECTIVES: Oral lichen planus (OLP) is a common mucocutaneous disorder and might be associated to a possible pathogenic relationship with hepatitis C virus (HCV) infection or hypersensitivity to dental alloy. We examined the clinical and immunohistochemical features of OLP associated with HCV infection (OLP-HCV), oral lichenoid contact sensitivity reaction (OLCSR), and idiopathic oral lichen planus (iOLP). The immunohistochemical expressions of CD4, CD8, B cells, Class II major histocompatibility complex antigen (HLA-DR), S-100, HSP60, Proliferating cell nuclear antigen (PCNA) and Ki-67 were compared to study the pathogenic differences of the three OLP groups. MATERIALS AND METHODS: Three groups of OLP patients, (I) OLP-HCV patients (n = 17), (2) OLCSR patients (n = 10) and (3) iOLP patients (n = 14) were retrieved from clinical records and tissues examined immunohistochemically by the avidin-biotin-complex technique. RESULTS: The patients with OLP-HCV showed widespread lesions. The proportion of CD8+ cells was found to be significantly higher in the lamina propria of the OLP-HCV patients and a significantly lower proportion of CD8+ cells of the OLCSR patients was noticed in the epithelium or the connective tissue papillae than in the iOLP patients. There were no significant differences in either the number of CD4+ cells or B cells between the three OLP groups. No significant differences in the number of HLA-DR+ cells were found between the three OLP groups and some OLP-HCV patients showed a significant increase of S-100+ cells in the epithelium compared with iOLP patients. There were no significant differences in either the number of PCNA+ or Ki-67+ cells between the groups. The patients showed similar weak expressions of HSP60 in the three OLP groups. CONCLUSION: The different distributions of the CD8+ cells that could have functionally different roles might be related to the distinct pathogenic mechanisms in the three OLP groups.
The development of lichen amyloidosis in a patient with chronic lichen planus is reported. To our knowledge, this is the first report of the coexistence of these 2 diseases. The disparate response of the 2 conditions to etretinate is discussed.
Tuberculosis verrucosa cutis (TBVC) is a rare form of skin tuberculosis in Western communities, and is generally seen in certain risk groups. A 52-year-old housewife with recalcitrant generalized cutaneous and mucosal lichen planus (LP) of more than a 20-year duration presented with an erythematous-edematous plaque with a warty surface containing deep hemorrhagic fissures and numerous orifices draining purulent material on the back of her left hand. On the basis of clinical, histological and bacteriological findings, TBVC was diagnosed. The patient was successfully treated with isoniazid, rifampicin, ethambutol and pyrazinamide. Interestingly, all lichen lesions improved completely with this therapy. To the best of our knowledge, this is the first documented case of TBVC associated with LP, which was cured by antitubercular polychemotherapy. The case is presented because it reflects a possible reciprocal causal relationship between two cutaneous conditions of different natures.
The linear pattern of lichen planus (LP) is extremely rare. In six publications 1256 patients with LP have been reviewed and only three cases of linear LP (LLP) are reported. The differential diagnosis of LLP includes a number of linear dermatoses in particular lichen striatus (LS) and the extent of overlap between these syndromes remains contentious.
Lichen planus-like keratosis (LPLK) (benign lichenoid keratosis) is a common skin lesion that shows some morphologic features of lichen planus (LP) and lichenoid actinic keratosis (LAK). To try to detect differences among these three entities, immunohistochemical staining for S100 protein and HLA-DR (with the antibody LN3) was performed in 31 cases of LPLK, 26 of LAK, and 25 of LP. Langerhans cells (LC) were counted per linear mm of epidermis in the S100 and LN3 slides. With anti-S100 staining, LP cases showed higher numbers of LC (mean = 25.3, SE = 2.84, median = 21.2) than did LPLK (mean = 17.3, SE = 2.26, median = 14.5) and LAK (mean = 9.7, SE = 1.5, median = 5.4). With LN3 stains, LP cases also showed higher numbers of LC than did LPLK and LAK. These results suggest that the involvement of LC in the production of lesions may be different in these three entities. However, due to the overlap in distribution of values observed, the use of these stains does not allow a definite diagnosis to be made exclusively based on the number of LC.
HLA antigens were examined in patients with erosive oral lichen planus (OLPe), cutaneous lichen planus (CLP), or lichenoid reactions (LR) adjacent to amalgam fillings. The control group had amalgam restorations in contact with the oral mucosa but without any reactions. A strong association was found between HLA-DR3 and OLPe, with an RR value of 21.0 (p less than 0.05). The corresponding values for CLP and LR were 2.3 and 1.5, respectively (NS). The haplotype A1-B8-DR3 was more frequently found in OLPe (p less than 0.05) and CLP (p less than 0.05) than in LR and controls (NS). The data indicate that OLPe, CLP, and LR, which present with virtually the same histopathologic features, are different in their association with HLA-DR3. Moreover, the increased frequency of HLA-DR3 in OLPe suggests an autoimmune component in the pathogenesis of this disorder.