1/22. Nodular tuberculid: a report of four patients.The tuberculids are hypersensitivity reactions to mycobacterium tuberculosis (MTB) and include papulonecrotic tuberculid (PNT), lichen scrofulosorum, erythema induratum of Bazin (EIB), and phlebitic tuberculid. Papulonecrotic tuberculid displays papulonecrotic lesions mostly on the extensor surfaces of the limbs. Histopathology shows necrosis, granulomatous inflammation (GI), and occasionally vasculitis, usually in the superficial dermis. erythema induratum of Bazin shows nodulo-ulcerative lesions on the posterior aspect of the legs. Histopathology reveals a septolobular panniculitis, necrosis, GI, and vasculitis. The Mantoux test is strongly positive and associated tuberculosis (TB) may be present in both conditions. MTB cannot be demonstrated with a Ziehl-Neelsen (ZN) stain or cultured. The polymerase chain reaction has demonstrated MTB dna in PNT (50%) and EIB (25%). The tuberculids respond to full anti-TB treatment. We document four patients with nodules on the legs in whom the pathologic changes were situated in the deep dermis and adjacent subcutaneous fat. Nodular tuberculid (NT) is regarded as a suitable term for these lesions. All patients were female. Their ages were 19 months, 12 years, 17 years, and 5 years. All patients presented with nodules on the limbs. These nodules were approximately 1 cm in diameter, dull red or bluish-red, and nontender. Ulceration was not present. The number of nodules varied from a few to many. The Mantoux test was strongly positive in all the patients. Associated pulmonary TB was present in two patients. Histopathology showed GI (n = 4), vasculitis (n = 2), and coagulative necrosis (n = 2). A ZN stain was negative in each case. All patients received anti-TB treatment for 6 months [rifampicin (n = 4), isoniazid (n = 4), pyrazinamide (n = 4), and ethambutol (n = 2)]. At 12 months follow-up, skin and pulmonary lesions had resolved in all. Nodular tuberculid should be distinguished from arthropod bites and papular urticaria, dermal erythema multiforme, evolving vasculitis, evolving folliculitis, and erythema nodosum. Histopathologically NT should be distinguished from other causes of granulomatous vasculitis and GI with or without necrosis. In children with nodules on the limbs unresponsive to routine treatment, skin biopsy should be done to exclude NT. Nodular tuberculid represents a hybrid between PNT and EIB with characteristic clinicopathologic features and should be included in the classification of cutaneous TB.- - - - - - - - - - ranking = 1keywords = lichen (Clic here for more details about this article) |
2/22. Generalized lichen amyloidosis associated with chronic lichen planus.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.- - - - - - - - - - ranking = 10keywords = lichen (Clic here for more details about this article) |
3/22. Acral pityriasis lichenoides.Two patients presented with acrally located papulosquamous lesions that were polymorphic and had an identical morphology to those of pityriasis lichenoides. The lesions remained localized to the feet and ankles for years. Multiple skin biopsies had the histopathological features of pityriasis lichenoides. In one biopsy syringotropic lymphocytes and early syringolymphoid hyperplasia were observed. This rare variant of pityriasis lichenoides may be under-recognized and misdiagnosed as it resembles a variety of papulosquamous disorders particularly psoriasis.- - - - - - - - - - ranking = 7keywords = lichen (Clic here for more details about this article) |
4/22. Purpuric generalized lichen nitidus: an unusual eruption simulating pigmented purpuric dermatosis.BACKGROUND: Generalized haemorrhagic lichen nitidus is rare. To our knowledge, this form of presentation has only been reported once. OBJECTIVE: To describe a new case of generalized haemorrhagic lichen nitidus simulating a pigmented purpuric dermatosis. methods AND RESULTS: We document a 24-year-old man who presented with an 8-month history of a progressive non-pruritic, red-brown papular eruption on the dorsa of the feet, ankles and distal third of the legs. A diagnosis of Schamberg's progressive pigmentary dermatosis was made, and no treatment was prescribed. Two months later, the lesions had extended to the abdomen, groins, forearms, elbows and wrists. biopsy of the skin of the right foot revealed lesions typical of lichen nitidus with subepidermal extravasation of red cells and capillary wall hyalinization. macrophages and T lymphocytes were abundant in the infiltrate. CONCLUSION: Purpuric generalized lichen nitidus should be included in the differential diagnosis of pigmented purpuric dermatoses.- - - - - - - - - - ranking = 8keywords = lichen (Clic here for more details about this article) |
5/22. Kobnerization in a woman with generalized lichen sclerosus.A 52-year-old woman presented with an 18-month history of genital and extragenital lichen sclerosus. In addition to the classical genital findings, lesions of lichen sclerosus were present over her back, chest and the medial aspect of her right thigh and leg. On her right thigh and extending to her right leg, lesions of lichen sclerosus displaying the Kobner response were noted over the course of a varicosed long saphenous vein. There were no features of varicose dermatitis in the region displaying the Kobner response. It is proposed that the ambulatory venous pressure within the vein acted as a stimulus for the Kobner response.- - - - - - - - - - ranking = 48.559368300876keywords = lichen sclerosus, sclerosus, lichen (Clic here for more details about this article) |
6/22. leg crossers' dimple: A form of localized lipoatrophy.We report eight individuals with localized lipoatrophy of the lateral lower leg that were seen by a single dermatologist in a 1-year period. All were asymptomatic and half had mild epidermal changes consistent with lichenification. Seven were an incidental finding during a general skin examination. All had a long-standing history of frequent leg crossing. The sites correlated with the area resting on the patella of the opposing knee. The depressions were larger on sides of leg-crossing preference. Only one had a significant rise in antinuclear antibodies, but this patient had no other clinical or serological abnormalities. This appears to be an extremely common yet previously unreported form of localized lipoatrophy.- - - - - - - - - - ranking = 1keywords = lichen (Clic here for more details about this article) |
7/22. Superficial thrombophlebitic tuberculide.BACKGROUND: Tuberculides are the result of immunologic reactions to hematogenously spread antigenic components of mycobacterium tuberculosis. There are three recognized tuberculides--papulonecrotic tuberculide, erythema induratum of Bazin, and lichen scrofulosorum. In 1997, in japan, Hara and coworkers reported five patients with what they called "nodular granulomatous phlebitis," which they proposed was a fourth type of tuberculide. We describe a patient who presented with features identical to those reported by Hara et al. in order to draw attention to the previous report and to support the concept of a fourth tuberculide which clinically resembles superficial thrombophlebitis. methods: A black South African man presented with cord-like thickening of superficial veins on the antero-medial aspects of the lower legs. Nodular swellings were palpable along the course of these veins. There was no evidence of tuberculosis elsewhere in the body, but the patient had a strongly positive tuberculin reaction. skin biopsies were performed for histologic examination, culture, and polymerase chain reaction (PCR). RESULTS: Histologic examination showed a granulomatous infiltrate localized to the veins in the subcutaneous fat. Stains for acid-fast bacilli and culture were negative, but PCR was positive for M. tuberculosis dna. The lesions responded promptly to antituberculous therapy. CONCLUSIONS: Our patient showed features identical to those of cases described by Hara and coworkers and assigned as a fourth type of tuberculide. As the lesions clinically resemble superficial thrombophlebitis, we propose the term "superficial thrombophlebitic tuberculide" rather than "nodular granulomatous phlebitis."- - - - - - - - - - ranking = 1keywords = lichen (Clic here for more details about this article) |
8/22. Vaginal ulcerations due to lithium carbonate therapy.A twenty-nine-year-old woman who had been taking lithium carbonate for seven years experienced ulcerated lesions of the vaginal mucosa and acneiform eruption on both thighs. Histopathologic appearance of the skin biopsy specimens was consistent with lichenoid cutaneous changes. The cutaneous lesions cleared when use of the drug was discontinued.- - - - - - - - - - ranking = 1keywords = lichen (Clic here for more details about this article) |
9/22. Differentiating vesicular linear lichen planus and lichen striatus.We present a case of vesicular linear lichen planus in a 62-year-old woman. This unusual presentation of lichen planus and other conditions in the differential diagnosis are discussed.- - - - - - - - - - ranking = 10keywords = lichen (Clic here for more details about this article) |
10/22. Familial occurrence of lichen sclerosus et atrophicus. case reports of a mother and daughter.A mother and daughter with lichen sclerosus et atrophicus (LSA) are described. Both had lesions restricted to their lower legs. Both patients were positive for HLA-B40, which has been associated with LSA. sex steroid hormones showed no decrease in dihydrotestosterone, free testosterone, or androstenedione levels in the daughter as was demonstrated in a previous study of this disease, but did show some decrease in androstenedione in the mother. This article provides further evidence for a possible familial predisposition for LSA.- - - - - - - - - - ranking = 34.685263072055keywords = lichen sclerosus, sclerosus, lichen (Clic here for more details about this article) |
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