1/68. Verruciform xanthoma and concomitant lichen planus of the oral mucosa. A report of three cases. Verruciform xanthomas are benign muco-cutaneous lesions of unknown aetiology. They have a papillated surface and histologically they are characterised by the presence of foam cells in connective tissue papillae between elongated parakeratinised epithelial rete ridges. Three cases are reported in which oral mucosal verruciform xanthoma and oral mucosal lichen planus occurred concomitantly. ( info) |
| Oral lichenoid lesions caused by hypersensitivity to mercury in amalgam fillings may mimic oral lichen planus on clinical and histologic examination. A positive patch test reaction to more than one mercurial allergen increases confidence in the diagnosis and justifies the removal and replacement of all amalgam fillings with those made of other materials. A complete remission may be expected about 3 months after the last amalgam filling is removed. ( info) |
3/68. Linear IgA disease histopathologically and clinically masquerading as lichen planus. In each of 2 cases reported, the patient presented with features of erosive lichen planus or lichenoid drug eruptions and an incisional biopsy taken from the patient was diagnosed histologically as lichen planus. Subsequent recurrences or exacerbations were associated with vesiculobullous lesions. Simultaneous or subsequent direct immunofluorescence studies--from the same tissue sample in one case and from a similar site in the other case--demonstrated classic features of linear IgA disease. Both patients were originally treated for lichen planus with systemic and/or topical corticosteroids with limited success. One patient was treated with sulfapyridine with minimal improvement. Both patients were subsequently treated with dapsone and demonstrated significant clinical improvement. We propose that linear IgA disease may be more common than reported in the oral cavity, inasmuch as many cases of recalcitrant lichen planus, erosive lichen planus, and lichenoid drug eruptions, especially those with a vesiculobullous component, may in reality represent linear IgA disease. We recommend that direct immunofluorescence be done in any case in which bullous lichen planus is suspected. ( info) |
4/68. Patient with lichen planus and conjunctival immunopathologic features of lupus erythematosus. PURPOSE: To report a case of severe cicatricial conjunctivitis in a patient with lichen planus, which is known to affect the skin and mucous membranes. The conjunctival immunopathologic features were consistent with lupus erythematosus rather than with lichen planus. METHOD: Oral mucosal and skin biopsies were performed with histopathologic and immunofluorescent studies consistent with lichen planus. The patient later had a biopsy of cicatrized conjunctiva with histopathologic and immunofluorescent findings consistent with lupus erythematosus. Evaluation by rheumatology and dermatology consultants demonstrated no evidence of active systemic lupus erythematosus or discoid lupus erythematosus. RESULTS: The patient was treated with topical and systemic immunosuppressives and her disease eventually stabilized. CONCLUSION: The case demonstrates two coexisting autoimmune disease entities: lichen planus of the skin and oral mucosa and a cicatricial conjunctivitis consistent with lupus erythematosus. ( info) |
| lichen sclerosus et atrophicus affecting only the oral mucosa is extremely rare. We report here a case of oral lichen sclerosus et atrophicus presenting as a white, flat lesion involving the right buccal and labial mucosa and vermillion border. The diagnosis was based on histopathologic features. Treatment with intralesional corticosteroid was successful in reducing the size of the lesion and the symptoms of the patient. A free gingival graft was also performed to restore the lost attached gingiva. No recurrence of the lesion was found after a 1-year follow-up period, and no skin or genital lesions developed during the 3 years of treatment. ( info) |
6/68. lichen planus--report of successful treatment with aloe vera. lichen planus is a disease that involves the skin and mucous membranes. It is characterized by unique eruptions. The cause of this disease is unknown, but has been linked to emotional stress, and has also been attributed to viral infections. A case is described of a successful treatment of lichen planus. ( info) |
| A 57-year-old man had had deformities of all ten fingernails for one and a half years before presentation and deformities of all ten toenails for the previous six months. The surfaces of the nails were rough, with excessive longitudinal striations. The bases of the nails were slightly hypertrophic, and the tips were atrophic and itchy. A longitudinal nail biopsy including the nail matrix revealed the typical histology of lichen planus. Reticulated pigmentation, maceration, and erosion on the buccal mucous membrane were also discovered. Histological analysis of the buccal mucous membrane revealed lichen planus intermingled with eosinophils. Immunological blood analysis revealed elevated CD4 T cells and CD4/CD8 ratio. He worked as a tinsmith and had dental metal. The metal series patch test revealed positive reactions to chromate and tin. Treatment with systemic steroids was quite effective in treating the nail lesions. ( info) |
8/68. Verrucous carcinoma occurring in a lesion of oral lichen planus. Verrucous carcinoma of the oral cavity is relatively rare. Well-documented associations include human papillomavirus and carcinogens such as tobacco. Less well understood is the association with chronic inflammation, such as seen in lichen planus. Verrucous carcinoma has previously been described occurring in lesions of lichen planus of the foot and penis. We report the first case, to our knowledge, of verrucous carcinoma occurring in a lesion of oral lichen planus. ( info) |
9/68. Previous tuberculosis, hepatitis c virus and lichen planus. A report of 10 cases, a causal or casual link? We report 10 cases of lichen planus (LP) and chronic liver disease linked to HCV. The mean age was 63.4 /- 5.1 years (range 51-73), five were female; six patients had an established cirrhosis of the liver, as shown by either a liver biopsy or the ultrasonographic and biohumoral evidence. The remaining four patients had chronic hepatitis. Histological examination confirmed the presence of LP: the localization of the dermatosis was restricted to the skin in four patients, to the mucous membranes in five (4 atrophic erosive and one erosive) while the remaining had mucous-cutaneous localization. A type II cryoglobulinemia was demonstrated in two and a type III in one of the patients, while no one had otherwise circulating autoantibodies (anti-nuclear, anti-smooth muscle, anti-liver kidney microsomal type 1 and anti-mitochondrial antigens) such as other etiological factors of liver disease. In six of the patients the history was positive for previous mycobacterium tuberculosis infection. In clinical practice the patients with chronic liver disease and HCV infection can also suffer from severe extrahepatic manifestations, including lichen planus. ( info) |
10/68. Oral mucosal lichenoid reaction to sulfamethoxazole. A clinical case of oral mucosal lichenoid reaction to sulfamethoxazole in a dental patient with complicating medical conditions is described. Although the relationship between oral mucosal lichenoid reaction and sulfa drugs has not been documented previously, the patient's lichenoid reaction corresponded with sulfamethoxazole use, and improved when the drug was discontinued. Reactions of this type should be monitored so that treatment and preventive measures may be instituted. ( info) |