1/12. Lichen planopilaris.P, a 20-year-old laborer displayed initial symptoms of the disease in question when he was 10 years old. Initially he had an asymptomatic progressive loss of hair on the scalp. A couple of years later he had mild to moderate pruritis, and the appearance of slate-blue eruptions on the scalp and elsewhere on the body. This resulted in a complete loss of hair on the vault of the scalp, which led him to seek specialist opinion. Skin surface examination revealed the presence of grayish-blue acuminate follicular papules, disposed singly and in groups (plaques). The pilo-sebaceous orifices were conspicuously obliterated and filled by keratin plugs. Perifollicular erythema was a predominant feature on the scalp. The lesions were present over the scalp, around the neck, chest, back, axillae, groin and legs. Shiny atrophied scalp skin depicting scarring alopecia mimicking male-type baldness was a salient feature. In addition, it was studded with conspicuous acuminate papules in its center (Fig. 1a). The known nonhairy (glabrous) skin had classic lichen planus lesions (Fig. 1b). Hemotoxylin-eosin stained microsections prepared from typical lichen planus (LP) lesions over the abdomen and those of lichen planopilaris (LPP) of the scalp were simultaneously studied. The former revealed changes in the epidermis comprising of hyperkeratosis, increase in thickness of stratum granulosum, hydropic degeneration of the basal cell layer and band-like lympho-histiocytic infiltrate pressing against and invading the epidermis, while the latter revealed uniform atrophy of the epidermis and vacuolization of basal cells. The hair follicles were dilated and were filled with keratin plugs. In addition to fibrosis of the dermis, pigment laden microphages and lympho-histiocytic infiltrate was prominent. The follicles and the sebaceous glands were absent. However, arrectores pilorum and sweat glands were preserved (Fig. 2a,b).- - - - - - - - - - ranking = 1keywords = lichen (Clic here for more details about this article) |
2/12. Isonicotinic acid hydrazide induced anagen effluvium and associated lichenoid eruption.A 32 year-old woman developed generalised lichenoid eruptions on her body followed by diffuse loss of scalp hair of the anagen effluvium type. She was receiving several anti-tubercular drugs, including rifampicin, isonicotinic acid hydrazide (INH), pyrazinamide, and ethambutol, for abdominal tuberculosis. INH, which is a leading cause of drug eruptions in the above group of drugs was withdrawn. However, the other antitubercular drugs were continued along with 40 mg of prednisolone in a single daily morning dose. The latter was discontinued slowly over a period of 10 weeks. There was complete recovery of hair loss and the regrowth started after 12 weeks of alopecia. Such anagen effluvium with lichenoid eruption following INH therapy has not been observed previously. The complete recovery from anagen effluvium is difficult to explain, but it could have been because of the early initiation of corticosteroid.- - - - - - - - - - ranking = 2keywords = lichen (Clic here for more details about this article) |
3/12. Frontal fibrosing alopecia.Two cases of frontal fibrosing alopecia in post menopausal women, one of them biopsy-proven, are reported. Both women showed a progressive marginal alopecia and none had multifocal areas of involvement typical of lichen planopilaris nor the mucosal or cutaneous lesions of lichen planus. However, scalp biopsy specimens from the frontal hair margin showed perifollicular fibrosis and lymphocytic inflammation. Because the histologic findings are indistinguishable from those seen in lichen planopilaris, frontal fibrosing alopecia is considered a variant of lichen planus pilaris with a particular specific localization and usually onset in the postmenopausal age.- - - - - - - - - - ranking = 1.3333333333333keywords = lichen (Clic here for more details about this article) |
4/12. Giant lichenification of the scalp.Lichenification is characterized clinically by thickening of areas of skin as a result of the itch-scratch cycle and therefore is seen in conditions associated with chronic pruritus. The characteristic feature of giant lichenification is the occurrence of tumour-like growths with a warty cribriform surface. We describe a renal transplant patient presenting with giant lichenification of the scalp following an attack of herpes zoster at the same site. Chronic pruritus following scalp dysaethesia secondary to herpes zoster was considered the most likely explanation for the occurrence of these lesions.- - - - - - - - - - ranking = 2keywords = lichen (Clic here for more details about this article) |
5/12. Short course of oral cyclosporine in lichen planopilaris.Lichen planopilaris is a rare inflammatory disorder of unclear etiology that causes permanent scalp hair loss. Current treatments for lichen planopilaris are limited and do not alter the eventual outcome of the disease. Oral cyclosporine has been successful in treating severe and refractory lichen planus of the skin, and has produced sustained remission in some patients. We present 3 patients with lichen planopilaris who were treated with a short course of oral cyclosporine and report their clinical features and responses, using a standardized method of patient assessment and 3 specific outcome measures. In all 3 patients alleviation of symptoms, resolution of clinical activity, and halting progression of hair loss was achieved in 3 to 5 months with sustained effect at 12 months after a short course of cyclosporine therapy.- - - - - - - - - - ranking = 2.3333333333333keywords = lichen (Clic here for more details about this article) |
6/12. lichen planus follicularis tumidus with cysts and comedones.The lichen planus follicularis tumidus was described by Belaich et al. in 1977, and we have found 13 cases published so far. We report two cases we have recently seen, one of them with multiple lesions on the head, and the other with a temporo-frontal lesion.- - - - - - - - - - ranking = 0.33333333333333keywords = lichen (Clic here for more details about this article) |
7/12. Bullous and haemorrhagic lichen sclerosus with scalp involvement.We describe a patient who developed a generalized blistering eruption due to lichen sclerosus and who was observed to have scalp involvement. Both are unusual manifestations of this disease which merit consideration. Lichen sclerosus is an uncommon disease that most frequently affects the external genitalia of perimenopausal women. The aetiology is unknown. Approximately 20% of affected patients have extragenital lesions that present as small, ivory, shiny round macules or papules that later become atrophic; extragenital lesions are generally asymptomatic. Bullous and haemorrhagic forms may occur but these are generally localized and reports of extensive or generalized involvement are rare. We describe an elderly woman with generalized bullous lichen sclerosus. As an incidental finding, she was observed to have lichen sclerosus affecting her scalp. This has rarely been described and it would appear that she is the third reported case of scalp involvement.- - - - - - - - - - ranking = 17.597476351297keywords = lichen sclerosus, sclerosus, lichen (Clic here for more details about this article) |
8/12. adult onset folliculocentric langerhans cell histiocytosis confined to the scalp.Langerhans cell histiocytosis (LCH) is a pleomorphic disease entity characterized by local or disseminated atypical langerhans cells found most commonly in bone, lungs, mucocutaneous structures, and endocrine organs. Cutaneous disease occurs in approximately one quarter of all cases. Cutaneous findings include soft-tissue swelling, eczematous changes, a seborrheic dermatitis-like appearance, and ulceration. We report a rare case of LCH confined to the scalp with folliculocentric infiltrates. This 32-year-old male patient presented with follicularly based erythema, scale, and pustules unresponsive to topicals and oral antibiotics. The patient's lesions mimicked lichen planopilaris and folliculitis decalvans during the disease process. On hematoxylin and eosin stain, scalp biopsy showed a perivascular interstitial patchy lichenoid mononuclear cell infiltrate that focally abutted follicular infundibula. Prominent mononuclear cells having reniform nuclei were present, and immunoperoxidase stains for CD1a confirmed Langerhans cell differentiation. Serological and imaging workup failed to display systemic involvement.- - - - - - - - - - ranking = 0.66666666666667keywords = lichen (Clic here for more details about this article) |
9/12. Familial Lassueur-Graham-Little-Piccardi syndrome.Lassueur-Graham-Little-Piccardi syndrome (LGLPS) is a rare lichenoid dermatosis characterized by progressive cicatricial alopecia of the scalp, loss of pubic and axillary hairs and keratosis pilaris. The syndrome is considered a form of follicular lichen planus (LP). Although the familial occurrence of LP is a well-described phenomenon, no familial case of LGLPS has ever been reported. We describe the occurrence of LGLPS in a mother and her daughter. HLA typing revealed HLA-DR1 in both patients. Topical tacrolimus was of partial benefit in the daughter.- - - - - - - - - - ranking = 0.66666666666667keywords = lichen (Clic here for more details about this article) |
10/12. Treatment of lichen planopilaris with mycophenolate mofetil.Mycophenolate mofetil (MMF) is an immunosuppressive drug that has recently been used to treat autoimmune and inflammatory skin diseases. We report the first case of lichen planopilaris (LPP) successfully treated with MMF. The treatment of our patient demonstrates a novel therapeutic option for patients with LPP; MMF treatment may be preferable to azathioprine treatment because MMF has a safer adverse-effect profile. Larger studies must be performed to establish the risk-benefit ratio of various therapeutic dosages of MMF for these patients.- - - - - - - - - - ranking = 1.6666666666667keywords = lichen (Clic here for more details about this article) |
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