Mast cells in oral lichen planus and oral lichenoid lesions related to dental amalgam contact

Abstract The aim of this study was to analyze the expression of mast cell markers toluidine blue, c-kit, and tryptase and presence of mononuclear inflammatory cells in oral lichen planus (OLP) and oral lichenoid lesions related to dental amalgam. Nineteen specimens of OLP, OLLC, and healthy oral mucosa were selected. Mononuclear inflammatory cells were analyzed. Histochemical and immunohistochemical analyses were performed using toluidine blue, anti-c-kit and anti-tryptase reagents, and the results were quantified in areas A and B of connective tissue. Mast cells of all OLP and OLLC samples were positive for toluidine blue, c-kit, and tryptase. The density of toluidine blue+, c-kit+ and tryptase+ mast cells was higher in tissue with OLP and OLLC compared with healthy controls (p < 0.05). No difference was noted in mast cells density between OLP and OLLC (p > 0.05). The density of tryptase+ mast cells was higher in the subepithelial region (area A) than the region below it (Area B) in OLLC (p = 0.047). The mononuclear inflammatory cell density was higher in OLLC compared to OLP, but without statistical significance (p > 0.05). A positive statistical correlation was found between mononuclear immune cells and density of c-kit+ and tryptase+ mast cells in OLP (r = 0.943 and r = 0.886, respectively). Our data demonstrate that the etiopathogenesis process of OLP and OLLC modulates the expansion and degranulation of mast cells; mast cells density, however, was similar between OLP and OLLC. The distribution of mast cells appears to vary along the lamina propria.

Motorcycling can be dangerous: verrucous lichenoid reaction to a tattoo

Abstract Tattooing one's body is currently a common practice worldwide; however, it is not risk-free. This is a case of a patient who tattooed himself motivated by his passion for motorcycles and then developed an exuberant lichenoid reaction to the red pigment used in the tattoo, with the appearance of verrucous lesions. Despite the lack of response to treatment, he states that he would tattoo his own skin again.

Analysis of clinical and pathological diagnoses of 29 987 skin biopsy samples in Peking Union Medical College Hospital / 中华皮肤科杂志

Objective To analyze the disease constitution,accuracy of clinical and pathological diagnoses of skin biopsy samples in Peking Union Medical College Hospital.Methods A total of 29987 patients subjected to skin biopsy were collected from Department of Dermatology,Peking Union Medical College Hospital from June 2010 to November 2018,and clinical and histopathological diagnoses of these skin biopsy samples were analyzed retrospectively.Results According to the results of histopathological diagnosis,confirmed diagnoses of these patients could be classified into 33 categories and 242 kinds.Common disease categories included epidermal tumors (2931 cases,9.77％),connective tissue diseases (2809 cases,9.37％),melanocytic tumors (2078 cases,6.93％),erythematous scaly pustular dermatoses (1376 cases,4.59％),lichenoid dermatoses (1291cases,4.31％),allergic or eczematous skin diseases (1282 cases,4.28％)and infectious skin diseases (1156 cases,3.86％).Common skin diseases included scleroderma (1887 cases,6.29％),pigmented nevus (1755 cases,5.85％),seborrheic keratosis (1136 cases,3.79％),eczema (1089 cases,3.63％),psoriasis (881 cases,2.94％),lichen planus (867 cases,2.89％),lupus erythematosus (638 cases,2.13％),pemphigus (549 cases,1.83％),and basal cell carcinoma (501 cases,1.67％).Poor consistency was observed between clinical diagnosis and histopathological diagnosis of lichen planus,bullous pemphigoid,granuloma annulare and hypereosinophilic dermatitis.Conclusions Common disease categories of the skin biopsy samples in Peking Union Medical College Hospital were epidermal tumors,connective tissue diseases,melanocytic tumors,erythematous scaly pustular dermatoses,lichenoid dermatoses,and allergic or eczematous skin diseases.Poor consistency was observed between clinical and pathological diagnosis in some skin diseases,and understanding of these diseases should be improved.

A Case Series of Esophageal Lichen Planus: An Underdiagnosed Cause of Dysphagia

Lichen planus (LP) is a chronic mucocutaneous inflammatory condition that typically affects middle-aged adults. Esophageal involvement in LP is rare and underrecognized, often leading to delayed diagnosis and treatment of LP. Herein, we describe three cases of esophageal LP (ELP) in clinically symptomatic patients with endoscopic lesions in the upper to mid-esophagus. This case series suggests that ELP is be more common than was previously thought and emphasizes that clinicians should have a high index of suspicion for this diagnosis, particularly when evaluating proximal esophageal lesions in patients presenting with dysphagia. The series also highlights the successful treatment of our patients with budesonide-honey slurry.

Coexistence of chronic cutaneous lupus erythematosus and frontal fibrosing alopecia

Abstract: Lupus erythemathosus is a chronic, relapsing disease with acute, subacute, and chronic lesions. Effluvium telogen occurs in the setting of systemic activity of the disease, and cicatricial alopecia results from discoid lesionsin on the scalp. Other types of alopecia, like alopecia areata, may rarely be found in lupus. Frontal fibrosing alopecia is characterized by frontotemporal hairline recession and eybrow loss. Histophatologically, it cannot be differentiated from lichen planopilaris.It is controversial whether frontal fibrosing alopecia is a subtype of lichen planopilaris.. A pacient with chronic lichenoid lupus erythematosus is described with clinical, histophatological and dermoscopic features of frontal fibrosing alopecia.We have not been able to find in the literature cases of frontal fibrosing alopecia as a clinical manifestation of lupus.

Reação liquenoide oral ao amálgama: uma lesão ainda vista / Oral lichenoid reaction to amalgam: a lesion still seen

O amálgama dental ainda é amplamente utilizado na prática odontológica, apesar do acordo assinado na Convenção de Minamata, na qual 140 países comprometeram-se a reduzir o uso do mercúrio. O uso desse material restaurador pode desencadear reações liquenoides orais (RLO) cujas lesões apresentam semelhanças clínicas e histológicas com líquen plano oral (LPO), dificultando o diagnóstico. Aqui relatamos o caso de uma paciente do sexo feminino, de 72 anos, que foi encaminhada com uma lesão na mucosa bucal esquerda, com 10 meses de evolução e queixa de dor. A lesão era adjacente ao segundo molar inferior esquerdo que tinha uma restauração de amálgama. A paciente não apresentava doença sistêmica ou hábitos deletérios e não estava usando drogas continuamente. O diagnóstico clínico presuntivo foi RLO versus LPO. Sessenta dias após a substituição da restauração do amálgama, observou-se a regressão completa da lesão e o diagnóstico final de RLO foi realizado. A avaliação clínica associada aos resultados obtidos após a substituição do material suspeito pode ser suficiente para estabelecer o diagnóstico, embora em alguns casos seja necessária a avaliação histopatológica.

Dental amalgam is still widely used in dental practice, despite the agreement signed at the Minamata Convention, in which 140 countries have committed to reducing the use of mercury. The use of this restorative material may trigger oral lichenoid reactions (OLR) whose lesions show clinical and histological similarities with oral lichen planus (OLP), making diagnosis difficult. Here we report the case of a female patient, 72-year-old, who was referred with a lesion in the left buccal mucosa, with 10 months of evolution and complaint of pain. The lesion was adjacent to the second lower left molar which had an amalgam restoration. The patient had no systemic disease or deleterious habits and was not using drugs continuously. The presumptive clinical diagnosis were OLR versus OLP. Sixty days after the replacement of amalgam restoration the complete regression of the lesion was observed and the final diagnosis of OLR was done. Clinical assessment associated with the results obtained after the replacement of suspect material may be sufficient to establish the diagnosis, although in some cases it may be necessary histopathological evaluation.

Segmental lichen aureus: an uncommon presentation

Abstract: Pigmented purpuric dermatoses are chronic vascular inflammatory conditions characterized by the presence of pigmented macules. Among its different presentations, lichen aureus is distinguished by the lichenoid conformation of its plaques and the predilection for lower limb involvement. Its segmented form is rare and difficult to control, especially in cases of symptomatic lesions. We report a rare case of segmental lichen aureus with six years of evolution associated with light itching. We also discuss the main therapeutic approaches to control the disease.

A Case of Cycloserine-Induced Lichenoid Drug Eruption Supported by the Lymphocyte Transformation Test

Lichenoid drug eruption (LDE) is a rare form of delayed-type drug eruption. Among anti-tuberculosis (Tb) agents, cycloserine (CS) has been reported as a rare cause of LDE. Positive results on the lymphocyte transformation test (LTT) have not been reported in patients with LDE. In the present case, we performed LTT and a patch test, and successfully proved CS as the offending drug in this patient, who had been treated with multiple anti-Tb drugs. These observations suggest that CS should be considered a possible cause of LDE and that LTT can be an option for the diagnosis of LDE.

Manifestações orais da doença do enxerto contra o hospedeiro crônica: revisão sistemática de literatura / Oral manifestations of chronic graft vs host disease: systematic literature review

Objetivo:Identificar a frequência das manifestações orais da DECHc em pacientes submetidos ao TCTH, através de uma revisão sistemática da literatura. Material e Métodos: Realizou-se uma revisão sistemática da literatura utilizando-se as bases de dados PubMed, Cochrane e Dentistry & Oral Sciences Source para realização da busca bibliográfica (setembro/2015), que resultou em um total de 212 publicações, entre as quais 40 foram incluídas no estudo. Resultados: As lesões liquenoides foram relatadas em 82,5% dos estudos, sendo as alterações mais frequentes entre diversas outras, como úlceras, relatadas em 57,1% dos estudos, atrofia da mucosa em 45,7%, mucocele em 37,1% e pseudomembranas em 17,1%. Entre os sintomas, a xerostomia foi relatada em 80% dos estudos, superando a dor (48,5%), sensibilidade/ queimação (34,2%) disgeusia/ageusia (17,1%), disfagia (14,2%), entre outras. Conclusão: Observou-se assim, na literatura, uma alta ocorrência de diversas manifestações orais associadas à DECHc.

Objective: To identify the frequency of oral manifestations of cGVHD in patients undergoing HSCT, through a systematic review of the literature. Material and Methods: It was performed a systematic review of the literature using the databases PubMed, Cochrane and Dentistry & Oral Sciences Source to perform the literature search (september/ 2015), which resulted in a total of 212 publications, among which 40 were included in the study. Results: The lichenoid lesions were reported in 82.5% of the studies, the most frequent changes among many others found, such as ulcers, reported in 57,1% of the studies, mucosal atrophy in 45,7%, mucocele in 37,1% pseudomembranes in 17.1%. Among the symptoms, dry mouth was reported in 80% of studies, overcoming the pain (48,5%), sensitivity/burning (34,2%) dysgeusia/ageusia (17,1%), dysphagia (14,2%), among others. Conclusion: There was, in the literature, a high occurrence of various oral manifestations associated with cGVHD.

Wolf's isotopic response, presenting as lichen planus

The term "Wolf's isotopic response" describes the occurrence of a new skin disorder at the site of another unrelated and already healed skin disease. In most cases, herpes zoster is the inicial disease. Different disorders may develop on the same site, most commonly granulomatous and lichenoid reactions, infiltration of hematologic diseases, skin tumors and infections. There are few related cases of lichen planus presenting as isotopic response. We report a case of a 74 year-old woman, with multiple itchy, rose-colored and shiny papules that developed at site of previously healed herpes zoster, on the right arm and shoulder. The pathogenesis of this phenomenon is still unknown and further studies are needed.

Paraneoplastic autoimmune multiorgan syndrome (paraneoplastic pemphigus) with unusual manifestations and without detectable autoantibodies.

We describe a patient with paraneoplastic autoimmune multiorgan syndrome (PAMS) secondary to a lymphoblastic T‑ cell lymphoma who presented with a lichenoid dermatitis and vitiligo, later developing bronchiolitis obliterans and autoimmune hepatitis. Notably, he had no detectable autoantibodies. The development of vitiligo and autoimmune hepatic involvement probably indicate a role for cytotoxic T‑ cell lymphocytes in the pathogenesis of this syndrome.

Lichen planus pigmentosus inversus / Liquen plano pigmentoso invertido

Twenty-five year old male patient presenting with asymptomatic brown spots, on cervical, axillary, inguinal and popliteal regions, for the last nine months. Pathological examination showed hydropic degeneration of the basal layer, pigmentary incontinence and moderate inflammatory lymphocytic infiltrate in the dermis. Lichen planus pigmentosus inversus is a rare subtype of lichen planus characterized by hyperchromic, asymptomatic or mildly pruritic macules, measuring from millimeters to centimeters in diameter, with defined borders, affecting intertriginous areas, most commonly in the axillae and groin of Caucasian patients. It presents unique lichenoid histology. We report a case with typical clinical features, histology and evolution.

Homem, 25 anos, com manchas acastanhadas, assintomáticas, nas regiões cervicais, axilares, inguinais e poplíteas há nove meses. Anatomopatológico com degeneração hidrópica da basal, incontinência pigmentar e infiltrado inflamatório linfocitário moderado na derme. O líquen plano pigmentoso invertido é um subtipo raro de líquen plano, caracterizado por máculas hipercrômicas, assintomáticas ou discretamente pruriginosas, de milímetros a centímetros de diâmetro, com limites nítidos, nas áreas intertriginosas, sendo mais comum nas flexuras axilares e inguinais de indivíduos de pele clara. Apresenta histologia liquenóide peculiar. Relata-se um caso com clínica, histologia e evolução típicas.

Etiogenic study on oral lichenoid reactions among Tamil Nadu population: A prospective cohort study.

Background: Most of the clinical, epidemiological, and etiogenic studies on oral lichenoid reactions (OLRs) have been undertaken in the United States, UK, Scandinavia, and other European countries. So far, very few cohort studies on a small population have been documented from South Asian region to implicate the role of various causative agents in the precipitation of OLR. Objectives: To implicate the role of various allopathic, alternate medicinal drugs, dental materials, etc., in the precipitation OLRs; to evaluate the pattern of remission; and to estimate the time period for the remission of lesions following the discontinuance of the suspected agents in the population of Tamil Nadu. Materials and Methods: A total of 102 patients were included, of whom 51 (mean age 43.3 years, SD 14.59) formed the study group, who possessed a positive drug history to the intake of either potential allopathic or alternate drugs or had recent dental metallic fillings/restorations, and 51 were (mean age 47.86 years, SD14.67) in the control group possessing oral lichen planus (OLP). The patients were followed up at a monthly interval period for a period of 18 months. Results: Complete remission of signs and symptoms was noticed in 41 patients, partial remission in 6, no change in 2, newer lesions in 1, and flaredup lesions were observed in 1 participant in the study group. The mean onset time for lichenoid eruptions was found to be 2.5 months (SD 58.82) and the mean remission time after discontinuing the drug was 9.1 months (SD 4.7). Conclusion: OLR could be implicated to documented lichenoid agents like calcium channel blockers, ACE inhibitors, atarvastatin, metformin, glibenclamide, dapsone, carbimazole, silver amalgam fillings, etc.in southSouth Indian population. Furthermore, the drugs like oflaxacin, arsenical album, and yellow orpimentumwere also found to have strong implication in the precipitation of OLR. Discontinuance of the suspected agents resulted in healing in the majority of cases.

Dermoscopy of lichen aureus / Dermatoscopia do liquen aureus

Lichen aureus (also called "lichen purpuricus") is an uncommon subtype of pigmented purpuric dermatosis. Clinically characterized by rust macules, papules or plaques, it is a chronic disease which more often affects young adults and is localized mainly on the lower extremities. The diagnosis is made on the basis of clinical and histopathological features. Dermoscopy findings are useful to confirm clinical diagnosis.

O líquen aureus (também denominado "liquen purpuricus") é um subtipo pouco comum entre as dermatoses purpúricas pigmentadas. Clinicamente caracterizado por máculas, pápulas ou placas de coloração ferruginosa, é doença crônica, que acomete mais frequentemente adultos jovens e localiza-se principalmente nos membros inferiores. O diagnóstico pode ser feito a partir das características clínicas e histopatológicas, sendo os achados dermatoscópicos úteis para corroborar o diagnóstico clínico.

Generalized Lichen nitidus associated with Down's syndrome: case report / Liquen nítido geneneralizado associado à síndrome de Down: relato de caso

Lichen nitidus is a disease of unknown etiology, characterized by flesh-colored, shiny papules of 1-2 mm and generally asymptomatic or with mild pruritus. The most common sites of occurrence are genitalia, upper limbs, trunk and abdomen. The generalized form is rare. This is the fourth reported case of lichen nitidus associated with Down Syndrome.

Líquen nítido é uma doença de etiologia desconhecida, caracterizada por pápulas normocrômicas, brilhantes medindo de 1 a 2 milímetros de diâmetro, geralmente assintomáticas ou com leve prurido. A forma mais comum é a localizada nos genitais, membros superiores, tronco e abdome. A forma generalizada é rara. Este é o quarto relato de caso descrito de líquen nítido associado à Síndrome de Down.

Case for diagnosis / Caso para diagnóstico

Dyschromicum erythema perstans, or ashy dermatosis, is a rare chronic acquired skin disease characterized by gray hyperpigmented patches with erythematous borders. Its etiology is unknown and there is no specific treatment for the condition. We report a case of ashy dermatosis in a 41-year-old patient with extensive lesions on the trunk and limbs.

Erythema dyschromicum perstans ou dermatose cinzenta é enfermidade cutânea adquirida, rara, de evolução crônica, caracterizada por máculas acinzentadas, com bordas eritematosas. A etiologia ainda é desconhecida, não havendo tratamento definido para a afecção. Apresenta-se um caso desta dermatose em paciente de 41 anos, com lesões disseminadas no tronco e membros.

Queratose liquenoide crônica: relato de caso / Keratosis lichenoides chronica: case report

A queratose liquenoide crônica ou doença de Nekam é uma dermatose mucocutânea rara da queratinização, com curso crônico e progressivo, que acomete geralmente indivíduos entre 20 e 40 anos. Existem, aproximadamente, 70 casos descritos na literatura. Devido à raridade desta dermatose e à ausência de tratamento efetivo, é uma doença de difícil manejo. No caso em questão, apresentamos um paciente de 42 anos com pápulas violáceas, hiperqueratósicas, algumas confluentes, com aspecto linear, rendilhado e em placas, localizadas no tronco e membros há cinco anos. Lesões aftoides na cavidade oral e úlceras rasas na genitália também faziam parte do quadro. O anatomopatológico foi bastante sugestivo de queratose liquenoide crônica. Introduziu-se tratamento com acitretina e dapsona, havendo melhora parcial do quadro.

Keratosis lichenoides chronica or Nekam's disease is a rare mucocutaneous dermatosis characterized by keratinization. It is chronic and progressive usually affecting individuals aged 20-40 years. Around 70 cases have been reported in the literature. Due to the rarity of this condition and the lack of effective treatment, it is a difficult disease to manage. In the case described below we present a 42-yearold patient with violaceous and hyperkeratotic papules in linear, reticular or plaque form, located on the trunk and limbs for five years. Aphthous lesions in the oral cavity and shallow ulcers on the genitalia also formed part of the clinical manifestation. Pathologic examination was suggestive of keratosis lichenoides chronica. Acitretin and dapsone was introduced and the lesions partially improved.

Micosis fungoide liquenoide atípica / Unusual lichenoid mycosis fungoides

Presentamos un caso de micosis fungoide liquenoide. La paciente presentó prurito intenso, pero con una buena evolución hasta el momento. Tanto clínica como histológicamente se correspondía con un patrón liquenoide, hecho de excepcional frecuencia. Respondió al tratamiento esteroideo tópico de alta potencia.

A 53-years-old woman with a lichenoid mycoses fungoides is reported. Both clinical and histological lichenoid pattern was finding, which is unusual. The treatment with high potency corticoids was successfully and the outcome is favorable up to now.

Líquen estriado no adulto / Lichen striatus on adult

Líquen estriado é uma erupção inflamatória incomum, de etiologia desconhecida. Raramente acomete adultos, e é caracterizada pelo surgimento abrupto de pápulas coalescentes, em arranjo linear, usualmente em extremidades. A histopatologia mostra reação liquenóide envolvendo folículos e glândulas. Ocasionalmente há sobreposição com líquen plano linear e "blaschkitis", seus principais diagnósticos diferenciais. Relata-se um caso de mulher adulta com pápulas eritematovioláceas em região cervical e hemiface direitas, cuja correlação clínico-histopatológica permitiu o diagnóstico de líquen estriado. Os achados atípicos e a dificuldade diagnóstica são discutidos.

Lichen Striatus is an uncommon inflammatory skin eruption of unknown etiology. It rarely affects adults, and it is characterized by abrupt onset of coalescent papules, in a linear disposition, usually on the extremities. Histopathology shows lichenoid reaction involving follicles and glands. Occasionally, there is overlap with linear lichen planus and "blaschkitis", the main differential diagnoses. It is reported here the case of an adult woman with erythematous violaceous papules on the right side of the neck and face, diagnosed with lichen striatus by clinical and histopathological correlation. The atypical findings and the diagnostic difficulty are discussed.

Oral lichenoid lesions associated with amalgam restorations: report of two cases / Lesões liquenóides bucais associadas a restaurações de amálgama: relatos de dois casos

PURPOSE: Dental amalgam has been used as a dental restoration for more than 165 years. However, some patients with these restorations may present oral lichenoid lesions (OLL). OLL are chronic oral mucosal contact reactions to dental amalgam. Their diagnosis usually is based on the direct contact of the affected mucosa with the amalgam restorations, clinical appearance, and lack of migrations. A patch-test for mercury can be performed to confirm the diagnosis. Thus, the objective this work was to discuss the occurrence of this disease and your possibilities of existing differential diagnostic. CASE DESCRIPTION: Two clinical cases were diagnosed as related to OLL. In both cases, the patients complained of a burning sensation in the oral mucosa adjacent to the amalgam restorations. The treatment involved replacing the amalgam restorations by composite. A complete remission of the painful symptoms was observed after 17 days in one case and after one month in the other, although the lesions in the oral mucosa did not disappear completely. CONCLUSION: Dentists should be aware of OLL occurrence close to amalgam restorations and should be able to diagnose it and recommend the best treatment option.

OBJETIVO: O amálgama dentário tem servido como restaurador dentário a mais de 165 anos. Entretanto, alguns pacientes com estas restaurações têm demonstrado a ocorrência de lesões liquenóides orais (LLO). As LLO são reações de contato da mucosa oral crônicas ao amálgama dentário. Geralmente, o diagnóstico da lesão é feito pelo contato direto da mucosa afeta com a restauração de amalgama, pela aparência clínica, e a ausência de migrações. Um teste de contato para o mercúrio pode ser realizado para confirmar o diagnóstico. Assim, o objetivo deste trabalho foi discutir a ocorrência desta doença e suas possibilidades de diagnóstico diferencial existentes. DESCRIÇÃO DO CASO: Dois casos clínicos foram diagnosticados como LLO. Em ambos os casos, os pacientes relataram sofrer de sensação de queimação na mucosa oral adjacente às restaurações de amálgama. Para ambos pacientes, os tratamentos envolveram a substituição das restaurações de amálgama. Completa remissão da sintomatologia dolorosa foi observada após 17 dias em um caso e após 30 dias em outro, embora as lesões na mucosa intrabucal não tenham desaparecido completamente. CONCLUSÃO: Os cirurgiões-dentistas devem estar cientes da ocorrência da LLO relacionadas a restaurações de amálgama e devem saber como fazer o diagnóstico correto para assim recomendar a melhor forma de tratamento.