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.

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.

Liquen aureus zosteriforme: Caso dínico pediatrico / Zosteriform lichen aureus: Pediatric clinical case

El liquen aureus es una dermatosis purpúrica pigmentaria infrecuente. Presentamos un caso inusual por su edad pediátrica y por la presencia de lesiones múltiples con patrón zosteriforme. Se trata de un niño de 10 años con máculas parduzcas, menores de 1 cm, con bordes definidos y superficie liquenificada, en la cara interna de la pierna izquierda con distribución zosteriforme, asintomáticas, de tres meses de evolución. La biopsia mostró infiltrado en banda en la dermis superior con linfocitos, histiocitos, hematíes y hemosiderina. Se diagnosticó liquen aureus zosteriforme y se trató con furoato de mometasona tópico durante 3 semanas con aclaramiento parcial. Las lesiones permanecen 2 años después y han aparecido nuevas en el tobillo ipsilateral. Debemos plantearnos el diagnóstico diferencial con otras dermatosis purpúricas pigmentarias crónicas y la variante purpúrica pigmentaria de la micosis fungoide. Existen muchas opciones terapéuticas e, incluso sin tratamiento, suelen desaparecer, por lo que son necesarios estudios que recopilen más evidencias.

ABSTRACT Lichen aureus is a rare pigmented purpuric dermatosis. We present anunusual case because of the pediatric age and the great number of lesions with zosteriform distribution. He is a 10-year-old boy, with a brownish, smaller than 1 cm, sharp edges, lichenified surface, asymptomatic macule, over the inner aspect of the left leg with a zosteriform distribution. The histology showed a band-like inflammatory infiltrate in the superficial dermis, composed of lymphocytes, histiocytes, erythrocytes and haemosiderin. He was diagnosed with zosteriform lichen aureus and was treated with topical mometasone furoate during 3 weeks resulting in partial lightening of the macules. Lesions have remained 2 years later, and new ones have appeared in the ipsilateral ankle. We must consider differential diagnosis with other pigmented purpuric dermatitis and pigmented purpuric mycosis fungoides. There are many therapeutic options and it tends to disappear spontaneously, so new studies are necessary

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.

Hyperpigmentation of the hard palate mucosa in a patient with chronic myeloid leukaemia taking imatinib / 대한악안면성형재건외과학회지

BACKGROUND: Imatinib mesylate is an inhibitor of the tyrosine kinase Bcr–Abl and a first-line treatment for Philadelphia chromosome-positive chronic myeloid leukaemia (CML). Dermatological side effects include superficial oedema, pustular eruption, lichenoid reactions, erythroderma, and skin rash. Depigmentation of the skin and/or mucosa is uncommon, and hyperpigmentation is rare. CASE PRESENTATION: We present the case of a 63-year-old Caucasian male with widespread hyperpigmentation of the hard palate associated with a 9-year history of imatinib therapy to treat CML. He did not complain of any symptoms. Clinical examination did not reveal any abnormal pigmentation of the skin or other region of the oral mucosa. He did not smoke cigarettes or drink alcohol. His medication regimen was a proton pump inhibitor, a beta-blocker, cardioaspirin, atorvastatin, and imatinib 400 mg/day. Histopathologically, melanin and haemosiderin deposits were evident in the lamina propria. The lesion persisted, with no clinical change, through several follow-ups. We reviewed the literature to explore the possible relationship between oral hyperpigmentation and long-term imatinib mesylate treatment. CONCLUSIONS: We diagnosed oral pigmentation associated with imatinib intake based on the medical history and clinical features of the pigmented macules. Oral pigmentation may have a variety of causes, and differential diagnosis requires nodal analysis. Clinicians should be aware of possible oral mucosal hyperpigmentation in patients taking imatinib mesylate. Such pigmentation is benign and no treatment is needed, but surveillance is advisable.

Necrolytic acral erythema: a rare skin disease associated with hepatitis C virus infection

Abstract: Necrolytic acral erythema is a rare skin disease associated with hepatitis C virus infection. We report a case of a 31-year-old woman with hepatitis C virus infection and decreased zinc serum level. Physical examination revealed scaly, lichenified plaques, well-demarcated with an erythematous peripheral rim located on the lower limbs. After blood transfusion and oral zinc supplementation the patient presented an improvement of lesions.

Primary localized cutaneous amyloidosis with lichen and poikiloderma-like lesions and an excellent response to systemic acitretin

Abstract: Primary localized cutaneous amyloidosis is a skin-limited amyloidosis that does not involve internal organs. It is clinically subclassified into 3 general categories and some rare variants. However, there is considerable overlap within the classification. Though there are a variety of therapeutic measures, the treatment is often unsatisfactory, particularly when the disease is severe and extensive. We describe a rare case of primary localized cutaneous amyloidosis with lichen and poikiloderma-like lesions that showed an excellent response to systemic acitretin.

Liquen oral, patrones reaccionales liquenoides y cáncer oral: estudio clínico e histopatológico retrospectivo de 12 años / Oral lichen, lichenoid reaction patterns and oral cancer: retrospective clinical and histopathological study of 12 years

Antecedentes: el liquen plano es una enfermedad con probabilidad de transformación maligna. La afectación oral se presenta en el 60 al 70% y el riesgo de cáncer oral es de 0-12,5%. La distinción entre liquen y reacción liquenoide oral es dificultosa. Se han descripto numerosos criterios para distinguirlas y se han asociado a riesgo de transformación maligna, pero aún así hay varias inconsistencias. Objetivo: determinar las características epidemiológicas y anatomopatológicas de los pacientes con liquen y reacción liquenoide oral. Establecer la frecuencia de progresión a cáncer considerando si hay diferencia entre los grupos. Diseño: estudio descriptivo, retrospectivo, observacional y longitudinal. Métodos: se recopilaron datos de pacientes evaluados en el Hospital Lagomaggiore de Mendoza, desde enero de 2003 a diciembre de 2014. Se incluyeron pacientes mayores de 18 años con confirmación histopatológica de liquen o reacción liquenoide oral. El análisis se realizó con Graph Pad Instat y se utilizaron medidas de tendencia central, de dispersión, test de normalidad y test exacto de Fisher. Resultados: se incluyeron 110 pacientes con confirmación histopatológica. Cuatro pacientes desarrollaron cáncer oral, 4,23% de los líquenes y 2,56% de las reacciones liquenoides. No hubo diferencia significativa entre grupos. En todos los casos, el cáncer oral ocurrió sobre la zona afectada previamente. Conclusiones: se registraron cuatro pacientes con progresión a cáncer oral. Estos hallazgos justifican el tratamiento y seguimiento. Se requieren más estudios para determinar si el liquen oral y las reacciones liquenoides son entidades separadas (AU)

Background: lichen planus is a disease with probability to become malignant. Oral affection occurs between 60% and 70% and the risk of oral cancer is from 0% to 12.5%. The difference between lichen and lichenoid oral reaction is troublesome. The literature has described numerous criteria to differentiate them and they have been associated to the risk of a malignant transformation, but there are still many inconsistencies. Objetive: to determine epidemiological and anatomopathological characteristics in patients with lichen and lichenoid oral reactions. To settle the frequency of progression to cancer, putting under consideration if there are differences between each group. Study design: Descriptive, retrospective, observational and longitudinal study. Methods: data have been taken from evaluated patients at Lagomaggiore Hospital in Mendoza, from January 2003 until December 2014. Patients over 18 years old with histopathological diagnosis of lichen or lichenoid oral reactions were included. The analysis was done with Graph Pad Instat and there were used central trends, dispersal, normal test and exact Fisher's test measures. Results: we include 110 patients with histopathological diagnosis confirmed. Four patients developed oral cancer; 4.23% of patients with lichen and 2.56% of patients with lichenoid reactions. We did not find a significant difference between groups. In all cases oral cancer occurs in the previously affected zone. Conclusions: there were registered four patients with cancer progression. These findings justify the follow up and treatment. More studies are needed to establish if oral lichen and oral lichenoid lesions are different entities (AU)

Epidermolysis bullosa pruriginosa: A case with a novel mutation and co-existent lichen amyloidosus.

Epidermolysis bullosa pruriginosa is a rare variant of dystrophic epidermolysis bullosa characterized by severely pruritic and cicatricial lesions localized to the extensor extremities. We report a Singaporean Chinese male with epidermolysis bullosa pruriginosa with an underlying novel mutation in the COL7A1 gene. A heterozygous acceptor splice site mutation IVS67‑1G>T probably led to in‑frame skipping of exon 68 (36‑basepairs), resulting in a loss of 12 amino acids. Among his three children, only the youngest son, who had bilateral big toenail thickening, possessed the same mutation. His skin biopsy one decade ago revealed association of focal amyloidosis; a recent skin biopsy showed more established features of lichen amyloidosis. It is debatable whether the cutaneous amyloidosis was a secondary or primary phenomenon. Our report highlights that the diagnosis of epidermolysis bullosa pruriginosa may be obscured when cutaneous amyloidosis is coexistent.

Duloxetine hydrochloride-induced oral lichenoid reaction: a case report

Objective: To report the first case of duloxetine hydrochloride [DH]-induced oral lichenoid drug reaction [OLDR]

Clinical Presentation and Intervention: A 57-year-old male patient presented with painful ulcerative lesions on the bilateral buccal mucosa of 2-year duration. The patient was on multiple drug therapy for his systemic ailments. After thorough evaluation for possible medical ailments and with the physician's consent, withdrawal of DH was done. The oral lesions were resolved after 2 weeks

Conclusion: In this case, DH induced OLDR

Oral and Cutaneous Lichenoid Eruption with Nail Changes Due to Imatinib Treatment in a Chinese Patient with Chronic Myeloid Leukemia

No abstract available.

Agminate lichen aureus / Liquen aureus agminado

Lichen aureus is a rare variant of pigmented purpura, with a chronic and benign course. It is generally asymptomatic and often occurs in the lower limbs, presenting as erythematous brownish, coppery or golden macules and/or papules. The diagnosis is based on clinical and histopathological findings. The dermatoscopic pattern has been considered a useful tool in diagnosis presumption. We describe a case with a confluent morphological pattern, called agminate lichen aureus.

O líquen aureus é uma variante rara das púrpuras pigmentares, com evolução crônica e benigna. A maioria é assintomática e predomina nos membros inferiores. O quadro clínico é constituído por máculas e/ou pápulas eritemato-acastanhadas, acobreadas ou douradas. O diagnóstico é clínico e histopatológico, porém o padrão dermatoscópico vem sendo uma ferramenta útil na presunção do diagnóstico. Descrevemos um caso com um padrão morfológico em que a lesão é confluente, sendo denominado líquen aureus agminado.

Chronic graft-versus-host disease: clinical presentation of multiple lesions of lichenoid and atrophic pattern / Doenca enxerto contra hospedeiro cronica: apresentacao clinica com inumeras lesoes de padrao liquenoide e de carater atrofico

Graft-versus-host disease is observed mainly in recipients of hematopoietic cell transplantation and is expressed by cutaneous or systemic signals and symptoms. Graft-versus-host disease is clinically classified as acute or chronic. Chronic Graft-versus-host disease occurs in up to 70% of hematopoietic cell transplanted patients and its clinical manifestations have important impact on morbidity and quality of life. The authors report an expressive cutaneous, oral and adnexal involvement in a patient with chronic Graft-versus-host disease with multiple lesions of lichenoid and atrophic pattern.

Doença enxerto contra hospedeiro é observada principalmente em pacientes transplantados de células de origem hematopoiéticas e se expressa por sinais e sintomas cutâneos ou sistêmicos. Clinicamente, a Doença enxerto contra hospedeiro é classificada em aguda ou crônica. As do tipo crônico ocorrem em até 70% dos pacientes e suas manifestações têm impacto importante na morbidade e na qualidade de vida. Os autores relatam caso com extenso comprometimento cutâneo, oral e de anexos cutâneos em paciente com Doença enxerto contra hospedeiro crônica expressa por inúmeras lesões de padrão liquenóide e de atrofia cutânea.