Facial and Extrafacial Lesions in an Ethnically Diverse Series of 91 Patients with Frontal Fibrosing Alopecia Followed at a Single Center.

BACKGROUND: Various facial and extrafacial lesions have been reported in frontal fibrosing alopecia (FFA). Facial papules have been associated with worse prognosis. OBJECTIVES: We sought to detect the prevalence of facial and extrafacial lesions and to analyze their relation to demographic and clinical variables in a large and ethnically diverse series of patients with FFA. METHODS: Charts of patients diagnosed with FFA between January 1, 2015, and December 31, 2017, at the Department of Dermatology, University of Miami, were reviewed retrospectively. RESULTS: 91 patients (87 women and 4 men) met inclusion criteria: 45% (n = 41) were of Hispanic/Latino ethnicity, and 34% (n = 30) were premenopausal. Facial papules were most commonly detected (41% among Hispanic/Latino patients). Significant associations were found between: (1) Hispanic/Latino ethnicity and any FFA-associated facial lesions, facial papules alone, or lichen planus pigmentosus alone, as well as premenopausal status; (2) any FFA-associated facial lesions or facial papules alone and premenopausal status; and (3) Hispanic/Latino ethnicity and simultaneous presence of facial and extrafacial lesions. CONCLUSIONS: There is a significant association among Hispanic/Latino ethnicity, facial papules, and premenopausal status, which may portend a susceptibility to severer disease and prompt early and aggressive treatment in this group.

A retrospective clinico-pathological study comparing lichen planus pigmentosus with ashy dermatosis.

BACKGROUND/OBJECTIVES: Controversy persists as to whether lichen planus pigmentosus and ashy dermatosis are separate clinical entities. This study was conducted to examine the clinicopathological features and treatment outcome of the two conditions. METHODS: A retrospective medical chart review of all patients who were diagnosed with lichen planus pigmentosus or ashy dermatosis was conducted. The information collected included the participants' age at onset, site of onset, duration of disease, presence of precipitating factors, distribution of disease, pigmentation and presence of symptoms. In patients from whom a biopsy was taken the histopathological reports were included. RESULTS: Altogether 26 patients with ashy dermatosis and 29 with lichen planus pigmentosus were included in the study. Compared with ashy dermatosis, lichen planus pigmentosus had a more localised distribution with a preponderance for facial involvement, compared with the truncal preponderance in ashy dermatosis. Ashy dermatosis tended to have a more stable clinical course than lichen planus pigmentosus, which was more likely to wax and wane. The utility of histopathology in differentiating between the two conditions is low. CONCLUSION: Ashy dermatosis and lichen planus pigmentosus, as defined in this study, appear to be two separate clinical entities with distinguishable clinical features and natural histories.

Lichen planus pigmentosus in linear and zosteriform pattern along the lines of Blaschko.

Lichen planus pigmentosus (LPP) is a variant of lichen planus (LP) reported in various ethnic groups. It occurs predominantly in the third or fourth decade of life and is characterized by the insidious onset of dark-brown macules in sun exposed areas and flexural folds. Rarely, has it been described in a linear or segmental distribution. Herein we describe a case of LPP with lesions lateralized to right side of body along the lines of Blaschko, in a linear and zosteriform pattern.

Lichen planopilaris is associated with HLA DRB1*11 and DQB1*03 alleles.

There are no studies of the possible association of the human leukocyte antigen (HLA) system with lichen planopilaris (LPP). To determine whether the HLA system is associated with LPP, 40 consecutive Jewish Israeli patients with LPP (study group) and 252 volunteers (controls) were typed for DRB1*and DQB1* loci by molecular methods. Compared with controls, the study group had a significantly higher frequency of the DRB1*11 allele (62% vs. 21%, corrected p-value (pc) = 0.001) owing to increased frequencies of DRB1*11: 01 and DRB1*11: 04. The DQB1*03 allele was also expressed at a significantly higher frequency in the study group (70% vs. 33%, pc = 0.0005); specifically, the frequency of DQB1*03: 01 was increased. The majority (82.5%) of the patients were of non-Ashkenazi origin. We conclude that LPP appears to be over-represented in non-Ashkenazi Jewish patients and is associated with an increased frequency of HLA DRB1*11 and DQB1*03 alleles. These findings suggest that immunogenetic factors play a role in LPP.

Facial hyperpigmentation: causes and treatment.

By midcentury, the U.S.A. will be more ethnically and racially diverse. Skin of colour will soon constitute nearly one-half of the U.S. population, and a full understanding of skin conditions that affect this group is of great importance. Structural and functional differences in the skin, as well as the influence of cultural practices, produce variances in skin disease and presentation based on skin type. In the skin of colour population, dyschromia is a growing concern, and a top chief complaint when patients present to the physician. A thorough understanding of the aetiology and management strategies of facial hyperpigmentation is of importance in caring for those afflicted and also in the development of new therapies.

Childhood lichen planus: demographics of a U.S. population.

Lichen planus is an inflammatory dermatosis of unknown origin that is relatively uncommon in children. Demographic data for lichen planus of children in the United States are lacking, with most large case reports originating from India, Kuwait, Mexico, and the United Kingdom. We hypothesized that a greater proportion of our pediatric lichen planus patients were African American, an observation not previously documented. A retrospective chart review was performed to investigate characteristics of our pediatric lichen planus patients. The ethnicity of the lichen planus patients was compared with the data for our general patient population. The proportion of African American patients in each group was compared using the chi-squared test. We report 36 children (female to male ratio 2:1) who presented with lichen planus to the pediatric dermatology clinic at Children's Hospital of Wisconsin. Twenty-six (72%) of these patients were African American (OR 9.63, p < 0.0001). A personal or family history of autoimmune disease was present in six (17%) patients. Although there has been no reported racial predominance of lichen planus, we observed lichen planus to occur more commonly in African American children. Interestingly, the incidence of autoimmune disease was higher than has previously been reported. Future studies will confirm or refute these observations and advance our understanding of potential genetic or environmental risk factors for the development of lichen planus.

Lichen planus in children: review of 26 cases.

Lichen Planus (LP) is a common, very itchy papulosquamous disorder. Most reports of LP in children have come from the Indian subcontinent, suggesting that children of South Asian origin are more susceptible to developing LP. We conducted a retrospective, open, observational study of children with LP over a 10-year period, comparing the proportion of ethnicity in this group with the background ethnicity using UK census data from 2001. Of 26 children included in the study, 21 (80.8%) were from the Indian subcontinent, whereas the majority of the child population of Birmingham (0-17 years) was white (58%), with only 28% of the population being South Asian. Statistical analysis showed that the over-representation of South Asians in our series is significant (P < 0.001, 95% CI 56-91%). To our knowledge, this is the largest study on LP in children outside the Indian subcontinent.

Lichen planus in African children: a study of 13 patients.

Lichen planus is an uncommonly encountered dermatosis in children, reported worldwide, however in sub-Saharan Africa there is paucity of data on Lichen planus among children. The aim of this study was to document the clinical types of Lichen planus observed in children in South East Nigeria from 1998 to 2001; and to highlight any differences and similarities with adult disease. In all, 13 patients (eight boys and five girls) aged between 3 and 15 years were diagnosed with Lichen planus. The limbs were the most common sites of involvement for nine (69.2%) children. Classic Lichen planus was the commonest clinical variant in eight (61.5%), while extensive hypertrophic plaques were observed in three (23.1%), linear lesions in two (15.4%) and eruptive generalized Lichen planus in two (15.4%). Koebner phenomenon was documented in five (38.5%); mucosal involvement, which is very uncommon in children affected by this disease, occurred in three (23.1%). Only one child had pterygium formation in all 20 nails (total nail dystrophy). No child had scalp or palmoplantar involvement. Despite the endemicity of hepatitis B surface antigen in our environment, this study also revealed that liver function tests were not significantly different between children with Lichen planus and hepatitis B surface antigen and those who were negative for this antigen; while anti-hepatitis C virus seropositivity was not recorded in any of these children.

HLA-DRB1*0101 is associated with the genetic susceptibility to develop lichen planus in the Mexican Mestizo population.

The etiology of lichen planus (LP) is still unknown and previous studies have found an association between LP and HLA-DR1, DR2, DR3, DR9 and DR10 in different populations. The aim of this study was to analyze the distribution of the HLA-DRB1 alleles in Mexican Mestizo patients with LP. The aim of this study was to determine the gene frequency of HLA-DR locus in Mexican Mestizo patients with LP. We studied 20 patients with LP and 99 healthy Mexican Mestizo controls. HLA-DRB1 was performed by PCR-SSO reverse dot blot hybridization. High resolution HLA typing was performed by PCR-SSP. The HLA-DRB1*0101 allele was associated significantly in LP patients compared with healthy controls (pC = 0.0007, OR = 5.46, 95% CI = 1.86-16.06). HLA-DRB1*0101 is a marker for the development of LP in Mexican Mestizo population, yet another gene or HLA marker within MHC region may be the causatively associated gene.

A study of 124 Indian patients with lichen planus pigmentosus.

Lichen planus pigmentosus is a fairly common disorder of pigmentation in Indians, but reports comprising a sizeable number of patients are lacking in the literature. We now describe the clinical and epidemiological features and histopathological findings for 124 lichen planus pigmentosus patients. A retrospective analysis of medical records of patients attending our centre during the past 12 years was undertaken. Of the 124 patients (56 male, 68 female), the majority (48.4%) had the disease for 6 months to 3 years. The face and neck were the commonest sites affected with pigmentation varying from slate grey to brownish-black. The pattern of pigmentation was mostly diffuse (77.4%), followed by reticular (9.7%), blotchy (7.3%) and perifollicular (5.6%). Lichen planus was noted in 19 patients with typical histopathological changes of the disorder. Lichen planus pigmentosus, a distinct clinical entity commonly encountered in the Indian population, should be considered in the spectrum of lichenoid disorders as a variant of lichen planus.

Immunological characterisation of the lichen planus infiltrate using monoclonal antibodies.

The immunological typing of cell populations in the skin biopsies of 20 cases of histologically proven lichen planus was done using monoclonal antibodies. The Avidin-Biotin-Complex immunoperoxidase technique was used. A predominance of T-helper/inducer cells in the dermal infiltrate was observed by a semiquantitative analysis. T-suppressor/cytotoxic cells and Langerhans cells were increased compared to eczema lesions. A comparison of the staining of Langerhans cells using monoclonal antibodies and the S100 protein stain showed that more Langerhans cells could be identified with the CD1 monoclonal antibody. The type of infiltrate did not correlate with the duration of disease. Direct immunofluorescence staining demonstrated fibrinogen at the dermo-epidermal junction and/or colloid bodies in the upper dermis. The immunophenotyping and immunofluorescence pattern in local cases of lichen planus are similar to previous reports from other countries. An interesting finding was the unexplained disproportionate predominance of Indians in the study cohort.

An immunofluorescence study of lichen planus among Asians in Singapore.

Forty-five Asian patients (Indians 35, Chinese 8, Malay 2) with histologically proven lichen planus were studied by immunofluorescence. The most characteristic feature, seen in 93% of the cases, was shaggy deposition of fibrinogen along the basement membrane. Immunoglobulin deposition along the basement membrane was notably, absent. Colloid bodies were observed in 87% of the cases. Fibrinogen was the most common immunoreactant, and its presence in colloid bodies was always associated with fibrinogen deposition along the basement membrane zone. Colloid bodies also contained a variety of other immunoreactants. However, staining for IgM was noted to be the most intense. The combination of shaggy deposition of fibrinogen along the basement membrane, in the absence of immunoglobulins, and the presence of colloid bodies around the basement membrane zone, is highly characteristic of lichen planus. The pattern of immunofluorescence among Asians with lichen planus, conforms to that observed in other races. There did not appear to be any difference in the immunofluorescence staining with pattern in the three racial groups studied.

Lichen planus: a study of 72 cases in Singapore.

Seventy-two patients attending this hospital with a diagnosis of lichen planus were examined. There was a striking predominance of Indians (69%) and a surprisingly low incidence of Chinese (24%) and Malays (4%) in the study population, compared to the racial composition of the general clinic population. The age distribution curve of the study population was bimodal with peaks at age groups 21-30 (22%) and 41-60 (33%) years. The most common morphologic variant was lichen planus vulgaris (common type) which we observed in 46 (64%) patients, followed by lichen planus hypertrophicus in 8 (11%) and lichen planus atrophicus in 2 (3%). Lichen planus confined to the skin was observed in 49 (68%) patients. Mucous membrane involvement was seen in 21 (29%)-17 (24%) had oral mucosa membrane involvement and 4 (6%) genital mucous membrane involvement. In 16 (22%) cases, mucous membranes were exclusively involved--12 (17%) had oral mucous membrane involvement and 4 (6%) genital mucous membrane involvement. Nail changes were only observed in 2 (3%) patients. Eight (11%) patients had associated diabetes mellitus. Overall, lichen planus appeared to pursue a protracted course with only 4 (6%) patients clearing completely after a disease duration of 5-12 months.