Unusual Occurrence Of Nail Lichen Planus In A Child And Response To Treatment

Lichen planus pigmentosus (LPP) is a atypical pigmented variety of lichen planus. Lichen planus pigmentosus is an unpredictable relapsing idiopathic dermatosis with periods of activation and remission with poor response to treatment and may leads to cosmetically disfiguring post inflammatory pigmentation. Aim - To study dermoscopic features of untreated cases of Lichen planus pigmentosus. Study subjects - All the patients who attended the dermatology clinic from November 2015 to November 2017 with the clinical diagnosis of LPP and who fulfilled the inclusion and exclusion criteria. Methodology - All the patients who attended the dermatology clinic with the diagnosis of LPP were examined by a dermatoscope. Dermoscopy was performed with DL4 dermatoscope. The images were further magnified with smart phone. Results - Our study showed various dermoscopic signs in cases of LPP like annular granular pattern (35 cases), annular globular pattern (5 cases), homogeneous brown pigmentation (12 cases), homogeneous brownish black pigmentation (8 cases), brownish ovoid nests (3 cases), bluish blackish fine dots (4 cases), Wickham’s striae(2 cases) and pigmented targetoid globules(3 cases). Discussion - Dermatoscope is an indispensible valuable tool in clinical practice which helps in making early lucid diagnosis of LPP with very high accuracy. Our study showed that annular granular pattern is the commonest pattern in Indian LPP cases followed by homogeneous brown pigmentation. In our Indian LPP dermoscopy study we discovered three novel dermoscopic signs which includes brownish globular nests, pigmented targetoid globules and bluish blackish fine dots. In our study we got few unique cases where Wickham’s striae was also present with other dermoscopic signs which supports the link of LPP to lichen planus. Dermatoscopic diagnosis of LPP is made by combination of various signs and should not be dependent on the presence of single marker.

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Lichen planus pemphigoides in a 2-year-old girl: Response to treatment with methotrexate

Journal of the American Academy of Dermatology ◽

10.1016/j.jaad.2011.12.024 ◽

2012 ◽

Vol 67 (4) ◽

pp. e154-e156 ◽

Cited By ~ 9

Author(s):

Buu Duong ◽

Shellie Marks ◽

Naveed Sami ◽

Amy Theos

Keyword(s):

Lichen Planus ◽

Response To Treatment

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Vulval lichen planus–lichen sclerosus overlap

International Journal of STD & AIDS ◽

10.1177/0956462418758777 ◽

2018 ◽

Vol 29 (10) ◽

pp. 1017-1023 ◽

Cited By ~ 2

Author(s):

Matthew Howard ◽

Anthony Hall

Keyword(s):

Lichen Planus ◽

Lichen Sclerosus ◽

Poor Response ◽

Clinical Findings ◽

Response To Treatment ◽

Prolonged Treatment ◽

Dramatic Improvement ◽

Labia Majora ◽

Erosive Lichen Planus ◽

Oral Corticosteroids

Vulval lichen planus–lichen sclerosus overlap is an emerging observation. Few clinical reports exist with no reviews of literature. We present a focused update of this phenomenon and discuss a clinical case. We report a 63-year-old woman with a 20-year history of ulcerative vulvo-vaginitis, initially diagnosed as benign mucous membrane (cicatricial) pemphigoid. This led to prolonged treatment with oral corticosteroids with minimal improvement in symptoms. Subsequent complications of long-term use of systemic corticosteroid ensued. A clinico-pathological diagnosis of severe erosive lichen planus was made on clinical findings and on non-specific biopsy changes of ulceration and inflammation. Treatment with topical clobetasol propionate 0.05% ointment twice daily led to dramatic improvement of ulceration, easing of discomfort and marked improvement in quality of life. Clinical examination revealed Wickham’s striae on the labia majora supporting the diagnosis. Six years after commencement of topical clobetasol, white plaques were noticed on the labia majora, perineum and peri-anal region consistent with lichen sclerosus, confirmed by repeat vulval skin biopsy and on vulvectomy. This case highlights the challenge of diagnosis of extensive vulvo-vaginal ulceration and the necessity to re-examine a previous diagnosis if there is poor response to treatment.

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Management Of Childhood Lichen Planus

Nepal Journal of Dermatology Venereology & Leprology ◽

10.3126/njdvl.v12i1.10588 ◽

2016 ◽

Vol 12 (1) ◽

pp. 1-6

Author(s):

DM Thapa ◽

M Malathi

Keyword(s):

Lichen Planus ◽

Treatment Options ◽

Poor Response ◽

Response To Therapy ◽

Response To Treatment ◽

Direct Immunofluorescence ◽

Topical Steroids ◽

Indian Children ◽

Lichen Planopilaris ◽

Oral Steroids

Childhood lichen planus (LP) is a rare entity, with less than 2–3% of all cases seen in patients under 20 years of age. LP in childhood is common in subtropical countries such as India. The most common clinical type of LP in Indian children is the classic form. Approximately 1–15% of patients with LP demonstrate nail involvement, but disease of the nails without skin involvement is rare. LP is diagnosed by historical and physical findings, biopsy results, and, in some cases, features on direct immunofluorescence (DIF). LP tends to have a chronic course. Depending on disease severity, however, LP may respond to a combination of topical or systemic therapies. The response to therapy may be similar to that seen in adults. Moderately potent or super potent steroids are the treatment of choice. Topical steroids can be combined with oral steroids in tapering doses over 2-12 weeks period. This is useful for children with widespread involvement or cutaneous LP lesions associated with significant morbidity. Intralesional steroid is effective for hypertrophic LP unresponsive to topical steroids. Topical steroids in adhesive base used several times a day for several months is a treatment of choice for symptomatic oral LP. Topical steroids in combination with systemic steroids can be given in a tapering dose over 3-6 weeks in very symptomatic cases in early stages. In severe unresponsive cases of both cutaneous and oral LP, oral retnoids are the preferred option. Treatment options for the nail LP in young children are oral steroids given as tapering dose over 4-12 weeks and oral retinoids. Intralesional steroids as nail matrix injection are the third option for older children. Most pediatric patients with LP respond to treatment with full clearance over 1-6 months. Poor response to treatment is a feature of hypertrophic LP and lichen planopilaris. DOI: http://dx.doi.org/10.3126/njdvl.v12i1.10588 Nepal Journal of Dermatology, Venereology & Leprology Vol.12(1) 2014 pp.1-6

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Nail lichen planus: response to treatment and long term follow-up

European Journal of Dermatology ◽

10.1684/ejd.2010.0952 ◽

2010 ◽

Vol 20 (4) ◽

pp. 489-496 ◽

Cited By ~ 30

Author(s):

Bianca Maria Piraccini ◽

Elena Saccani ◽

Michela Starace ◽

Riccardo Balestri ◽

Antonella Tosti

Keyword(s):

Lichen Planus ◽

Response To Treatment ◽

Long Term Follow Up

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Coexistence of palmoplantar lichen planus and lupus erythematosus with response to treatment using acitretin

British Journal of Dermatology ◽

10.1111/j.1365-2133.1996.tb16245.x ◽

1996 ◽

Vol 134 (3) ◽

pp. 538-541 ◽

Cited By ~ 1

Author(s):

E. M. G. J. JONG ◽

P. C. M. KERKHOF

Keyword(s):

Lichen Planus ◽

Lupus Erythematosus ◽

Response To Treatment

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Effects of the pseudomonad phytotoxin coronatine on tomato leaf structure and ultrastructure

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100140683 ◽

1995 ◽

Vol 53 ◽

pp. 862-863

Author(s):

D.A. Palmer ◽

C.L. Bender

Keyword(s):

Pseudomonas Syringae ◽

Membrane Integrity ◽

Leaf Tissue ◽

Cell Number ◽

Cell Ultrastructure ◽

Response To Treatment ◽

Prominent Symptom ◽

Chlorophylls A And B ◽

Cell Dimensions ◽

Structure And Ultrastructure

Coronatine is a non-host-specific phytotoxin produced by several members of the Pseudomonas syringae group of pathovars. The toxin acts as a virulence factor in P. syringae pv. tomato, allowing the organism to multiply to a higher population density and develop larger lesions than mutant strains unable to produce the toxin. The most prominent symptom observed in leaf tissue treated with coronatine is an intense spreading chlorosis; this has been attributed to a loss of chlorophylls a and b in tobacco. Coronatine's effects on membrane integrity and cell ultrastructure have not been previously investigated. The present study describes changes in tomato leaves in response to treatment with purified coronatine, infection by a coronatine-producing strain of P. syringae pv. tomato, and infection by a cor" mutant.In contrast to H2O-treated tissue, coronatine-treated tissue showed a diffuse chlorosis extending approximately 5 mm from the inoculation site. Leaf thickness, cell number, and cell dimensions were similar for both healthy and coronatine-treated, chlorotic tissue; however, the epidermal cell walls were consistently thicker in coronatine-treated leaves (Figs, la and lb).

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