Vulval lichen planus–lichen sclerosus overlap

2018 ◽  
Vol 29 (10) ◽  
pp. 1017-1023 ◽  
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.

Indian Dermoscopic Study of Forty Six Cases of Lichen Planus Pigmentosus - New Dermoscopy Signs Discovered

2018 ◽  
Vol 3 (02) ◽  
Author(s):  
Rahul Kumar Sharma, Rajendra Kumar Sharma
Keyword(s):  
Lichen Planus ◽  
Smart Phone ◽  
Poor Response ◽  
Response To Treatment ◽  
Dermatology Clinic ◽  
Single Marker ◽  
Brownish Black ◽  
Brown Pigmentation ◽  
Black Pigmentation ◽  
Very High

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.

scholarly journals Management Of Childhood Lichen Planus

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

scholarly journals Persistent airway inflammation and high exacerbation rate in asthma that starts at menopause

2016 ◽  
Vol 67 (3) ◽  
Author(s):  
G. Balzano ◽  
S. Fuschillo ◽  
E. De Angelis ◽  
C. Gaudiosi ◽  
A. Mancini ◽  
...  
Keyword(s):  
Airway Inflammation ◽  
Eosinophil Count ◽  
Poor Response ◽  
Clinical Severity ◽  
Response To Treatment ◽  
High Dose ◽  
Severe Exacerbation ◽  
Sputum Eosinophil ◽  
Exacerbation Rate ◽  
Oral Corticosteroids

Background and Aim. Asthma that begins around the time of menopause is frequently characterised by marked clinical severity and poor response to treatment. We sought to assess the clinical characteristics, bronchial responsiveness, perception of induced bronchoconstriction and airway inflammation in women with menopausal asthma, as compared to women of a similar age with pre-existing asthma. Methods. Nine women with pre-existing asthma were selected for clinical severity (symptoms, lung function and medication requirements) similar to that in 11 women with menopausal asthma. Anti-asthmatic treatment in all of the study patients included high dose inhaled (with or without oral) corticosteroids. Results. The women with menopausal asthma demonstrated less atopy, more chronic recurrent sinusitis, similar airway responsiveness, and similar perception of induced bronchoconstriction, but a significantly higher sputum eosinophil count (19.5 ± 10.8 versus 3.3 ± 4.3%; p < 0.001) and a higher severe exacerbation rate during the 1-year follow-up period (5.09 ± 4.85 versus 0.78 ± 0.97; p < 0.05). Sputum eosinophil count and severe asthma exacerbation rate correlated well in both groups considered as a whole (r = 0.65; p < 0.005). Conclusion. The eosinophilic airway inflammation present in women with menopausal asthma is poorly responsive to anti-inflammatory treatment with corticosteroids and predisposes to frequent severe exacerbations. Airway inflammation should be monitored in women with menopausal asthma.

Vulval Lichen sclerosus, Erosive Lichen Planus, and Vulvodynia

2014 ◽  
pp. 615-623
Author(s):  
Rosalind C. Simpson ◽  
Ruth Murphy ◽  
David Nunns
Keyword(s):  
Lichen Planus ◽  
Lichen Sclerosus ◽  
Erosive Lichen Planus

scholarly journals Correlation Of Clinical Severity Of Oral Lichen Planus With Treatment Prognosis - A Retrospective Institution Based Study

2020 ◽  
Vol 11 (SPL3) ◽  
pp. 1937-1942
Author(s):  
Krishnapriya Umashankar ◽  
Hannah R
Keyword(s):  
Lichen Planus ◽  
Oral Lichen Planus ◽  
Clinical Findings ◽  
Clinical Severity ◽  
Genital Organ ◽  
Duration Of Treatment ◽  
Erosive Lichen Planus ◽  
Etiological Agents ◽  
Treatment Prognosis ◽  
Oral Lichen

Lichen planus is a chronic mucocutaneous immunologically mediated disease which is triggered by varied etiological agents. Lichen planus shows many clinical features affecting the skin, oral cavity, genital organ, nail and scalp. Lichen planus has well documented clinical findings and histological findings that aid in diagnosis. This retrospective study was done to assess the clinical severity of Oral Lichen Planus (OLP) and compare it to the treatment prognosis of the patients visiting our institution. A total of 60 clinically diagnosed OLP patients were included. Clinical and treatment details were recorded and tabulated using Excel. The collected data were then analyzed by appropriate statistics using SPSS software. The results revealed 60% of the cases to be females with 58.3% accounting for the erosive type of lichen planus. 60% had involvement of bilateral buccal mucosa. Erosive variant showed eight months duration of treatment using systemic steroids. Within the limitations of the study, we observed that  OLP accounts for nearly 28.4% of the OPMD reporting to the institution and females were found to be more commonly affected than males. Erosive lichen planus was the most common variant which exhibited maximum treatment duration. Hence, it is necessary to follow up the OLP patients regularly and to provide a precise treatment which prevents the remission of the disease in these patients.

Criteria positive and criteria negative anaphylaxis, with a focus on undifferentiated somatoform idiopathic anaphylaxis: A review and case series

2020 ◽  
Vol 41 (6) ◽  
pp. 436-441 ◽  
Author(s):  
Daniel A. Rosloff ◽  
Kunal Patel ◽  
Paul J. Feustel ◽  
Jocelyn Celestin
Keyword(s):  
Diagnostic Criteria ◽  
Statistical Significance ◽  
Case Series ◽  
Poor Response ◽  
Response To Treatment ◽  
Fisher Exact Test ◽  
Subjective Symptoms ◽  
Significant Difference ◽  
Physical Findings ◽  
Idiopathic Anaphylaxis

Background: Undifferentiated somatoform (US) idiopathic anaphylaxis (IA) is considered a psychogenic disorder characterized by a lack of observable physical findings and poor response to treatment. Although failure to diagnose true anaphylaxis can have disastrous consequences, identification of US-IA is crucial to limit unnecessary expenses and use of health care resources. Objective: To better define the presentation and understand the potential relationship between US-IA and underlying psychiatric comorbidities. Methods: We retrospectively reviewed 110 visits by 107 patients to our institution for evaluation and management of anaphylaxis over a 1-year period. The patients were classified as having either criteria positive (CP) or criteria negative (CN) anaphylaxis based on whether they met Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network Symposium criteria for the clinical diagnosis of anaphylaxis. Patient characteristics, including objective and subjective signs and symptoms, and the presence of psychiatric diagnoses were collected and analyzed. Statistical significance was assessed by using the Fisher exact test. A literature review of US-IA and other psychogenic forms of anaphylaxis was performed. Results: Patients with CP anaphylaxis were more likely to present with hypotension, wheezing, urticaria, and vomiting than were patients with CN anaphylaxis. The patients with CN anaphylaxis were more likely to present with subjective symptoms of sensory throat tightness or swelling compared with patients with CP anaphylaxis. No significant difference was detected in the prevalence of psychiatric conditions between the two groups. Conclusion: Patients who met previously established diagnostic criteria for anaphylaxis were more likely to present with objective physical findings than those who did not meet criteria for true anaphylaxis. CN patients who presented for treatment of anaphylaxis were more likely to present with subjective symptoms. Formal diagnostic criteria should be used by clinicians when evaluating patients with suspected anaphylaxis.

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