Extragenital lichen sclerosus of the breast and silicone breast implants

Lichen sclerosus of the breast (LSB) is an uncommon inflammatory dermatosis of an incompletely understood pathogenesis. Herein, we report the case of a 29-year-old female who developed LSB 23 years after a silicone breast implant. A diagnostic skin biopsy revealed the typical three-layered pathology of an atrophic epidermis with the loss of rete ridges and basal keratinocyte vacuolization, a subepidermal band of sclerosis, and a lichenoid infiltrate of lymphocytes beneath that band. We discuss the possible relationship between silicone breast implants and autoimmune disorders.

CHARACTERISTICS OF PERIPHERAL NERVOUS SYSTEM IN PATIENTS WITH PSORIASIS

Psoriasis is a chronic non-infectious inflammatory dermatosis characterized by excessive proliferation of epithelial cells, impaired differentiation, often involving the musculoskeletal system. Materials and Methods. The authors examined 60 patients with psoriasis, 39 men and 21 women, aged from 21 to 69 (the average subject age was 46.3±13.94). All patients underwent a standard dermatological and neurological examination. Motor function was assessed according to knee jerk, elbow jerk and Achilles jerk. Pain sensitivity was established after pricking the thumb dorsum with a special blunt-end needle. Nonparametric methods were used for statistical analysis. The Mann-Whitney U-test was used to check the differences between independent groups of patients. The distribution of characteristic was assessed using a probability calculator. Differences were statistically significant at 95 % probability (p<0.05). Results. Mild psoriasis was found in 8 patients (13.3 %), moderate-to-severe psoriasis – in 14 patients (23 %) (PASI=11–30), severe psoriasis – in 38 patients (63.7 %) (PASI>30). Type I psoriasis was detected in 32 patients (53.2 %), type II – in 28 patients (46.8 %). Dysfunctions of the peripheral nervous system were found in 30 patients (50 %). In 12 subjects (20 %) symmetrical sensory and motor disturbances were observed in the distal parts of all four limbs. In 9 patients (15 %) symmetrical decrease in knee and Achilles jerks was observed. Symmetrical decrease in tactile and temperature sensitivity in the distal parts of the lower extremities was noted in 9 patients with psoriasis (15 %). Conclusion. Distal symmetric sensorimotor polyneuropathy is common in patients with psoriasis. Severe psoriasis is accompanied by distal symmetric sensorimotor polyneuropathy. Key words: psoriasis, comorbidity, demyelination, polyneuropathy. Псориаз – это хронический неинфекционный воспалительный дерматоз, характеризующийся избыточной пролиферацией эпителиоцитов, нарушением их дифференциации, нередко вовлекающий в процесс опорно-двигательный аппарат. Материалы и методы. Обследовано 60 больных псориазом, из них 39 мужчин и 21 женщина в возрасте от 21 до 69 лет (средний возраст обследуемых 46,3±13,94 года). Всем больным проводился стандартный дерматологический и неврологический осмотр. Двигательная функция исследовалась с помощью оценки коленного, локтевого и ахиллова рефлексов. Болевая чувствительность устанавливалась после укола тыльной поверхности большого пальца специальной иглой с притупленным концом. Для статистического анализа использовались непараметрические методы. Для проверки отличий между независимыми группами больных применялся Mann – Whitney U-test. Распределение признака оценивалось с помощью вероятностного калькулятора. Статистические значимыми считались отличия при уровне вероятности более 95 % (p<0,05). Результаты. Легкая степень псориаза установлена у 8 (13,3 %) больных, умеренно тяжелый псориаз – у 14 (23 %) пациентов (индекс PASI 11–30 баллов), тяжелая форма псориаза – у 38 (63,7 %) больных (индекс PASI более 30 баллов). Псориаз I типа определялся у 32 (53,2 %) больных, II типа – у 28 (46,8 %). У 30 (50 %) больных обнаружены нарушения функции периферической нервной системы. У 12 (20 %) чел. наблюдались симметричные сенсорные и двигательные нарушения в дистальных отделах всех четырех конечностей. У 9 (15 %) чел. отмечалось симметричное снижение коленного и ахиллова рефлексов. Девять (15 %) больных псориазом имели симметричное снижение тактильной и температурной чувствительности в дистальных отделах нижних конечностей. Выводы. У больных псориазом часто встречается дистальная симметричная сенсорно-моторная полинейропатия. Тяжелое течение псориаза сопровождается дистальной симметричной сенсорно-моторной полинейропатией. Ключевые слова: псориаз, коморбидность, демиелинизация, полинейропатия.

Vulvar Lichen Sclerosus et Atrophicus in girls

The review is devoted to diagnosing and treating lichen sclerosus (LS), a chronic inflammatory dermatosis with a predisposition to lesions of the anogenital region in girls. An essential role in the aetiology of this form of pathology is attributed to genetic mutations, injuries, infections and autoimmune diseases, and hormonal and local factors. The peak incidence is observed in 4-6 year girls, accounting for 7-15% of all cases of vulvar LS. The main goal of pharmacotherapy for vulvar LS is to relieve clinical symptoms and prevent scarring and adhesions. The authors analyzed international and domestic publications from 2017 to 2021. PubMed and Google Academy databases were used for the search, keywords: lichen sclerosus, girls. The retrospective and prospective cohort, randomized clinical trials, case series and literature reviews, and clinical guidelines were considered. Our review presents modern data on the diagnosis and treatment of SL in girls, which will be useful for both pediatric gynecologists and doctors of related specialties. The first symptoms of LS are usually nonspecific and are misdiagnosed by non-profile specialists. Some symptoms of LS may disappear spontaneously after menarche, and the course of the disease may be latent. This is why it is generally accepted that the epidemiology of LS is underestimated. Despite this, it can be assumed that the etiology and pathogenesis of LS is probably multifactorial. This review describes several leading etiological factors regarding the potential etiopathogenesis of vulvar LS in girls.

Hyperbaric oxygen therapy as an adjunctive treatment for pyoderma gangrenosum: a case report

<p class="abstract">Pyoderma gangrenosum is an uncommon inflammatory dermatosis associated with chronic wounds. Diagnosis and management can be challenging to clinicians due to the relapsing nature of the disorder, atypical presentations, and exclusion of other conditions before diagnosis. Hyperbaric oxygen therapy is not a mainstay of treatment for pyoderma gangrenosum, but it is used for non-healing wounds associated with diabetes and vascular insufficiency due to its primary mechanism of tissue hyperoxia, resultant angiogenesis, and reduction of edema and inflammation. This case report presents two patients with pyoderma gangrenosum who were provided adjunctive therapy with hyperbaric oxygen with favorable outcomes.</p>

The role of food allergy in the etiology of infantile eosinophilic pustular folliculitis

Eosinophilic pustular folliculitis (EPF) of infancy (EPFI), as a rare variant of EPF, is an inflammatory dermatosis characterized by recurrent outbreaks, itchy papulopustules and involvement of scalp and other body areas. In our case, we present a 3-month-old boy with persistent itchy vesiculopustular rashes on the scalp, hands and feet, eosinophilia in the peripheral blood test, widespread eosinophil clusters in the swab of the pustule and egg allergy in the skin prick test. This is the first case of EPFI associated with food allergy that is permanently suppressed by elimination diet with the limited use of cetirizine.

Zosteriform lichen planus as a manifestation of Wolf’s isotopic response

Background Wolf’s isotopic response has been described in association with malignancy, infections, and inflammatory disorders. Lichenoid tissue reactions are a rare but recognized example of this phenomenon; only 41 cases of zosteriform lichen planus exist in publication. This case adds to the minimal literature describing lichenoid inflammatory dermatosis compatible with Wolf’s isotopic response. Methods Literature review and case description. Results A man in his 30s with a history of herpes zoster presented with a pruritic rash on his left arm. Clinical and histopathological evaluation were consistent with lichen planus in the distribution of a healed herpes zoster rash. The skin lesions improved after six weeks of treatment with clobetasol 0.05% ointment twice daily. Conclusions The presentation of lichen planus as Wolf’s isotopic response is uncommon, but responsive to standard topical therapy.

Malignant Transformation of Labial Lichen Planus: A Case Report and a Review of the Literature

Oral Lichen Planus (OLP) is a chronic inflammatory dermatosis usually benign that can affect skin, integuments and mucosal membranes presented with various clinical appearances. Typically characterized by the presence of white lace-like lesions, with or without atrophic or erosive areas. Its diagnosis is based on the clinical examination and histological analysis. In most of the cases, the OLP has a benign evolution but malignant transformation may occur justifying the strict surveillance of the disease and effective treatment of relapses. We report the case of a 58-year-old man, without specific and non-smoking history, reported to the Oral Surgery Department of the Consultation Center of Dental Treatment of Rabat, presenting oral lesions lasting for three years. The intraoral examination and biopsy were concluded an erosive oral lichen planus. Two years after, the labial lesion changed its appearance. Pathological diagnosis confirmed the presence of squamous cell carcinoma. Total surgical excision was performed with respect of carcinologic resection margins. The present case supports the view that OLP may undergo malignant transformation, and that this does not require exogenous carcinogens. Oral lichen planus is a potentially malignant disorder with a capacity, although low, for malignant transformation. Of all the factors related to the process of malignant transformation, the chronic inflammation seems to be the key factor in the development of oral cancer. The highest rate of malignancy was noted in erythematous and erosive lesions. In this way, follow-up of OLP patients could be carried out more efficiently and appropriately.

AYURVEDIC APPROACH ON LICHEN PLANUS WITH SPECIAL REFERENCE TO KITIBHA KUSHTHA: A CASE STUDY

Skin disease makes as a great impact as other serious medical conditions when assessed by effects on health-related quality of life. There has been widespread acknowledgment that skin diseases can affect physical, social, and psychological aspects of patient’s everyday lives, as well as their partners, family, and friends, one such disease is Lichen planus. Lichen planus is a pruritic, benign, papulo-squamous, inflammatory dermatosis of unknown aetiology that affects either or all the skin, mucous membrane, hair, and nails. In its classical form, it presents with violaceous, scaly, flat topped, polygonal and papules. In classical texts of Ayurveda, the diagnosis is considered as Kitibha Kushtha. Kitibha Kushtha is vata and kapha dosha dominant condition in class of Kshudra Kushtha which has lakshanas like Shyava, Kina-khara sparsha, Parusha. Here, an effort was made to treat a thirty-eightyears old female diagnosed with Kitibha Kushtha vis-a-vis Lichen planus by classical Ayurveda regimens. She was administered with Shodhana therapies (bio-cleansing procedures) and then followed by intake of Thuvaraka rasayana and Shamana Aushadhis. The total duration of the treatment was 44 days, and the Study subject assessed before treatment and after treatment for improvement using Lichen planus Severity Index. All the symptoms observed in the beginning were found considerably reduced, and the severity also found mild.

Cutaneous Adverse Reactions to COVID-19 Vaccines: Insights from an Immuno-Dermatological Perspective

(1) Background: Numerous vaccines are under preclinical and clinical development for prevention of severe course and lethal outcome of coronavirus disease 2019 (COVID-19). In light of high efficacy rates and satisfactory safety profiles, some agents have already reached approval and are now distributed worldwide, with varying availability. Real-world data on cutaneous adverse drug reactions (ADRs) remain limited. (2) Methods: We performed a literature research concerning cutaneous ADRs to different COVID-19 vaccines, and incorporated our own experiences. (3) Results: Injection site reactions are the most frequent side effects arising from all vaccine types. Moreover, delayed cutaneous ADRs may occur after several days, either as a primary manifestation or as a flare of a pre-existing inflammatory dermatosis. Cutaneous ADRs may be divided according to their cytokine profile, based on the preponderance of specific T-cell subsets (i.e., Th1, Th2, Th17/22, Tregs). Specific cutaneous ADRs mimic immunogenic reactions to the natural infection with SARS-CoV-2, which is associated with an abundance of type I interferons. (4) Conclusions: Further studies are required in order to determine the best suitable vaccine type for individual groups of patients, including patients suffering from chronic inflammatory dermatoses.