Bullous lichen planus and lichen planus pemphigoides-clinico-pathological comparisons

Abstract

Two patients with lichen planus pemphigoides and two with bullous lichen planus were compared. Lichen planus pemphigoides was clinically distinguished by a more generalized lichen planus, more extensive blistering, the need for systemic corticosteroids and by a longer course. The blister of bullous lichen planus was a subepidermal bulla showing degeneration of the epidermal basal layer and other features of lichen planus, whereas in lichen planus pemphigoides the bulla was similar to that of bullous pemphigoid albeit with rather more neutrophils than are usually seen. Direct immunofluorescence was positive in lichen planus pemphigoides and negative in bullous lichen planus. Lichen planus pemphigoides and bullous lichen planus are separate entities: the former is an auto-immune disease precipitated by lichen planus and not related to bullous pemphigoid, the latter is probably not auto-immune but represents the extreme consequence of the lymphoid infiltrate at the dermo-epidermal junction.

Clinicopathological Study of Lichenoid Reactions: A Retrospective Analysis

“…20,21 Thickening of basement membrane zone was observed in systemic lupus erythematosus specimen which was concurrent to findings of Alahlafi AM et al 22 HPE of follicular lichen planus showed characteristic follicular plugging, similar findings were noticed by Wilk M et al 23 in fully developed lesions of follicular lichen planus. Subepidermal bulla noticed in the bullous lichen planus was a typical feature as reported by authours 24,25 in earlier reports and studies. Lichen sclerosus et atrophicus characteristic feature of follicular plugging was seen in both the specimen which has also been noticed by Kowalewski et al 26 Parakeratosis was seen in oral lichen planus specimen.…”

Lichen planus Presenting with Erythema-multiforme-Like Bullous Lesions in a Patient with Systemic Scleroderma

“…According to a recent clinical description, BLP blisters develop 'on long-standing LP lesions' [12] or 'on erythem atous skin, or normal-appearing skin' [13]. DIF findings are those of LP, and in no way do they remind of bullous pem phigoid [9], IIF performed on an autologous or allogenic LP papular substrate has been said to show immunoglobu lin deposits in the granular layer as in classical LP. In fact, this is true only in 50% of cases 113.…”

“…They have been described either as LP pemphigoid (LPP) or bullous LP (BLP) [9], In LPP. the eruption is acute and consists in large bullae on both involved and uninvolved skin.…”

Bullous lichen planus – a review

“…22 Direct immunofluoresence shows linear deposition of IgG and C3 along the dermoepidermal junction. 23,24 Immuno-electron microscopic studies show this deposition to be localized at the base of the bulla, in contrast to BLP where it appears to be on its roof. 25 As in bullous pemphigoid (BP), there are circulating IgG autoantibodies against 180kDa BP antigen and specifically against its major extracellular non-collagenic part.…”