Differentiating bullous lichen planus and lichen planus pemphigoides

Camisa, Charles; Olsen, Richard G.; Yohn, Joseph

doi:10.1016/s0190-9622(84)80203-0

Cited by 13 publications

(4 citation statements)

References 7 publications

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“…As it is a rare disease, most reported cases are isolated or included in limited series. Only 78 cases of LPP were reported in the English literature (including ours) during the last 31 years 2–49 . According to our series, the disease occurs mainly in adults, 5,6,22 but compared with BP, LPP has a younger average age of onset and has been more frequently reported in children (16.6%) 2,13,22,25,31,34 …”

Section: Discussionmentioning

confidence: 51%

Lichen planus pemphigoides: four new cases and a review of the literature

Zarâa¹,

Mahfoudh²,

Sellami³

et al. 2013

Int J Dermatology

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Lichen planus pemphigoides (LPP) is a rare autoimmune blistering disease. It appears to be combination of lichen planus and bullous pemphigoid. We describe four new cases of LPP and discuss the epidemiological, clinical, pathological, and therapeutic features of this singular association through a review of the 74 published cases within the English literature. We report four cases of LPP (three women aged respectively 47, 51, and 53 years old, and a 53-year-old man). All patients presented with bullae on lichenoid and normal skin, predominately on the extremities. The diagnosis was confirmed by immunohistological findings. Our patients were treated with oral corticosteroids with a good response. Our review of the literature of 78 cases of LPP (65 adults and 13 children) showed that it involved adults (mean age: 54 years), with a slight female preponderance. A mean lag time between LP and the development of LPP was 8.3 months. LPP is characterized by developing blisters on lichenoid lesions and on uninvolved skin with more acral distribution of bullous lesions. Involvement of palms and soles was more frequent in children. The diagnosis is based on pathological and immunological confrontation. LPP is usually idiopathic, but some cases were reported in association with various drugs. There have also been reports of association with internal malignancy. Most cases of LPP are successfully treated with systemic corticosteroids. In most cases, the prognosis was good.

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Section: Discussionmentioning

confidence: 51%

Lichen planus pemphigoides: four new cases and a review of the literature

Zarâa¹,

Mahfoudh²,

Sellami³

et al. 2013

Int J Dermatology

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“…Since then, many have attempted to clarify the definition of LPP and distinguish it from bullous LP or coexisting LP and BP. [4][5][6][7][8][9][10][11][12][13] Clinically, LPP is characterized by the abrupt onset of tense bullae prior to, during, or after a papular eruption of LP. 8 The bullae arise on uninvolved skin as well as on pre-existing LP papules.…”

Section: Discussionmentioning

confidence: 99%

Lupus vulgaris complicated by metastatic squamous cell carcinoma

et al. 1998

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A 47-year-old Bedouin man presented with an ulcerated nodule of several months' duration on the nape of the neck. The nodule developed on an asymptomatic, slowly growing plaque which appeared during childhood. Physical examination revealed two erythematous plaques covering the posterior and right lateral aspects of the neck. The border of the plaques was soft, circinate, with a reddish-brown color, while the center was slightly erythematous and atrophic. An ulcerated nodule measuring 2 cm was seen on one of the plaques. Physical examination was unremarkable with no lymphadenopathy. Laboratory tests, including complete blood cell count, erythrocyte sedimentation rate (ESR), and routine chemistry tests, were all within normal limits. Chest X-ray showed a small calcified perihilar lymph node. The Mantoux test was positive with erythema and induration of 15 mm after 48 h. Biopsy from a plaque showed extensive diffuse granulomatous infiltration throughout the dermis with epithelioid and Langhans giant cells surrounded by mononuclear inflammatory cells. No caseation necrosis was present. Ziehl-Neelsen, periodic acid-Schiff (PAS), and Giemsa stains were negative. Polymerase chain reaction (PCR) for the detection of Mycobacterium tuberculosis and atypical mycobacteria from a skin sample was also negative. Fresh tissue cultures yielded M. tuberculosis after 6 weeks. A biopsy specimen from the ulcerated nodule demonstrated islands of atypical malignant squamous cells invading the dermis, which were compatible with moderately differentiated squamous cell carcinoma (SCC). The ulcerated nodule was completely excised, and treatment for tuberculosis was initiated with a combination of isoniazid, rifampicin, and pyrazinamide. Within 3 months of therapy, the patient's lesions resolved, leaving only slightly atrophic hypopigmented scars. A month after the treatment's initiation, an enlarged cervical lymph node was noted showing metastatic SCC on histologic examination. The patient underwent neck dissection and radiation therapy without evidence of any further metastases.

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“…He wondered whether the patient had pemphigus and employed the term lichen ruber pemphigoides . Since then, many have attempted to clarify the definition of LPP and distinguish it from bullous LP or coexisting LP and BP 4–13 . Clinically, LPP is characterized by the abrupt onset of tense bullae prior to, during, or after a papular eruption of LP 8 .…”

Section: Discussionmentioning

confidence: 99%

Lichen planus pemphigoides presenting with a strikingly unilateral distribution

et al. 1998

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A 44‐year‐old Pakistani woman presented with a unilateral eruption of 2 months’ duration. She was in her usual state of health when she awoke one morning with an acute blistering eruption in the right axilla. At that time she also began to experience “rough spots” on the buccal mucosa. Approximately 4 days later, lesions, including small blisters, appeared at multiple other sites, all in a right‐sided distribution. The patient had an 8‐year history of hypothyroidism and was treated with levothyroxine. Physical examination revealed a widely distributed and strikingly right‐sided eruption. Dark brown macules and patches measuring 0.1–1.2 cm, some of which were confluent, were located in the right axillary area at the site of previous blister formation (Fig. 1a). Close inspection revealed that some of these lesions had a glistening and violaceous appearance at their periphery. Discrete, small, flat‐topped papules with similar qualities were also present at this location. Lichenoid lesions were evident in multiple other 1 (a) Hyperpigmented macules and patches in the right axillary region. Some of these lesions had a glistening, violaceous, and raised quality at the periphery (white arrow) suggesting post‐inflammatory hyperpigmentation secondary to lichen planus. (b) Lichenoid lesions in the intergluteal area and the right buttock right‐sided areas, including the submammary area, lower back, intergluteal region, buttock (Fig. 1b), inguinal crease, and knee. Similar lesions on the right arm appeared Koebnerized, extending linearly along the lateral aspect of the mid upper arm to the mid forearm. Examination of the oral mucosa revealed violaceous patches with a lacy pattern on the buccal mucosa. The remainder of the examination was unremarkable. Routine bloodwork was noncontributory. Hepatitis C antibodies were negative. Thyroid function tests were within the range of normal, as were a chest X‐ray examination and routine urinalysis. Punch biopsy of a lower back lichenoid lesion demonstrated a subepidermal bulla with festooning of the dermal papillae (Fig. 2a). Other features included orthokeratosis, a sparse superficial dermal infiltrate (composed of lymphocytes, histiocytes, and eosinophils), and numerous melanophages. A second biopsy from this region was divided for routine histopathology and direct immunofluorescence (DIF). Histopathologic examination was consistent with lichen planus. The features included compact orthokeratosis, hypergranulosis, and irregular, saw‐toothed acanthosis. The basal layer exhibited marked vacuolar change and a band‐like lymphohistiocytic infiltrate was present in the superficial‐most dermis (Fig. 2b). DIF revealed a conspicuous and linear deposition of immunoglobulin G (IgG), C3, and fibrinogen along the epidermal basement membrane zone. There was no staining with antisera to IgM or IgA. Colloid bodies were not identified. Indirect immunofluorescence studies were negative. 2 (a) Biopsy specimen of lichenoid papule on the lower back demonstrated features of bullous pemphigoid. Thes...

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Differentiating bullous lichen planus and lichen planus pemphigoides

Cited by 13 publications

References 7 publications

Lichen planus pemphigoides: four new cases and a review of the literature

Lichen planus pemphigoides: four new cases and a review of the literature

Lupus vulgaris complicated by metastatic squamous cell carcinoma

Lichen planus pemphigoides presenting with a strikingly unilateral distribution

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