Oral and cutaneous lichen planus pemphigoides

Maceyko, Ronald F.; Camisa, Charles; Bergfeld, Wilma F.; Valenzuela, Rafael

doi:10.1016/0190-9622(92)70275-k

Cited by 23 publications

(9 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The bullae arise on uninvolved skin as well as on pre‐existing LP papules. Intraoral involvement has been described frequently 10 , 14 , 15 . Koebnerization of lesions, as seen in our patient, is commonly seen in LP and has been reported previously in LPP 10 , 16 .…”

Section: Discussionsupporting

confidence: 85%

“…This hypothesis is clinically supported by those cases where the lichenoid eruption antedates the blistering lesions; however, in some patients, the bullous phase antedates the lichenoid eruption. Moreover, 50–66% of all patients with LPP do not have detectable circulating anti‐basement membrane antibodies 10 , 13 , 14 , 17 , 18 . More patients with this rare disease must be investigated in order to fully resolve these issues.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Lichen planus pemphigoides presenting with a strikingly unilateral distribution

et al. 1998

View full text Add to dashboard Cite

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...

show abstract

Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Lichen planus pemphigoides presenting with a strikingly unilateral distribution

et al. 1998

View full text Add to dashboard Cite

show abstract

“…In some of the patients LP lesions were reported to recur without further blistering episodes 12 . Lichen planus pemphigoides may be treated with topical steroids, systemic steroids, tetracycline and nicotinamide, isotretinoin, dapsone and immunosuppressive drugs with variable success 7,11 , 13–15 . Systemic steroids appear to be the most effective treatment in extensive LPP.…”

Section: Discussionmentioning

confidence: 99%

Lichen planus pemphigoides: report of two cases

2001

View full text Add to dashboard Cite

Case 1 A 73‐year‐old woman with a 5‐month history of widespread lichenoid eruption developed disseminated blisters. She had insulin‐dependent diabetes mellitus and renal tuberculosis treated with isoniazide (300 mg/day), rifampin (600 mg/day), ethambutol (1.5 g/day) and pyrazinamide (2 g/day) following right nephrectomy. Antituberculous therapy which had been begun 2 months before the onset of lichenoid eruption was stopped by the patient following the appearence of blisters. Examination revealed lichenoid plaques on the face, neck, trunk and extremities and tense bullae on the neck and extremities (Fig. 1a). The bullae were either on lichenoid plaques or normal appearing skin. Some of the blisters were hemorrhagic. Two skin biopsies were performed. The first biopsy from a blister with a lichenoid base on the arm, showed typical changes of lichen planus (LP) with subepidermal cleft formation. The second biopsy from a blister on normal appearing skin on the trunk showed subepidermal bulla with perivascular inflammatory cell infiltrate of eosinophils and lymphocytes. Direct immunofluorescence (DIF) of perilesional skin showed linear deposition of IgG and C3 along basal membrane zone (BMZ). Direct immunofluorescence on salt‐split skin revealed epidermal binding of immunoreactants. Indirect immunofluorescence showed a circulating IgG autoantibody binding to the BMZ at a titre of 1/200. Immunoblot analysis of her serum recognized minor 180 Kd BP antigen. An initial trial of dapsone (100 mg/day) for 2 weeks was not effective. She was then treated with oral methylprednisolone (32 mg/day), which induced rapid improvement in her skin lesions (Fig. 1b). After 2 months of treatment, corticosteroid was stopped and the patient stayed in remission for 1 year till she died due to myocard infarction. 1 (a) Lichenoid papules and hemorrhagic blisters on the face and the neck. (b) After 2 months of oral methylprednisolone therapy Case 2 A 64‐year‐old man with a 2‐year history of pruritic papules on his hands developed a bullous eruption on his extremities. Physical examination revealed violaceous flat‐topped papules on the dorsum of the hands and blisters on the extremities (Fig. 2). Some of the blisters occured on an erythematous base while others occurred on normal appearing skin. Mucous membranes were not affected. A skin biopsy taken from a blister revealed subepidermal bulla containing fibrin, eosinophils and neutrophils and perivascular inflammatory infiltrate of lymphocytes and eosinophils in the dermis. Adjacent to the blister were changes typical of LP (Fig. 3). Direct immunofluorescence showed linear deposition of IgG and C3 along BMZ. Direct immunofluorescence on salt‐split skin showed epidermal binding of immunoreactants. The patient's skin lesions cleared rapidly after oral methylprednisolone (48 mg/day) and dapsone (100 mg/day) started. Methylprednisolone and dapson was discontinued after 12 and 16 weeks, respectively. There has been no recurrence during the follow‐up period of 1 year. 2 Crusted and eroded les...

show abstract

“…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.…”

Section: Discussionmentioning

confidence: 99%

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

1995

View full text Add to dashboard Cite

A patient with systemic scleroderma is described who developed a cutaneous eruption of papules and vesicobullae. Over time, the latter turned into papules. The histopathological and immunofluorescence features of the papular lesions were unequivocally those of lichen planus, while those of the bullous lesions reminded of erythema multiforme. Histologically, erythema multiforme shares common features with lichenoid reactions, such as necrotic keratinocytes. Our case suggests that erythema multiforme and lichen planus may coexist or succeed each other as different stereotype immune reactions against the same antigen(s) within the epidermis.

show abstract

Oral and cutaneous lichen planus pemphigoides

Cited by 23 publications

References 20 publications

Lichen planus pemphigoides presenting with a strikingly unilateral distribution

Lichen planus pemphigoides presenting with a strikingly unilateral distribution

Lichen planus pemphigoides: report of two cases

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

Contact Info

Product

Resources

About