There is a recent increase in the relatively new subgroups of the lichenoid clinical picture. Sign out skin lesion, midmiddle back, punch biopsy. There is irregular epidermal hyperplasia forming a characteristic sawtooth appearance with wedgeshaped hypergranulosis. Interface dermatitis is characterized by inflammatory infiltration dermoepidermal junction and defined as lichenoid tissue reaction. Erythroplakia is an uncommon and subtly innocuous change of the oral mucosa, but it has very specific and identifiable clinical characteristics, therapies, and prognostic features. Sontheimer1 a number of uncommon, clinically diverse and poorly understood inflammatory skin diseases are linked by the presence of a set of histopathological elements that have traditionally been referred to as the lichenoid tissue reaction. A pseudolymphomatous reaction is an unusual immune response that can be caused by a tattoo, most commonly by red ink. Irritant or allergic contact dermatitis usually presents as an eczematous process, clinically characterized by erythematoedematovesicous lesions with intense itching in the acute phase. Lichenoid eruption associated with antituberculous drug. Lichen planus is believed to represent an abnormal immune response in which epithelial cells are recognized. It is not known what causes the reaction, but triggers include minor trauma such as friction, drugs, dermatitis, and sun exposure. The diagnosis may be suspected from the unusual clinical features and a skin biopsy then taken.
Treating lichenoid keratosis will usually begin with using a prescription medicated topical cream that contains corticosteroids as the main ingredient or covered with liquid nitrogen. Multifocal oral involvement with roughly symmetrical distribution. Lichenoid actinic keratosis has atypical hyperchromatic basal cells esp. The authors describe the clinical and histologic features of lichenoid drug reaction in 20 biopsies from 15 patients on anti pd1 agents and 9. Histologic assessment of lichenoid dermatitis observed in. A number of uncommon, clinically diverse and poorly understood inflammatory skin diseases are linked by the presence of a set of histopathological elements that have traditionally been referred to as the lichenoid tissue reactioninterface dermatitis ltrifd.
Lichenoid drug reaction differential diagnosis lichen planus. When a person opts to use liquid nitrogen to remove the lichenoid keratosis it is called liquid nitrogen and curettage. Edwards, bsc, msc, dds robert kelsch,dmd abstract oral lichen planus olp is a chronic mucosal condition commonly encountered in clinical dental practice. Lichenoid tissue reaction or interface dermatitis embrace several clinical conditions, the prototype of which is lichen planus and its variants, drug induced lichenoid dermatitis, special forms of lichenoid dermatitis, lichenoid dermatitis in lupus erythematosus, and miscellaneous disorders showing lichenoid dermatitis, the salient clinical and histological features of which are described to. The pathological features of a lichenoid drug eruption may be difficult to distinguish from idiopathic lichen planus, but the diagnosis of lichenoid drug eruptions may be suggested by the types and distribution of inflammatory cells as well as other changes. Clinicopathologic correlation of oral lichen planus and oral. A clinicopathological study of lichenoid tissue reactions. Histopathological characterization of the oral lichenoid. Scanning power view of lichen planus shows a lichenoid reaction pattern figure 1 characterised by the combination of degeneration of the basal layer of the epidermis and a band like lymphocytic infiltrate obscuring the dermoepidermal junction. In lichenoid drug reactions the pathology is nearly identical to lichen planus. They can be clinically similar but they have different etiologic factors. What is a lichenoid drug eruption lichenoid eruptions are uncommon skin rashes that can be induced by many environmental agents, medications or industrial byproducts such as inhaled particles.
Jaad case reports volume 2, number 5 raymond, konya, and bakispetsoglou 381. Imatinib mesylate imatinib is a tyrosine kinase inhibitor initially approved by the us food and drug administration in 2001 for chronic myeloid leukemia cml. Lichenoid drug reactions are induced by a medication or another exogenous source which can mimic other lichenoid dermatoses clinically and histologically. Since then, the number of indicated uses for imatinib has substantially increased. It is increasingly important that dermatologists re. So, a total of 90 cases were diagnosed histologically, of which 42 were of the lichen planus type and 48 were lichenoid eruptions.
Lichenoid mucosal reaction to rituximab article pdf available in the oncologist 1910 august 2014 with 400 reads how we measure reads. Some of the types of drugs that may trigger this condition include. The authors describe the clinical and histologic features of lichenoid drug reaction in 20 biopsies from 15 patients on anti pd1 agents and 9 biopsies from 7 patients on anti pd1 plus ipilimumab. Lichenoid drug reaction is a common adverse reaction in patients taking immunemodulatory agents such as antiprogramed cell death pd1 and cytotoxic t lymphocyte antigen4 agents. This clinical uncertainty is usually the result of similar changes in the gross histopathologic structure. Lichen planus is a bilateral andor multifocal disease. The most common agents are nonsteroidal antiinflammatory drugs and angiotensin converting enzyme inhibitors. Statins and lichenoid drug eruption introduction statins inhibit the enzyme hmgcoa 3hydroxymethylglutarylcoenzyme areductase, which plays an important role in the synthesis of cholesterol by catalysing the conversion from hmgcoa to mevalonate.
Lichenoid dermatitis occurs in anytime in the persons life. Lichenoid definition of lichenoid by medical dictionary. Unlike idiopathic lichen planus, which typically involves flexural surfaces, lichenoid drug eruption is characterized by an extensive symmetric eruption of flattopped violaceous plaques involving the trunk and extremities. It may appear as smooth, velvety, granular or nodular lesion, often with welldefined margins adjacent to normal looking. Olls seem to grossly underrated and most cases were clubbed as olp. Druginduced oral lichenoid reactions or oral lichenoid lesions were first cited in 1971 by almeyda and levantine.
A clinicopathological study of lichenoid tissue reactionsa. Histopathology reports blinded to patch test results were scrutinized. Soeprono teaches and practices dermatopathology at loma linda university, school of medicine, department of dermatology. May 20, 2015 patients seen in an oral medicine unit over a 10. Jul 31, 20 dermatopathology reference describes lichenoid drug eruptions histopathology including histologic features and provides links to additional medical references. Results in a set of 25 patients with lichenoid oral manifestations, patch tests showed a positive reaction to one or more tested substances in 15 patients 60 %, with a total of 31 positive reactions. We present the case of a 40yearold woman with discolored and pruritic plaques in the areas of red ink tattooed on her right ankle that developed shortly after tattoo application. The prototypic skin disease in this category is lichen planus. Management of oral lichenoid reaction associated with antitubercular therapy. Gianotticrosti syndrome presenting as lichenoid dermatitis. The term biphasic amyloidosis is used when macular amyloidosis and lichen amyloidosis coexist. Since then, many drug substances have been associated with such lesions.
Type iv hypersensitivity reaction via langerhans cells\r. A and b, lichenoid reaction pattern on histopathology. Oral lichen planus olp and oral lichenoid lesions oll are clinically and histologically similar lesions but their treatment planning and prognosis are different. Not infrequently, however, contact dermatitis presents with. A superficial examination of these lesions clinically and histologically often. Lichenoid dermatitis project gutenberg selfpublishing. Fewer cases of lichenoid interface dermatoses other than lichen planus was one of the limitations which undermined the analysis and correlation.
Oral lichen planus and oral lichenoid lesions in addition, lichenoid lesions on the mucosal side of the lip, possibly initiated by microbial plaque precipitated on the buccal surfaces of the anterior teeth, have been reported as a. This clinical uncertainty is usually the result of similar changes in the gross histopathologic. Oral lichenoid disease, histopathology, subtypes, characterization, oral lichen planus, oral lichenoid lesion, epithelial dysplasia. The presence or absence of eosinophils can also be helpful in distinguishing a psoriasiform spongiotic reaction often present from psoriasis absent, or a lichenoid drug reaction present figure 3, a and b from. Oral lichenoid lesions related to contact with dental materials idus. It is characterized by a symmetric eruption of flattopped, erythematous or violaceous papules resembling lichen planus on the trunk and extremities. Lichenoid contact dermatitis secondary to methylisothiazolinone mi james raymond, bcomllbhons, bpharm, mbbs, mtax. Oral lichenoid contact reaction to cinnamoncontaining products such as gums and candies can cause a hypersensitivity reaction termed cinnamon stomatitis.
Lichen planus lp is a chronic inflammatory and immunemediated disease that affects the skin, nails, hair, and mucous membranes. The clinical and histopathology similarity between olp and olr made differential diagnosis very difficult. Lichen planus and lichenoid reactions of the oral mucosa. A histological pattern, not a distinct clinical entity due to drug eruption, actinic keratosis, lupus erythematosus, acute graft versus host disease, regressing melanoma and dermatofibroma.
Oral lichenoid lesions or reactions ollsolrs are clinical and histological contemporaries of the classical oral lichen planus olp that have generated a lot of debate in literature. Lichenoid dermatitis can be caused for many reasons, so it is important to know them and know how to treat lichenoid dermatitis. A lichenoid drug eruption is a reaction to a medication. Thus, the aim of this study was to determine the correlation of histopathology and clinical olp. Clinicohistopathological correlation for diagnosis of.
Oral lichenoid disease, histopathology, subtypes, characterization, oral lichen. Lichenoid contact dermatitis secondary to methylisothiazolinone mi. The case discussed here is a case of lichenoid reaction associated with anti tubercular therapy. Histopathological characterization of the oral lichenoid disease. Oral lichen planus, a common and under recognized inflammatory disorder, shares many clinical and histopathological features with oral lichenoid drug. The rash of a lichenoid drug eruption can sometimes be difficult to distinguish from idiopathic lichen planus because of similarities in the clinical appearance and the pathology seen on skin biopsy. It is well known that mimci can cause allergic contact dermatitis with a spongiotic reaction pattern. Soepronos textbook is available on and includes detailed information on over 600 entities and includes four dvd diskettes with highresolution images that provide a virtual dermatopathology reference and guide. During the study period, 107 cases were clinically diagnosed as lichenoid reactions, of which 84 cases were concordant on histopathology and 6 cases were diagnosed, solely based on the histology. Definite clinical and histological features were uncovered to establish the identity of this lesion. Lichenoid keratosis pictures, symptoms, causes, treatment.
It is characterized by polygonal, flattopped, violaceous papules and plaques with overlying, reticulated, fine white scale wickhams striae, commonly affecting dorsal hands, flexural wrists and forearms, trunk, anterior lower legs and oral mucosa. The search words included oral lichen planus, oral lichenoid lesions, oral drug reactions, lichenoid dysplasia, and adverse effects of dental materials. The role of patch testing in the management of oral lichenoid. The lichenoid eruptions are a challenge diagnostically, to both the clinician and the histopathologist, especially in dermatoses which have a lichenoid phase. Lichenoid tissue reactioninterface dermatitis skin diseases have traditionally been subdivided into those clinical disorders that display a highdensity cellrich inflammatory infiltrate and those that display a lowdensity cellpoor infiltrate romero et al. Lichenoid keratoses also known as benign lichenoid keratosis, and solitary lichen planus 12 is a cutaneous condition characterized by brown to red, scaling maculopapules found on sunexposed skin of extremities. Lichen planus lp is a mucocutaneous disease with wellestablished clinical and microscopic features.
The aim of this article was to study the spectrum of clinicohistopathological lesions with an age and sex distribution in various lichenoid reactions of the skin. Pseudolymphomatous and lichenoid reaction to a red tattoo. The patient had 2 other tattoos with red ink for more than 20 years without any disfigurement. Lichenoid tissue reaction or interface dermatitis embrace several clinical conditions, the prototype of which is lichen planus and its variants, drug induced lichenoid dermatitis, special forms of. The final diagnosis was gotten through the anamnesis, clinical examination and the allergic test. The lichenoid reaction pattern lichenoid tissue reaction, interface dermatitis is characterized histologically by epidermal basal cell damage. Histology finding in olr consists of more eosinophils, plasma cells and granulocytes in comparison to olp lesions. However, the ltrifd can also be seen in skin disorders. Such manifestations become erythematousscaly as the condition progresses to the subacute phase and papularhyperkeratotic in the chronic phase. Methylisothiazolinone and methylchloroisothiazolinone mimci are broadspectrum preservatives widely used in cosmetics and household and industrial products. Practical strategies to improve the clinical utility of.
This histopathological appearance and pathophysiological process are mainly observed in lichen planus, lichenoid drug reaction, lichenoid autoimmune connective tissue disease, lichenoid purpura and lichenoid granulomatosis dermatitis. Oral lichenoid reaction pada pasien pengonsumsi obat. Oral lichen planus and oral lichenoid lesions in addition, lichenoid lesions on the mucosal side of the lip, possibly initiated by microbial plaque precipitated on the buccal surfaces of the anterior teeth, have been reported as a possible entity 26. Clinical examples of a cellrich ltr include lichen planus and its variants. Hypertension drugs contains arb, oral lichenplanus, oral lichenoid reaction. Histopathological discriminant criteria between lichenoid drug. Histopathological discriminant criteria between lichenoid. The role of patch testing in the management of oral. The oral mucosa and skin may present clinical and microscopic alterations similar to those observed in lp, called lichenoid reactions lrs, which are triggered by systemic or topical etiological agents. In contrast to the idiopathic nature of olp, olls are often associated with a known identifiable inciting factor. Clinicopathologic correlation of oral lichen planus and.
Apr 17, 2018 lichenoid dermatitis is an uncommon skin condition within the eczema category. Imatinib mesylateinduced lichenoid drug eruption mdedge. Olp and oral lichenoid reactions are two distinct diseases. The spectrum of clinical diseases which is related to the lichenoid tissue reaction is wider. Pdf the concept of lichenoid tissue reactioninterface dermatitis was introduced in dermatology.545 1185 1112 593 1260 1149 633 1122 581 1117 261 1362 841 691 17 564 794 1340 415 1011 715 27 1458 208 376 839 1067 590 198 356 14 1428 1386 1311 1455 1292 974 1069 253 218 1472 823 72