Lichenoid drug reaction differential diagnosis lichen planus. Multifocal oral involvement with roughly symmetrical distribution. Jul 31, 20 dermatopathology reference describes lichenoid drug eruptions histopathology including histologic features and provides links to additional medical references. Lichen planus and lichenoid reactions of the oral mucosa. Oral lichenoid lesions related to contact with dental materials idus. 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.
The diagnosis may be suspected from the unusual clinical features and a skin biopsy then taken. Some of the types of drugs that may trigger this condition include. Olls seem to grossly underrated and most cases were clubbed as olp. The role of patch testing in the management of oral lichenoid.
There is a recent increase in the relatively new subgroups of the lichenoid clinical picture. 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. This clinical uncertainty is usually the result of similar changes in the gross histopathologic structure. Oral lichenoid disease, histopathology, subtypes, characterization, oral lichen planus, oral lichenoid lesion, epithelial dysplasia. A superficial examination of these lesions clinically and histologically often. Histopathological characterization of the oral lichenoid disease. Methylisothiazolinone and methylchloroisothiazolinone mimci are broadspectrum preservatives widely used in cosmetics and household and industrial products. 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.
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. 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. It is increasingly important that dermatologists re. A lichenoid drug eruption is a reaction to a medication. Clinicohistopathological correlation for diagnosis of. Lichen planus lp is a chronic inflammatory and immunemediated disease that affects the skin, nails, hair, and mucous membranes. Gianotticrosti syndrome presenting as lichenoid dermatitis. The authors describe the clinical and histologic features of lichenoid drug reaction in 20 biopsies from 15 patients on anti pd1 agents and 9. Lichenoid keratosis pictures, symptoms, causes, treatment. 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. 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. This takes the form of cell death andor vacuolar change liquefaction degeneration.
A clinicopathological study of lichenoid tissue reactionsa. Clinicopathologic correlation of oral lichen planus and oral. Histologic assessment of lichenoid dermatitis observed in. 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. When a person opts to use liquid nitrogen to remove the lichenoid keratosis it is called liquid nitrogen and curettage. 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. Soeprono teaches and practices dermatopathology at loma linda university, school of medicine, department of dermatology. Oral lichen planus, a common and under recognized inflammatory disorder, shares many clinical and histopathological features with oral lichenoid drug. 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.
Since then, many drug substances have been associated with such lesions. Lichenoid definition of lichenoid by medical dictionary. The term biphasic amyloidosis is used when macular amyloidosis and lichen amyloidosis coexist. 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. 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. 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. 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. Jaad case reports volume 2, number 5 raymond, konya, and bakispetsoglou 381. Practical strategies to improve the clinical utility of. The search words included oral lichen planus, oral lichenoid lesions, oral drug reactions, lichenoid dysplasia, and adverse effects of dental materials. Interface dermatitis is characterized by inflammatory infiltration dermoepidermal junction and defined as lichenoid tissue reaction. In contrast to the idiopathic nature of olp, olls are often associated with a known identifiable inciting factor. So, a total of 90 cases were diagnosed histologically, of which 42 were of the lichen planus type and 48 were lichenoid eruptions. However, the ltrifd can also be seen in skin disorders.
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. Lichen planus is a bilateral andor multifocal disease. It is not known what causes the reaction, but triggers include minor trauma such as friction, drugs, dermatitis, and sun exposure. Lichenoid drug reactions are induced by a medication or another exogenous source which can mimic other lichenoid dermatoses clinically and histologically.
Thus, the aim of this study was to determine the correlation of histopathology and clinical olp. Management of oral lichenoid reaction associated with antitubercular therapy. They can be clinically similar but they have different etiologic factors. 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 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. 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. Definite clinical and histological features were uncovered to establish the identity of this lesion.
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. Imatinib mesylate imatinib is a tyrosine kinase inhibitor initially approved by the us food and drug administration in 2001 for chronic myeloid leukemia cml. The lichenoid reaction pattern interface dermatitis. Edwards, bsc, msc, dds robert kelsch,dmd abstract oral lichen planus olp is a chronic mucosal condition commonly encountered in clinical dental practice. The final diagnosis was gotten through the anamnesis, clinical examination and the allergic test. Clinical examples of a cellrich ltr include lichen planus and its variants.
Oral lichenoid disease, histopathology, subtypes, characterization, oral lichen. 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. 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. There is irregular epidermal hyperplasia forming a characteristic sawtooth appearance with wedgeshaped hypergranulosis. The role of patch testing in the management of oral. Type iv hypersensitivity reaction via langerhans cells\r. Imatinib mesylateinduced lichenoid drug eruption mdedge. Since then, the number of indicated uses for imatinib has substantially increased. Oral lichenoid contact reaction to cinnamoncontaining products such as gums and candies can cause a hypersensitivity reaction termed cinnamon stomatitis.
The lichenoid eruptions are a challenge diagnostically, to both the clinician and the histopathologist, especially in dermatoses which have a lichenoid phase. A and b, lichenoid reaction pattern on histopathology. 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. Lichenoid actinic keratosis has atypical hyperchromatic basal cells esp.
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 clinical and histopathology similarity between olp and olr made differential diagnosis very difficult. Lichenoid dermatitis can be caused for many reasons, so it is important to know them and know how to treat lichenoid dermatitis. The case discussed here is a case of lichenoid reaction associated with anti tubercular therapy. Clinicopathologic correlation of oral lichen planus and. 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. Histopathological discriminant criteria between lichenoid drug. Lichenoid mucosal reaction to rituximab article pdf available in the oncologist 1910 august 2014 with 400 reads how we measure reads. This clinical uncertainty is usually the result of similar changes in the gross histopathologic. Lichen planus is believed to represent an abnormal immune response in which epithelial cells are recognized.
Lichenoid keratosis is an inflammatory reaction arising in a regressing existing solar lentigo or seborrhoeic keratosis. Lichenoid dermatitis project gutenberg selfpublishing. The prototypic skin disease in this category is lichen planus. It is well known that mimci can cause allergic contact dermatitis with a spongiotic reaction pattern. 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. May 20, 2015 patients seen in an oral medicine unit over a 10. Lichenoid drug eruption, also called druginduced lichen planus, is an uncommon cutaneous adverse effect of several drugs. Lichenoid dermatitis occurs in anytime in the persons life. Histopathological characterization of the oral lichenoid. Such manifestations become erythematousscaly as the condition progresses to the subacute phase and papularhyperkeratotic in the chronic phase. 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. The patient had 2 other tattoos with red ink for more than 20 years without any disfigurement.
Histopathological discriminant criteria between lichenoid. It is characterized by a symmetric eruption of flattopped, erythematous or violaceous papules resembling lichen planus on the trunk and extremities. Hypertension drugs contains arb, oral lichenplanus, oral lichenoid reaction. Lichenoid contact dermatitis secondary to methylisothiazolinone mi james raymond, bcomllbhons, bpharm, mbbs, mtax. Histopathology reports blinded to patch test results were scrutinized. Apr 17, 2018 lichenoid dermatitis is an uncommon skin condition within the eczema category.
In lichenoid drug reactions the pathology is nearly identical to lichen planus. 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. Olp and oral lichenoid reactions are two distinct diseases. Lichenoid eruption associated with antituberculous drug. Fewer cases of lichenoid interface dermatoses other than lichen planus was one of the limitations which undermined the analysis and correlation. The spectrum of clinical diseases which is related to the lichenoid tissue reaction is wider. Lichenoid contact dermatitis secondary to methylisothiazolinone mi. The most common agents are nonsteroidal antiinflammatory drugs and angiotensin converting enzyme inhibitors. Irritant or allergic contact dermatitis usually presents as an eczematous process, clinically characterized by erythematoedematovesicous lesions with intense itching in the acute phase.
The lichenoid reaction pattern lichenoid tissue reaction, interface dermatitis is characterized histologically by epidermal basal cell damage. 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. Lichen planus lp is a mucocutaneous disease with wellestablished clinical and microscopic features. 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. A pseudolymphomatous reaction is an unusual immune response that can be caused by a tattoo, most commonly by red ink. It may appear as smooth, velvety, granular or nodular lesion, often with welldefined margins adjacent to normal looking. Druginduced oral lichenoid reactions or oral lichenoid lesions were first cited in 1971 by almeyda and levantine. Histology finding in olr consists of more eosinophils, plasma cells and granulocytes in comparison to olp lesions. Pdf the concept of lichenoid tissue reactioninterface dermatitis was introduced in dermatology. Pseudolymphomatous and lichenoid reaction to a red tattoo. Sign out skin lesion, midmiddle back, punch biopsy. 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. Oral lichenoid reaction pada pasien pengonsumsi obat.
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