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 © 2001-2009, DermAtlas | Image Name: | dermatitis_herpetiformis_4_070429 | File Type: | jpg | |
| Diagnosis: | DERMATITIS HERPETIFORMIS | Category: | vesiculobullous eruptions, immunobullous / vesiculobullous eruptions | ||
| Body Site: | arm / elbow | Age: | 58 years | ||
| Contributor: | Grant Anhalt, MD | ||||
| Description: | Granular deposits of IgA are seen in the dermal papillae. | ||||
| Comments: | These changes are typical of dermatitis herpetiformis | ||||
| Related Images: | All related Images dermatitis_herpetiformis_9_070429 dermatitis_herpetiformis_8_070429 dermatitis_herpetiformis_7_070429 dermatitis_herpetiformis_6_070429 dermatitis_herpetiformis_5_070429 dermatitis_herpetiformis_3_070429 dermatitis_herpetiformis_2_070429 dermatitis_herpetiformis_1_070429 | ||||
 © 2001-2009, DermAtlas | Image Name: | oropharyngeal_lichen_planus_1_050115 | File Type: | jpg | |
| Diagnosis: | LICHEN PLANUS | Category: | dental/oral disorder / cutaneous sign of systemic disease | ||
| Body Site: | mouth / gingiva | Age: | 76 years | ||
| Contributor: | Grant Anhalt, MD | ||||
| Description: | superficial erosions and friable pink and white gingiva | ||||
| Comments: | This 76-year-old woman noted vaginal bleeding, which was initially diagnosed as lichen sclerosis. She then developed intermittent painful lesions in oral mucosa followed by dysphagia. Initially she had trouble swallowing pills, but ater she developed dysphagia with most foods, choking sensation, and retrosternal pain. She lost significant weight over 2-3 years. A biopsy of the gingiva was consistent with lichen planus, and endoscopy revealed a cervical esophageal stricture severe enough to prevent passage of the endoscope. A complete medical and laboratory evaluation was otherwise normal. She was treated with oral prednisone and mycophenolate mofetil and tacrolimus topically. Prednisone was tapered slowly. Serial esophageal dilations with intralesional steroid injections into stricture was also performed. Lichen planus (LP) is an idiopathic disease of the skin and mucosa. Mucosal surfaces involved in lichen planus may include perineum, oral mucosa and pharynx. Histologically, LP is characterized by a dense, band-like lymphocytic infiltrate under an acanthotic epidermis, destruction of the basal layer and hypergranulosis. Histology of mucosal epithelium in LP is slightly different than cutaneous LP. It frequently shows parakeratoisis and often fails to show hypergranulosis. The epithelium may be atrophic rather than acanthotic. Oral lichen planus is seen in approximately 1-4 percent of the population, with onset of disease occurring most frequently in the 5th and 6th decade. Approximately 25 percent of all patients with LP have only mucosal manifestations. The most common form of oral LP is the reticular pattern, characterized by Wickham’s striae, that is usually asymptomatic. Erosive oral LP, on the other hand, is less common, but may be extremely painful. Esophageal lichen planus is often under reported and diagnosed. It should always be evaluated for in patients with oral LP. Esophageal LP occurs mainly in middle-aged women. The overwhelming clinical complaint is dysphagia, but reflux type symptoms or a history of retrosternal pain can often be elicited. All of the patients, thus far reported, with esophageal disease have had concomitant oral LP. Although the histology and clinical exam often make the diagnosis of lichen planus, the differential diagnosis of esophageal strictures with ulceration should include esophagitis from pill ingestion, GERD, infectious agents, and medication induced LP-like lesions (from gold, thiazides, and anti-malarials). Correct diagnosis and treatment of esophageal LP is of critical importance. Delay in diagnosis may lead to serial dilations of esophageal strictures that, without simultaneous medical treatment, may lead to koebnerization of lichen planus and worsening of the stricture. Patients can lose significant weight and become dehydrated secondary to stenosis. In addition, patients should be monitored for transformation of oral LP lesions into squamous cell carcinoma, as this has been reported in several studies. Therapy for oral lichen planus with esophageal involvement includes systemic as well as possible topical therapies. Referral to a gastroenterologist for endoscopy and dilations, with or without steroid injections, is often necessary. At first diagnosis, systemic steroids are often needed to quell the inflammation. A variety of steroid sparing agents have been used successfully including mycophenolate mofetil, azathioprine, cyclosporine, and etretinate. Topical steroids and tacrolimus may ease the symptoms. References: Abraham SC, Ravich WJ, Anhalt GJ, et al. Esophageal lichen planus: Case report and review of the literature. American Journal of Surg Path. 2000; 24(12): 1678-1682. Menges M, Hohloch K, et al. Lichen planus with esophageal involvement. Digestion. 2002; 65: 184-189. Harewood GC, Murray JA, Cameron AJ. Esophageal lichen planus: the Mayo Clinic experience. Dis Esophagus. 1999; 12(4): 309-311. | ||||
 © 2001-2009, DermAtlas | Image Name: | oropharyngeal_lichen_planus_7_050115 | File Type: | jpg | |
| Diagnosis: | LICHEN PLANUS | Category: | dental/oral disorder / cutaneous sign of systemic disease | ||
| Body Site: | mouth / gingiva | Age: | 76 years | ||
| Contributor: | Grant Anhalt, MD | ||||
| Description: | Hydropic degeneration of the basal cell layer is evident with numerous apoptotic pink keratinocytes (Civatte bodies). An intense lymphocytic infiltrate is present in the superficial lamina propria. These changes are typical of lichen planus of the oral mucosa. | ||||
| Comments: | This 76-year-old woman noted vaginal bleeding, which was initially diagnosed as lichen sclerosis. She then developed intermittent painful lesions in oral mucosa followed by dysphagia. Initially she had trouble swallowing pills, but ater she developed dysphagia with most foods, choking sensation, and retrosternal pain. She lost significant weight over 2-3 years. A biopsy of the gingiva was consistent with lichen planus, and endoscopy revealed a cervical esophageal stricture severe enough to prevent passage of the endoscope. A complete medical and laboratory evaluation was otherwise normal. She was treated with oral prednisone and mycophenolate mofetil and tacrolimus topically. Prednisone was tapered slowly. Serial esophageal dilations with intralesional steroid injections into stricture was also performed. Lichen planus (LP) is an idiopathic disease of the skin and mucosa. Mucosal surfaces involved in lichen planus may include perineum, oral mucosa and pharynx. Histologically, LP is characterized by a dense, band-like lymphocytic infiltrate under an acanthotic epidermis, destruction of the basal layer and hypergranulosis. Histology of mucosal epithelium in LP is slightly different than cutaneous LP. It frequently shows parakeratoisis and often fails to show hypergranulosis. The epithelium may be atrophic rather than acanthotic. Oral lichen planus is seen in approximately 1-4 percent of the population, with onset of disease occurring most frequently in the 5th and 6th decade. Approximately 25 percent of all patients with LP have only mucosal manifestations. The most common form of oral LP is the reticular pattern, characterized by Wickham’s striae, that is usually asymptomatic. Erosive oral LP, on the other hand, is less common, but may be extremely painful. Esophageal lichen planus is often under reported and diagnosed. It should always be evaluated for in patients with oral LP. Esophageal LP occurs mainly in middle-aged women. The overwhelming clinical complaint is dysphagia, but reflux type symptoms or a history of retrosternal pain can often be elicited. All of the patients, thus far reported, with esophageal disease have had concomitant oral LP. Although the histology and clinical exam often make the diagnosis of lichen planus, the differential diagnosis of esophageal strictures with ulceration should include esophagitis from pill ingestion, GERD, infectious agents, and medication induced LP-like lesions (from gold, thiazides, and anti-malarials). Correct diagnosis and treatment of esophageal LP is of critical importance. Delay in diagnosis may lead to serial dilations of esophageal strictures that, without simultaneous medical treatment, may lead to koebnerization of lichen planus and worsening of the stricture. Patients can lose significant weight and become dehydrated secondary to stenosis. In addition, patients should be monitored for transformation of oral LP lesions into squamous cell carcinoma, as this has been reported in several studies. Therapy for oral lichen planus with esophageal involvement includes systemic as well as possible topical therapies. Referral to a gastroenterologist for endoscopy and dilations, with or without steroid injections, is often necessary. At first diagnosis, systemic steroids are often needed to quell the inflammation. A variety of steroid sparing agents have been used successfully including mycophenolate mofetil, azathioprine, cyclosporine, and etretinate. Topical steroids and tacrolimus may ease the symptoms. References: Abraham SC, Ravich WJ, Anhalt GJ, et al. Esophageal lichen planus: Case report and review of the literature. American Journal of Surg Path. 2000; 24(12): 1678-1682. Menges M, Hohloch K, et al. Lichen planus with esophageal involvement. Digestion. 2002; 65: 184-189. Harewood GC, Murray JA, Cameron AJ. Esophageal lichen planus: the Mayo Clinic experience. Dis Esophagus. 1999; 12(4): 309-311. | ||||
 © 2001-2009, DermAtlas | Image Name: | oropharyngeal_lichen_planus_3_050115 | File Type: | jpg | |
| Diagnosis: | LICHEN PLANUS | Category: | dental/oral disorder / cutaneous sign of systemic disease | ||
| Body Site: | esophagus | Age: | 76 years | ||
| Contributor: | Grant Anhalt, MD | ||||
| Description: | The esophageal biopsy showed a focal erosion with acute and chronic inflammation. Reactive epithelial changes with acantholysis and a cleft compatible with bulla formation was also seen. | ||||
| Comments: | This 76-year-old woman noted vaginal bleeding, which was initially diagnosed as lichen sclerosis. She then developed intermittent painful lesions in oral mucosa followed by dysphagia. Initially she had trouble swallowing pills, but ater she developed dysphagia with most foods, choking sensation, and retrosternal pain. She lost significant weight over 2-3 years. A biopsy of the gingiva was consistent with lichen planus, and endoscopy revealed a cervical esophageal stricture severe enough to prevent passage of the endoscope. A complete medical and laboratory evaluation was otherwise normal. She was treated with oral prednisone and mycophenolate mofetil and tacrolimus topically. Prednisone was tapered slowly. Serial esophageal dilations with intralesional steroid injections into stricture was also performed. Lichen planus (LP) is an idiopathic disease of the skin and mucosa. Mucosal surfaces involved in lichen planus may include perineum, oral mucosa and pharynx. Histologically, LP is characterized by a dense, band-like lymphocytic infiltrate under an acanthotic epidermis, destruction of the basal layer and hypergranulosis. Histology of mucosal epithelium in LP is slightly different than cutaneous LP. It frequently shows parakeratoisis and often fails to show hypergranulosis. The epithelium may be atrophic rather than acanthotic. Oral lichen planus is seen in approximately 1-4 percent of the population, with onset of disease occurring most frequently in the 5th and 6th decade. Approximately 25 percent of all patients with LP have only mucosal manifestations. The most common form of oral LP is the reticular pattern, characterized by Wickham’s striae, that is usually asymptomatic. Erosive oral LP, on the other hand, is less common, but may be extremely painful. Esophageal lichen planus is often under reported and diagnosed. It should always be evaluated for in patients with oral LP. Esophageal LP occurs mainly in middle-aged women. The overwhelming clinical complaint is dysphagia, but reflux type symptoms or a history of retrosternal pain can often be elicited. All of the patients, thus far reported, with esophageal disease have had concomitant oral LP. Although the histology and clinical exam often make the diagnosis of lichen planus, the differential diagnosis of esophageal strictures with ulceration should include esophagitis from pill ingestion, GERD, infectious agents, and medication induced LP-like lesions (from gold, thiazides, and anti-malarials). Correct diagnosis and treatment of esophageal LP is of critical importance. Delay in diagnosis may lead to serial dilations of esophageal strictures that, without simultaneous medical treatment, may lead to koebnerization of lichen planus and worsening of the stricture. Patients can lose significant weight and become dehydrated secondary to stenosis. In addition, patients should be monitored for transformation of oral LP lesions into squamous cell carcinoma, as this has been reported in several studies. Therapy for oral lichen planus with esophageal involvement includes systemic as well as possible topical therapies. Referral to a gastroenterologist for endoscopy and dilations, with or without steroid injections, is often necessary. At first diagnosis, systemic steroids are often needed to quell the inflammation. A variety of steroid sparing agents have been used successfully including mycophenolate mofetil, azathioprine, cyclosporine, and etretinate. Topical steroids and tacrolimus may ease the symptoms. References: Abraham SC, Ravich WJ, Anhalt GJ, et al. Esophageal lichen planus: Case report and review of the literature. American Journal of Surg Path. 2000; 24(12): 1678-1682. Menges M, Hohloch K, et al. Lichen planus with esophageal involvement. Digestion. 2002; 65: 184-189. Harewood GC, Murray JA, Cameron AJ. Esophageal lichen planus: the Mayo Clinic experience. Dis Esophagus. 1999; 12(4): 309-311. | ||||
 © 2001-2009, DermAtlas | Image Name: | oropharyngeal_lichen_planus_4_050115 | File Type: | jpg | |
| Diagnosis: | LICHEN PLANUS | Category: | dental/oral disorder / cutaneous sign of systemic disease | ||
| Body Site: | esophagus | Age: | 76 years | ||
| Contributor: | Grant Anhalt, MD | ||||
| Description: | The esophageal biopsy showed a focal erosion with acute and chronic inflammation. Reactive epithelial changes with acantholysis and a cleft compatible with bulla formation was also seen. | ||||
| Comments: | This 76-year-old woman noted vaginal bleeding, which was initially diagnosed as lichen sclerosis. She then developed intermittent painful lesions in oral mucosa followed by dysphagia. Initially she had trouble swallowing pills, but ater she developed dysphagia with most foods, choking sensation, and retrosternal pain. She lost significant weight over 2-3 years. A biopsy of the gingiva was consistent with lichen planus, and endoscopy revealed a cervical esophageal stricture severe enough to prevent passage of the endoscope. A complete medical and laboratory evaluation was otherwise normal. She was treated with oral prednisone and mycophenolate mofetil and tacrolimus topically. Prednisone was tapered slowly. Serial esophageal dilations with intralesional steroid injections into stricture was also performed. Lichen planus (LP) is an idiopathic disease of the skin and mucosa. Mucosal surfaces involved in lichen planus may include perineum, oral mucosa and pharynx. Histologically, LP is characterized by a dense, band-like lymphocytic infiltrate under an acanthotic epidermis, destruction of the basal layer and hypergranulosis. Histology of mucosal epithelium in LP is slightly different than cutaneous LP. It frequently shows parakeratoisis and often fails to show hypergranulosis. The epithelium may be atrophic rather than acanthotic. Oral lichen planus is seen in approximately 1-4 percent of the population, with onset of disease occurring most frequently in the 5th and 6th decade. Approximately 25 percent of all patients with LP have only mucosal manifestations. The most common form of oral LP is the reticular pattern, characterized by Wickham’s striae, that is usually asymptomatic. Erosive oral LP, on the other hand, is less common, but may be extremely painful. Esophageal lichen planus is often under reported and diagnosed. It should always be evaluated for in patients with oral LP. Esophageal LP occurs mainly in middle-aged women. The overwhelming clinical complaint is dysphagia, but reflux type symptoms or a history of retrosternal pain can often be elicited. All of the patients, thus far reported, with esophageal disease have had concomitant oral LP. Although the histology and clinical exam often make the diagnosis of lichen planus, the differential diagnosis of esophageal strictures with ulceration should include esophagitis from pill ingestion, GERD, infectious agents, and medication induced LP-like lesions (from gold, thiazides, and anti-malarials). Correct diagnosis and treatment of esophageal LP is of critical importance. Delay in diagnosis may lead to serial dilations of esophageal strictures that, without simultaneous medical treatment, may lead to koebnerization of lichen planus and worsening of the stricture. Patients can lose significant weight and become dehydrated secondary to stenosis. In addition, patients should be monitored for transformation of oral LP lesions into squamous cell carcinoma, as this has been reported in several studies. Therapy for oral lichen planus with esophageal involvement includes systemic as well as possible topical therapies. Referral to a gastroenterologist for endoscopy and dilations, with or without steroid injections, is often necessary. At first diagnosis, systemic steroids are often needed to quell the inflammation. A variety of steroid sparing agents have been used successfully including mycophenolate mofetil, azathioprine, cyclosporine, and etretinate. Topical steroids and tacrolimus may ease the symptoms. References: Abraham SC, Ravich WJ, Anhalt GJ, et al. Esophageal lichen planus: Case report and review of the literature. American Journal of Surg Path. 2000; 24(12): 1678-1682. Menges M, Hohloch K, et al. Lichen planus with esophageal involvement. Digestion. 2002; 65: 184-189. Harewood GC, Murray JA, Cameron AJ. Esophageal lichen planus: the Mayo Clinic experience. Dis Esophagus. 1999; 12(4): 309-311. | ||||
 © 2001-2009, DermAtlas | Image Name: | oropharyngeal_lichen_planus_5_050115 | File Type: | jpg | |
| Diagnosis: | LICHEN PLANUS | Category: | dental/oral disorder / cutaneous sign of systemic disease | ||
| Body Site: | mouth / gingiva | Age: | 76 years | ||
| Contributor: | Grant Anhalt, MD | ||||
| Description: | There is a full thickness ulceration adjacent to intact epithelium with an intense lymphocytic and plasma cell infiltrate in the superficial lamina propria. | ||||
| Comments: | This 76-year-old woman noted vaginal bleeding, which was initially diagnosed as lichen sclerosis. She then developed intermittent painful lesions in oral mucosa followed by dysphagia. Initially she had trouble swallowing pills, but ater she developed dysphagia with most foods, choking sensation, and retrosternal pain. She lost significant weight over 2-3 years. A biopsy of the gingiva was consistent with lichen planus, and endoscopy revealed a cervical esophageal stricture severe enough to prevent passage of the endoscope. A complete medical and laboratory evaluation was otherwise normal. She was treated with oral prednisone and mycophenolate mofetil and tacrolimus topically. Prednisone was tapered slowly. Serial esophageal dilations with intralesional steroid injections into stricture was also performed. Lichen planus (LP) is an idiopathic disease of the skin and mucosa. Mucosal surfaces involved in lichen planus may include perineum, oral mucosa and pharynx. Histologically, LP is characterized by a dense, band-like lymphocytic infiltrate under an acanthotic epidermis, destruction of the basal layer and hypergranulosis. Histology of mucosal epithelium in LP is slightly different than cutaneous LP. It frequently shows parakeratoisis and often fails to show hypergranulosis. The epithelium may be atrophic rather than acanthotic. Oral lichen planus is seen in approximately 1-4 percent of the population, with onset of disease occurring most frequently in the 5th and 6th decade. Approximately 25 percent of all patients with LP have only mucosal manifestations. The most common form of oral LP is the reticular pattern, characterized by Wickham’s striae, that is usually asymptomatic. Erosive oral LP, on the other hand, is less common, but may be extremely painful. Esophageal lichen planus is often under reported and diagnosed. It should always be evaluated for in patients with oral LP. Esophageal LP occurs mainly in middle-aged women. The overwhelming clinical complaint is dysphagia, but reflux type symptoms or a history of retrosternal pain can often be elicited. All of the patients, thus far reported, with esophageal disease have had concomitant oral LP. Although the histology and clinical exam often make the diagnosis of lichen planus, the differential diagnosis of esophageal strictures with ulceration should include esophagitis from pill ingestion, GERD, infectious agents, and medication induced LP-like lesions (from gold, thiazides, and anti-malarials). Correct diagnosis and treatment of esophageal LP is of critical importance. Delay in diagnosis may lead to serial dilations of esophageal strictures that, without simultaneous medical treatment, may lead to koebnerization of lichen planus and worsening of the stricture. Patients can lose significant weight and become dehydrated secondary to stenosis. In addition, patients should be monitored for transformation of oral LP lesions into squamous cell carcinoma, as this has been reported in several studies. Therapy for oral lichen planus with esophageal involvement includes systemic as well as possible topical therapies. Referral to a gastroenterologist for endoscopy and dilations, with or without steroid injections, is often necessary. At first diagnosis, systemic steroids are often needed to quell the inflammation. A variety of steroid sparing agents have been used successfully including mycophenolate mofetil, azathioprine, cyclosporine, and etretinate. Topical steroids and tacrolimus may ease the symptoms. References: Abraham SC, Ravich WJ, Anhalt GJ, et al. Esophageal lichen planus: Case report and review of the literature. American Journal of Surg Path. 2000; 24(12): 1678-1682. Menges M, Hohloch K, et al. Lichen planus with esophageal involvement. Digestion. 2002; 65: 184-189. Harewood GC, Murray JA, Cameron AJ. Esophageal lichen planus: the Mayo Clinic experience. Dis Esophagus. 1999; 12(4): 309-311. | ||||
 © 2001-2009, DermAtlas | Image Name: | oropharyngeal_lichen_planus_6_050115 | File Type: | jpg | |
| Diagnosis: | LICHEN PLANUS | Category: | dental/oral disorder / cutaneous sign of systemic disease | ||
| Body Site: | mouth / gingiva | Age: | 76 years | ||
| Contributor: | Grant Anhalt, MD | ||||
| Description: | Hydropic degeneration of the basal cell layer is evident with numerous apoptotic pink keratinocytes (Civatte bodies). An intense lymphocytic infiltrate is present in the superficial lamina propria. These changes are typical of lichen planus of the oral mucosa. | ||||
| Comments: | This 76-year-old woman noted vaginal bleeding, which was initially diagnosed as lichen sclerosis. She then developed intermittent painful lesions in oral mucosa followed by dysphagia. Initially she had trouble swallowing pills, but ater she developed dysphagia with most foods, choking sensation, and retrosternal pain. She lost significant weight over 2-3 years. A biopsy of the gingiva was consistent with lichen planus, and endoscopy revealed a cervical esophageal stricture severe enough to prevent passage of the endoscope. A complete medical and laboratory evaluation was otherwise normal. She was treated with oral prednisone and mycophenolate mofetil and tacrolimus topically. Prednisone was tapered slowly. Serial esophageal dilations with intralesional steroid injections into stricture was also performed. Lichen planus (LP) is an idiopathic disease of the skin and mucosa. Mucosal surfaces involved in lichen planus may include perineum, oral mucosa and pharynx. Histologically, LP is characterized by a dense, band-like lymphocytic infiltrate under an acanthotic epidermis, destruction of the basal layer and hypergranulosis. Histology of mucosal epithelium in LP is slightly different than cutaneous LP. It frequently shows parakeratoisis and often fails to show hypergranulosis. The epithelium may be atrophic rather than acanthotic. Oral lichen planus is seen in approximately 1-4 percent of the population, with onset of disease occurring most frequently in the 5th and 6th decade. Approximately 25 percent of all patients with LP have only mucosal manifestations. The most common form of oral LP is the reticular pattern, characterized by Wickham’s striae, that is usually asymptomatic. Erosive oral LP, on the other hand, is less common, but may be extremely painful. Esophageal lichen planus is often under reported and diagnosed. It should always be evaluated for in patients with oral LP. Esophageal LP occurs mainly in middle-aged women. The overwhelming clinical complaint is dysphagia, but reflux type symptoms or a history of retrosternal pain can often be elicited. All of the patients, thus far reported, with esophageal disease have had concomitant oral LP. Although the histology and clinical exam often make the diagnosis of lichen planus, the differential diagnosis of esophageal strictures with ulceration should include esophagitis from pill ingestion, GERD, infectious agents, and medication induced LP-like lesions (from gold, thiazides, and anti-malarials). Correct diagnosis and treatment of esophageal LP is of critical importance. Delay in diagnosis may lead to serial dilations of esophageal strictures that, without simultaneous medical treatment, may lead to koebnerization of lichen planus and worsening of the stricture. Patients can lose significant weight and become dehydrated secondary to stenosis. In addition, patients should be monitored for transformation of oral LP lesions into squamous cell carcinoma, as this has been reported in several studies. Therapy for oral lichen planus with esophageal involvement includes systemic as well as possible topical therapies. Referral to a gastroenterologist for endoscopy and dilations, with or without steroid injections, is often necessary. At first diagnosis, systemic steroids are often needed to quell the inflammation. A variety of steroid sparing agents have been used successfully including mycophenolate mofetil, azathioprine, cyclosporine, and etretinate. Topical steroids and tacrolimus may ease the symptoms. References: Abraham SC, Ravich WJ, Anhalt GJ, et al. Esophageal lichen planus: Case report and review of the literature. American Journal of Surg Path. 2000; 24(12): 1678-1682. Menges M, Hohloch K, et al. Lichen planus with esophageal involvement. Digestion. 2002; 65: 184-189. Harewood GC, Murray JA, Cameron AJ. Esophageal lichen planus: the Mayo Clinic experience. Dis Esophagus. 1999; 12(4): 309-311. | ||||
 © 2001-2009, DermAtlas | Image Name: | oropharyngeal_lichen_planus_2_050115 | File Type: | jpg | |
| Diagnosis: | LICHEN PLANUS | Category: | dental/oral disorder / cutaneous sign of systemic disease | ||
| Body Site: | esophagus | Age: | 76 years | ||
| Contributor: | Grant Anhalt, MD | ||||
| Description: | endoscopy showing erosions (top left), stricture and erosions (right top), stricture (left bottom), and bulla formation (right bottom) in the esophagus | ||||
| Comments: | This 76-year-old woman noted vaginal bleeding, which was initially diagnosed as lichen sclerosis. She then developed intermittent painful lesions in oral mucosa followed by dysphagia. Initially she had trouble swallowing pills, but ater she developed dysphagia with most foods, choking sensation, and retrosternal pain. She lost significant weight over 2-3 years. A biopsy of the gingiva was consistent with lichen planus, and endoscopy revealed a cervical esophageal stricture severe enough to prevent passage of the endoscope. A complete medical and laboratory evaluation was otherwise normal. She was treated with oral prednisone and mycophenolate mofetil and tacrolimus topically. Prednisone was tapered slowly. Serial esophageal dilations with intralesional steroid injections into stricture was also performed. Lichen planus (LP) is an idiopathic disease of the skin and mucosa. Mucosal surfaces involved in lichen planus may include perineum, oral mucosa and pharynx. Histologically, LP is characterized by a dense, band-like lymphocytic infiltrate under an acanthotic epidermis, destruction of the basal layer and hypergranulosis. Histology of mucosal epithelium in LP is slightly different than cutaneous LP. It frequently shows parakeratoisis and often fails to show hypergranulosis. The epithelium may be atrophic rather than acanthotic. Oral lichen planus is seen in approximately 1-4 percent of the population, with onset of disease occurring most frequently in the 5th and 6th decade. Approximately 25 percent of all patients with LP have only mucosal manifestations. The most common form of oral LP is the reticular pattern, characterized by Wickham’s striae, that is usually asymptomatic. Erosive oral LP, on the other hand, is less common, but may be extremely painful. Esophageal lichen planus is often under reported and diagnosed. It should always be evaluated for in patients with oral LP. Esophageal LP occurs mainly in middle-aged women. The overwhelming clinical complaint is dysphagia, but reflux type symptoms or a history of retrosternal pain can often be elicited. All of the patients, thus far reported, with esophageal disease have had concomitant oral LP. Although the histology and clinical exam often make the diagnosis of lichen planus, the differential diagnosis of esophageal strictures with ulceration should include esophagitis from pill ingestion, GERD, infectious agents, and medication induced LP-like lesions (from gold, thiazides, and anti-malarials). Correct diagnosis and treatment of esophageal LP is of critical importance. Delay in diagnosis may lead to serial dilations of esophageal strictures that, without simultaneous medical treatment, may lead to koebnerization of lichen planus and worsening of the stricture. Patients can lose significant weight and become dehydrated secondary to stenosis. In addition, patients should be monitored for transformation of oral LP lesions into squamous cell carcinoma, as this has been reported in several studies. Therapy for oral lichen planus with esophageal involvement includes systemic as well as possible topical therapies. Referral to a gastroenterologist for endoscopy and dilations, with or without steroid injections, is often necessary. At first diagnosis, systemic steroids are often needed to quell the inflammation. A variety of steroid sparing agents have been used successfully including mycophenolate mofetil, azathioprine, cyclosporine, and etretinate. Topical steroids and tacrolimus may ease the symptoms. References: Abraham SC, Ravich WJ, Anhalt GJ, et al. Esophageal lichen planus: Case report and review of the literature. American Journal of Surg Path. 2000; 24(12): 1678-1682. Menges M, Hohloch K, et al. Lichen planus with esophageal involvement. Digestion. 2002; 65: 184-189. Harewood GC, Murray JA, Cameron AJ. Esophageal lichen planus: the Mayo Clinic experience. Dis Esophagus. 1999; 12(4): 309-311. | ||||
 © 2001-2009, DermAtlas | Image Name: | pyoderma_ganagrenosum_7_030510 | File Type: | jpg | |
| Diagnosis: | PYODERMA GANGRENOSUM / LUPUS ERYTHEMATOSUS, SYSTEMIC | Category: | ulcer / cutaneous sign of systemic disease / collagen vascular disease | ||
| Body Site: | leg / ankle | Age: | 50 years | ||
| Contributor: | Grant Anhalt, MD | ||||
| Description: | A skin biopsy obtained from the ulcer border showed edema, superficial perivascular lymphocytic infiltrate, and massive deep dermal neutrophilic infiltration, thrombosis of small and medium sized vessels, necrosis, hemorrhage, and abscess formation. | ||||
| Comments: | These findings of a suppurative granulomatous process without a leukocytoclastic vasculitis are consistent with clinical diagnosis of pyoderma gangrenosum. Special stains failed to reveal infection. | ||||
| Related Images: | All related Images pyoderma_ganagrenosum_1_030510 pyoderma_ganagrenosum_2_030510 pyoderma_ganagrenosum_3_030510 pyoderma_ganagrenosum_4_030510 pyoderma_ganagrenosum_5_030510 pyoderma_ganagrenosum_6_030510 | ||||
 © 2001-2009, DermAtlas | Image Name: | pyoderma_ganagrenosum_6_030510 | File Type: | jpg | |
| Diagnosis: | PYODERMA GANGRENOSUM / LUPUS ERYTHEMATOSUS, SYSTEMIC | Category: | ulcer / cutaneous sign of systemic disease / collagen vascular disease | ||
| Body Site: | leg / ankle | Age: | 50 years | ||
| Contributor: | Grant Anhalt, MD | ||||
| Description: | A skin biopsy obtained from the ulcer border showed edema, superficial perivascular lymphocytic infiltrate, and massive deep dermal neutrophilic infiltration, thrombosis of small and medium sized vessels, necrosis, hemorrhage, and abscess formation. | ||||
| Comments: | These findings of a suppurative granulomatous process without a leukocytoclastic vasculitis are consistent with clinical diagnosis of pyoderma gangrenosum. Special stains failed to reveal infection. | ||||
| Related Images: | All related Images pyoderma_ganagrenosum_1_030510 pyoderma_ganagrenosum_2_030510 pyoderma_ganagrenosum_3_030510 pyoderma_ganagrenosum_4_030510 pyoderma_ganagrenosum_5_030510 pyoderma_ganagrenosum_7_030510 | ||||
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