Clinical and epidemiological profile of lichen striatus in children-Experience from a tertiary care hospital.

We analyzed records of 30 patients with lichen striatus (age < 18 years) in this retrospective study. Seventy percent were females and 30% were males with a mean age of diagnosis of 5.38 ± 4.22 years. The most common age group affected was 0-4 years. The mean duration of lichen striatus was 6.66 ± 4.22 months. Atopy was present in 9 (30%) patients. Although LS is a benign self-limited dermatosis, long-term prospective studies with a greater number of patients will help in better understanding of the disease including its etiopathogenesis and association with atopy.

Paraneoplastic pemphigus: Revised diagnostic criteria based on literature analysis.

BACKGROUND: Paraneoplastic pemphigus (PNP) is a rare autoimmune bullous disease classically associated with an underlying neoplasm. The heterogeneous clinical and histopathologic features of the disease make diagnosis challenging for clinicians. There are no formally accepted diagnostic criteria, and newer techniques for identifying antibodies directed against plakin proteins have largely replaced immunoprecipitation, the historic gold standard. METHODS: An analysis of 265 published cases of PNP was performed. The clinical, histopathologic, and immunologic features of PNP were assessed. RESULTS: Based on this review, we modified previous diagnostic criteria to capture 89.4% of PNP cases compared to 71.2% of cases captured by the most commonly referenced criteria devised by Camisa and Helm (p-value < 0.01, z-test; 95% CI [10.2, 33.6]). CONCLUSION: These revised diagnostic criteria address the variable clinical, histopathologic, and biochemical features of PNP, allowing physicians to have greater confidence in diagnosis of this rare and often fatal disease. The revised criteria include three major criteria and two minor criteria, whereby meeting either all three major criteria or two major and both minor criteria would fulfill a diagnosis of paraneoplastic pemphigus. The major criteria include (a) mucous membrane lesions with or without cutaneous involvement, (b) concomitant internal neoplasm, and (b) serologic evidence of anti-plakin antibodies. The minor criteria include (a) acantholysis and/or lichenoid interface dermatitis on histopathology and (b) direct immunofluorescence staining showing intercellular and/or basement membrane staining.

Histopathological evaluation of cutaneous reactions to tattoos: Study at a tertiary care center.

BACKGROUND: Tattooing has been around for many years and is becoming an increasingly common fashion trend. As there are often few regulatory laws regarding the practice, an increase in the incidence of cutaneous reactions to tattoo inks is noted. These include allergic reactions, granulomatous dermatitis, infections, lichenoid dermatoses, and sometimes malignancy. The present study examines the histopathological changes seen in patients with cutaneous reactions to tattoo ink. METHOD: A prospective observational study was conducted over 18 months in the dermatology clinic of a tertiary care center in western India. The study population included 22 patients with cutaneous reactions over the tattoos. Punch biopsy specimens were sent to study the pattern of histopathological response. RESULTS: All 22 patients studied were between the ages of 17 and 35 years. The mean duration of development of reaction was 8.1 months. Most of the reactions were seen in black ink tattoos performed by amateurs. Perivascular and spongiotic dermatitis suggestive of allergic response was the most common feature on histopathology. Granulomatous response and lichenoid response were seen in five and three biopsies, respectively. CONCLUSION: Legalization is needed for this practice to prevent tattoo reactions. Histopathological evaluation is important as tattoo reactions may be associated with skin infections and malignancies.

Malignant transformation in oral lichen planus and lichenoid lesions: a 14-year longitudinal retrospective cohort study of 829 patients in New Zealand.

OBJECTIVE: The aim of this study was to identify the rate of malignant transformation in a longitudinal cohort of patients with oral lichen planus and oral lichenoid lesion (OLP/OLL) and to assess the associations between clinicopathologic aspects and malignant transformation. STUDY DESIGN: Data were taken from the records of 829 patients histologically diagnosed with OLP/OLL in the years 2005 to 2018. RESULTS: Of the study patients, 548 (66.1%) were females and 281 (33.9%) were males. The average age at diagnosis was 57.3 years. The hyperplastic type was the most frequent (58.5%). Most patients had multiple sites of involvement, with the buccal mucosa being the most frequent site of biopsy. Oral epithelial dysplasia developed in 5 (0.6%) patients with a previous histologic diagnosis of OLP/OLL and developed oral squamous cell carcinoma (OSCC) in 23 patients (2.8%) during the follow-up period. The atrophic/ulcerative forms are 25.8 times more likely to progress to OSCC compared with the hyperplastic types (hazard ratio [HR] 25.8; P < .05). The HR increases by 5% with every year of age (HR 1.05; 95% confidence interval; P < .05). CONCLUSIONS: In our study, oral epithelial dysplasia developed in less than 1% of patients with OLP/OLL, and OSCC in 2.8%during the follow-up period. The atrophic/ulcerative forms are 25.8 times more likely to progress to OSCC compared with the hyperplastic types. The HR increases by 5% with every year of age.

Survival and prognosis of individuals receiving programmed cell death 1 inhibitor with and without immunologic cutaneous adverse events.

BACKGROUND: The treatment response to new immunotherapy in advanced melanoma patients remains varied between individuals. Immune-related cutaneous side effects might have prognostic value. OBJECTIVE: To determine whether development of ≥1 of the 3 immune-mediated cutaneous events (eczema, lichenoid reaction, or vitiligo-like depigmentation) is associated with improved progression-free survival. METHODS: A cohort study of adults with stage IIIC-IV melanoma treated with pembrolizumab or nivolumab during May 1, 2012-February 1, 2018, at Westmead Hospital, Sydney, Australia. Treatment response was based on iRECIST version 1.1. RESULTS: In total, 82 patients of an average age of 59.9 years were included. Median follow-up was 40.7 months; 33 patients had ≥1 target skin reaction. Skin reactions developed in one-third of individuals by 6 months. At any given time, the instantaneous risk of disease progression and death was lower for individuals who had ≥1 cutaneous adverse event (CAE) develop. Compared with individuals with no CAE, the hazard ratio for disease progression and death for individuals who had ≥1 CAE develop was 0.46 (95% confidence interval 0.23-0.91; P = .025) by the time-dependent Cox proportional hazards model. LIMITATIONS: Single-center study. CONCLUSION: This study demonstrates an association between the development of ≥1 of 3 CAEs and improved progression-free survival in this cohort of patients.

Adult-onset lichen striatus versus adult blaschkitis: a clinicopathological review of 40 cases of acquired blaschkolinear inflammatory dermatosis.

BACKGROUND: Since the first description of adult blaschkitis (AB), the existence of this entity has been a matter of great debate. OBJECTIVES: To compare clinicopathological features of lichen striatus (LS) and AB cases. MATERIALS AND METHODS: We retrospectively reviewed the clinicopathological features of patients who clinically showed linear inflammatory dermatosis along Blaschko's lines based on a skin biopsy registry. RESULTS: Through a process of clinicopathological differential diagnosis, 27 cases of LS, three of AB, eight of linear lichen planus, and two of linear psoriasis were identified. Clinicopathological differences between LS and AB were mostly insignificant except for age at onset and multiple site involvement. In these cases, females were affected more frequently than males. The mean age at onset was 31.6 years, and the most common involved site was the leg. The lesions lasted approximately 8.3 months with few relapses. The most common histopathological finding was perivascular infiltration followed by peri-appendageal infiltration. CONCLUSION: Distinction between LS and AB appears to be unnecessary given their overlapping features.

Clinical and Dermoscopic Features of Lichenoid Keratosis: A Retrospective Case Study.

BACKGROUND: Lichenoid keratosis is a benign cutaneous lesion exhibiting many clinical faces and different dermoscopic features. OBJECTIVE: This study aims to determine the pattern of different clinical subtypes of lichenoid keratosis and to establish whether there is any correlation between the clinical variants of lichenoid keratosis and their dermoscopic appearance. METHODS: We retrospectively analyzed the medical records and clinical database of patients who had received a histological diagnosis of lichenoid keratosis. Based on the literature review and the clinical-dermoscopic features of lichenoid keratosis, we divided the lesions into 6 clinical subtypes to evaluate potential correlations between clinical and dermoscopic features in all subtypes. RESULTS: Fifty-one lesions were included in this clinical study. Preoperatively, only 1.9% of cases were clinically diagnosed as lichenoid keratosis, and the most common misdiagnosis was basal cell carcinoma (52.9%). We identified 6 subtypes of lichenoid keratosis and their corresponding dermoscopic features and clues. CONCLUSION: Since lichenoid keratosis has no pathognomonic dermoscopic clues and it is commonly misdiagnosed as malignant skin neoplasms, such as basal cell carcinoma and melanoma, improving the knowledge of both clinical and dermoscopic variability of lichenoid keratosis may help dermatologists to reduce unnecessary surgery and to reduce health care spending.

Oral lichenoid reaction showing multiple ulcers associated with anti-programmed death cell receptor-1 treatment: A report of two cases and published work review.

Anti-programmed cell death receptor-1 (PD-1) antibodies represent an effective treatment opinion for advanced melanoma and non-small-cell lung cancer, as well as other cancerous entities. Immune checkpoint inhibitors such as anti-PD-1 antibody result in a unique side-effect profile, commonly described as immune-related adverse events (irAE). These irAE affect the skin, gastrointestinal tract, liver, endocrine system and other organ systems. We report two cases of oral lichenoid reaction showing multiple ulcers associated with nivolumab treatment. Both patients presented with multiple ulcers covered with fibrinous plaque over the entire oral mucosa, lips and tongue. Histopathological examination of ulceration showed epithelial necrosis and subepidermal clefts with dense band-like layers of lymphohistiocytic infiltrate within the upper dermis. Nivolumab was interrupted in both cases. Case 1 responded well to topical corticosteroids. Case 2 required oral corticosteroids, however, nivolumab could be restarted without recurrence of oral ulcers. We provide a comprehensive review of reported cases of lichenoid reaction showing multiple oral ulcers associated with anti-PD-1 therapy to date. Early recognition and management may improve treatment, avoid discontinuation of life-saving therapy and maintain quality of life in these patients.

Clinical outcomes in a specialist male genital skin clinic: prospective follow-up of 600 patients.

It is important to assess outcomes for medical interventions in order to focus scarce resources on outcomes with a known positive benefit. An open, observational study was performed to assess the clinical outcomes of 600 male patients with a genital skin problem attending a specialist secondary care dermatology facility. Patients were mainly referred by general practitioners and genitourinary medicine physicians. Outcome was measured at 3 and 6 months, and was determined by clinical examination and assessment of patient symptoms. The mean age of the group was 45.3 years. The commonest diagnoses were lichen sclerosus (30.5%), balanitis (17.3%), eczema (12.8%), lichen planus (7.3%), psoriasis (7.2%) and benign lesions (5.5%). The commonest presenting symptoms were genital rash (43%), genital soreness, pain or burning (17.5%), and penile lesions (15.7%). Lichen sclerosus and all forms of balanitis were more common in uncircumcised patients, whereas lichen planus was more common in circumcised males. Short-term outcome was excellent, with 11.5% of patients being reassured and discharged on their first visit, and after 6 months 58% of all patients were clear and 12% had improved. Only 4.5% reported no improvement in symptoms. Diagnostic biopsy demonstrated malignant or premalignant lesions in nearly a fifth of those having a procedure. Close working with urological and genitourinary medicine colleagues is important to manage the various aspects of male health.

Betel quid oral lichenoid lesions: a hospital based cross-sectional study.

OBJECTIVE: The aim of this study was to assess the prevalence and risk indicators of betel quid oral lichenoid lesions in chewers. METHODS: A total of 1209 chewers were identified and categorized into three main groups based on the type of lesion: betel quid oral lichenoid lesions only, betel quid oral lichenoid lesions in association with quid-induced other oral mucosal lesions, and no lesions. Multinomial regression analyses were used to determine associations between dependent and independent variables. RESULTS: Betel quid oral lichenoid lesions were more common in individuals who chewed quid comprising both tobacco and areca nut, and in those who chewed it two to three, or greater than three, times a day. Betel quid oral lichenoid lesions + quid-induced other oral mucosal lesions were more likely to occur in females, and in individuals who chewed quid containing both tobacco and areca nut, in their processed and unprocessed forms, and greater than three times a day. CONCLUSION: The prevalence of betel quid oral lichenoid lesions was higher than that reported in previous studies conducted in India. Increase in the frequency and duration of quid chewing was associated with increased likelihood of developing these oral lichenoid lesions.

Perianal lichen dermatoses: A review of 60 cases.

OBJECTIVES: To determine the diagnostic range of lichen dermatoses of the perianus, their extent, and response to treatment. METHODS: We reviewed perianal biopsies submitted to a tertiary referral pathology service between January 2010 and July 2014, interpreted as 'lichen' or 'lichenoid'. We collected data on patients' characteristics, referring specialty, extent of lesion and response to treatment. RESULTS: During the study period, 60 perianal biopsies met our inclusion criteria. The distribution of diagnoses was lichen sclerosus (LS) in 25/60 (42%), lichen simplex chronicus (LSC) in 23/60 (38%), lichen planus (LP) in 10/60 (17%), and a non-specific lichenoid reaction in 2/60 (3%). Eleven of 25 cases of LS (44%) showed superimposed LSC. Of 10 LP cases, nine (90%) were hypertrophic and three of these showed pseudoepitheliomatous hyperplasia; none were erosive LP. Compared with patients in the LS and LSC groups, those with LP were more likely to have a localised lesion. Topical steroids were prescribed in 91% cases with treatment data available, and 98% of treated patients who returned for follow up had improved or their disease was resolved. CONCLUSIONS: We encountered a spectrum of perianal lichen dermatoses, with LS, LP and LSC all represented. LS biopsied at the perianus is often lichenified. Hypertrophic LP is a common form of LP at the perianus.

Analysis of clinical features and lifestyle in Korean senile gluteal dermatosis patients.

BACKGROUND: Senile gluteal dermatosis (SGD) is characterized by hyperkeratotic lichenified skin lesions on the superior part and both sides of the anal cleft. These lesions are particularly prevalent in sedentary and elderly patients. OBJECTIVES: The purpose of this study was to investigate the prevalence, clinical manifestations, and other clinical characteristics of SGD in elderly Korean individuals. METHODS: A total of 280 subjects aged >60 years identified through the outpatient department at our hospital were included in this study. Basic clinical information was collected, and the subjects were evaluated clinically for gluteal lesions. Skin biopsies were performed in eight of the patients diagnosed with SGD. RESULTS: Among a total of 280 subjects, 37 were diagnosed with SGD. Their mean age was 70.4 years. The prevalence of SGD was found to increase with age. In addition, there was a significant positive correlation between SGD and lower lean body mass, longer period of a sedentary lifestyle, use of a Korean-style mattress, and diabetes mellitus. Most patients had either mild symptoms or were asymptomatic. Skin biopsies showed hyperkeratosis, acanthosis, follicular plugging, and meandering superficial vessel proliferation with mild lymphohistiocytic infiltration. None of the biopsy specimens exhibited amyloid deposition. CONCLUSIONS: Our findings suggest that SGD is a common disorder in elderly Korean individuals and is associated with prolonged periods of rest such as those occurring in a highly sedentary lifestyle and with sleeping on a Korean-style mattress.

Prevalence of habits and oral mucosal lesions in Jaipur, Rajasthan.

INTRODUCTION: Dental health and oral health are used almost synonymously when stating the goals of oral health; such statements are only valid for dental health. This may lead to severe underestimation of the need of total oral health care. When planning measures of oral health care, the lack of data may lead to a risk of overlooking diseases of the soft tissue in, and adjacent to, the oral cavity. Prevalence data of oral mucosal lesions are available from many countries, but the information is usually restricted to very few lesions in each survey. MATERIALS AND METHODS: The present study is an attempt to assess and compare the various deleterious habits and its associated oral mucosal lesions among patients visiting outpatient department of Jaipur Dental College, Jaipur, Rajasthan. RESULTS: It was found that the prevalence of habits was 51.4% including both the sexes and prevalence of oral mucosal lesions were 9.9%. DISCUSSION: The prevalence of habits and oral mucosal lesions is very high as compared with other studies. The habit of smoking was higher in males as compared to females.

The value of a multi-specialty service, including genitourinary medicine, dermatology and urology input, in the management of male genital dermatoses.

We undertook a retrospective case note review of our monthly multi-specialty penile dermatoses clinic (which includes clinicians from Genitourinary medicine, Dermatology and Urology), to examine conditions presenting to the service, and compare clinical management and outcomes with other similar services in the UK. Over the 3-year study period, 226 patients were reviewed over 240 individual episodes. Lichenoid conditions were the most common category of genital pathologies seen (n = 60, 24%), but non-specific balanitis was the most common individual diagnosis (n = 55, 22%). Other common conditions seen included eczema and psoriasis (n = 28, 11%), Zoon/plasma cell balanitis (n = 26, 10%), malignancy/pre-malignant change (n = 25, 10%) and infective conditions (n = 24, 9%). The clinic had a biopsy rate of 10%; the most common indication was for confirmation of a clinical suspicion of malignancy/pre-malignancy. There was a high clinical-to-histological correlation in the biopsies of 79%. The most common treatment prescribed was topical corticosteroids and the clinic had a high discharge rate of 93%, the majority of patients discharged back to General Practice.

[Potentially malignant character of oral lichen planus and lichenoid lesions]. / Caractère potentiellement malin du lichen plan buccal et des lésions lichénoïdes.

INTRODUCTION: Many authors have reported the possible malignant transformation of oral lichen. The incidence of this event remains controversial. Many authors make a distinction between the "true" oral lichen planus (OLP) and lichenoid lesions (LL) according to the WHO clinical and histological classification. For these authors an increased risk of development of oral cancer could occur only on LL. Our aim was to check this hypothesis on a cohort followed for 10 years. MATERIAL AND METHODS: We included patients who were referred to our team for the first time between 1995 and 1997, still followed in 2010, with a histological diagnosis of buccal lichen planus. We classified lesions as OLP or LL according to the WHO clinical and histological classification: the two clinical criteria for OLP were a reticulated aspect and bilateral and symmetric lesions. Three histological criteria were necessary for the diagnosis: dense inflammatory infiltrate in the upper lamina propria, liquefaction degeneration of basal keratinocytes, and no signs of dysplasia. The final diagnosis was OLP, when all clinical ad histological criteria were met otherwise it was LL. We studied the patient's outcome between their first consultations and May 2010. RESULTS: Thirty-two patients, whose data was available, met inclusion criteria. Eight were diagnosed with OLP and 24 with LL. The mean follow-up was 164 months [154-183]. No oral cancer was observed in the OLP group. Two patients in the LL group presented with oral cancer after 45 and 143 months of follow-up. DISCUSSION: Malignant transformations were observed only in the LL group. Our results correlate with those of Van Der Meij et al. published in 2006. The strict use of the WHO diagnostic criteria seems to allow identifying patients at risk of developing oral cancer (LL) and others with only a benign course of this chronic oral mucosal disease. These results need to be confirmed by prospective multicentric studies.

Photosensitive spongiotic/lichenoid eruption of micropapules and plaques: a morphologically distinct entity.

BACKGROUND: A distinct morphological pattern of photodermatosis has been observed with shiny skin colored to hypopigmented tiny papules, discrete or coalescing to form plaques. AIMS: To study the clinico-pathological features of patients presenting with these lesions. METHODS: A total of 72 patients were recruited. Clinical examination and skin biopsy was carried out to evaluate the morphological patterns and the histopathological features. RESULTS: In all patients, tiny discrete to coalescent papules were observed on sun-exposed sites but usually sparing the face. The condition occurred more commonly in women. Three specific histopathological patterns were observed : spongiotic (43.7%), lichenoid (22.5%), psoriasiform (18.7%) and also perivascular pattern in 5%. CONCLUSION: Photosensitive lichenoid eruption is a morphologically distinct photodermatoses that is commonly seen in Indian patients with pathological features showing mostly spongiotic changes and in some cases lichenoid changes.

Liquen estriado del adulto: experiencia en un servicio de Dermatología / Adult lichen striatus: experience in dermatology service

Introducción. El liquen estriado es una dermatosis que sigue el trayecto de las líneas de Blaschko, se presenta característicamente en población pediátrica y es rara en pacientes adultos. Objetivo. Describir las características epidemiológicas y clínicas de los pacientes adultos con diagnóstico de liquen estriado diagnosticados en el período 1998-2010 en el Hospital Nacional Daniel Alcides Carrión (HNDAC). Material y Métodos. Estudio descriptivo de tipo serie de casos. Se revisó las historias clínicas de los casos de liquen estriado y se obtuvo datos epidemiológicos (edad, sexo), antecedentes de importancia (comorbilidad) y aspectos clínicos de los pacientes (tiempo de enfermedad, características de las lesiones, síntomas asociados). Los datos obtenidos fueron registrados en un instrumento de recolección de datos. Resultados. Ingresaron al estudio un total de 10 casos, el promedio de edad fue de 27 años (rango 16-48 años), 80% de los casos fueron de sexo femenino. Las lesiones clínicas eran placas formadas por pápulas milimétricas levemente descamativas de color piel, eritematosas o ligeramente hipopigmentada de distribución lineal y que seguían las líneas de Blaschko. Las lesiones se presentaron con mayor frecuencia en miembros inferiores (60%) y tronco (40%). El síntoma más frecuentemente referido porlos pacientes fue prurito (70%). La comorbilidad más frecuente fue atopía que se presentó en 40% de los pacientes. Conclusión. Los pacientes adultos con diagnóstico de liquen estriado del HNDAC presentan características clínicas similares a las descritas en pacientes pediátricos. La atopía constituye la comorbilidad más frecuente.

Back ground. Lichen adult is a dermatosis that follows the Blaschko lines, tipically it present in pediatrics population and is rare in adult patients. Objective. Describe the epidemiological and clinical characteristics with diagnosis of lichen striatus that were diagnosed between1998-2010 at National Hospital Daniel Alcides Carrion (HNDAC). Material and methods. Descriptive study of a case series. Clinical records were reviewed, obtaining epidemiological data (age, genre), background of importance (comorbidity) and clinical aspects of the patients ( time of illness , characteristics of the injuries, associated symptoms) that were recorded in a data collection instrument. Results. Ten cases were enrolled, the age average was 27 years old (range 16-48 years), 80% of cases corresponded to females. Clinical injuries were plates formed by millimeter papules slightly descamatives of skin color, eritematoses or slightly hypopigmentated od linear distribution and that followed the blaschko lines. Injuries were presented with more frequency at the lower limbs (60%) andin trunk (40%). The most frequent symptom was the pruritus (70%).The most frequent comorbidity was the atopy, presents in 40% of the patients. Conclusion. Adult patients with diagnosis of lichen striatus atthe HNDAC present clinical characteristics similar to pediatrics patients. The comorbility more frequent is the atopy.

Oral involvement of chronic graft-versus-host disease in hematopoietic stem cell transplant recipients.

Oral manifestations are common in patients who are diagnosed with chronic graft-versus-host-disease (cGVHD). These manifestations can present as oral mucosal lesions, salivary gland dysfunction, or reduction of the mouth opening due to cutaneous sclerosis. Although several studies have reported the prevalence of oral involvement in cGVHD, few have reported details of different types and severity of oral lesions of cGVHD, according to the NIH. Furthermore, the authors are aware of only one published study concerning oral manifestations of cGVHD in Brazil. The purpose of this study was to evaluate the prevalence and severity of oral involvement of cGVHD. Oral evaluation of hematopoietic stem cell transplant (HSCT) recipients was conducted on 22 patients (12 men and 10 women) from December 2007 to May 2009. The following categories were assessed: Age, gender, underlying disease, time postHSCT, history of GVHD, therapy for GVHD, oral lesions, xerostomia, resting salivary flow rate, and mouth opening. Oral lesions were classified according to NIH criteria, and the results were submitted to a descriptive analysis. According to the NIH, patients presented diagnostic (40.9%), distinctive (31.9%), and common (9.1%) features of oral cGVHD. Oral involvement of cGVHD was identified in 81.8% of patients, 68.2% as mucosal lesions and 59.1% as salivary gland dysfunction. Reduced mouth opening was observed in 12 patients (80%), with one case associated with cutaneous sclerosis. Oral involvement was frequent in these patients; for many, it was the first clinical manifestation of cGVHD.

A multicenter study of oral lichen planus in Thai patients.

AIM: Oral lichen planus is an oral mucosal disease that affects middle-aged patients. The characteristics of oral lichen planus in Thai patients from a multicenter were studied. METHODS: Data of 533 patients from the oral medicine clinics at Chulalongkorn and Mahidol (central Thailand), Chiang Mai (northern Thailand), and Khon Kaen (northeastern Thailand) universities during 2002-2007 were analyzed. The diagnosis of patients with oral lichen planus was clinically and/or histopathologically confirmed. RESULTS: There was a greater number of female patients than males (4:1). There were significant differences in age, sex, and some systemic diseases among the oral lichen planus patients from the three centers. Burning sensation was the most common symptom (72.9%), followed by pain (26.5%), roughness (6.4%), and then no other symptoms (7.9%). The most common site of lesions was found at the buccal mucosa (87.1%). Atrophic oral lichen planus was common in Thai patients. There were significant differences in the types of oral lichen planus, including reticular, atrophic, and ulcerative oral lichen planus among these patients from the three centers (P = 0.000). Nine cases (1.7%) showed dysplasia, but one case (0.2%) developed squamous cell carcinoma. CONCLUSION: Patients with oral lichen planus from the central, northern, and northeastern parts of Thailand presented with distinct characteristics. The malignant transformation of oral lichen planus was low in Thai patients.

A 10-year retrospective study on palladium sensitivity.

BACKGROUND: Palladium has become an important contact allergen because of increased use in industry, jewelry, and dentistry. OBJECTIVE: To determine the frequency of palladium allergy in a US patch-test population tested to palladium. METHODS: A 10-year retrospective review (1997-2006) was performed on patients sensitive to palladium at the Department of Dermatology, Mayo Clinic, Rochester, MN. RESULTS: A total of 910 patients were tested to a series that included palladium chloride 2% in petrolatum. A palladium-positive patch-test result was noted in 110 patients (12.1%). Of the 106 patients sensitized to palladium who had records available for review, 15.1% had a diagnosis of lichen planus-like eruptions; 13.2%, burning mouth; 27.4%, stomatitis; and 29.2%, hand and body dermatitis. CONCLUSION: Palladium sensitivity is more common in oral diseases than in skin. We describe a previously unknown high degree of co-reactivity of gold with palladium to the same degree as the known co-reactivity with nickel.