Assessment of PD-1 and PD-L1 tissue expression levels in lichen planus patients: a case-control study.

Programmed cell death protein-1 (PD-1) is an immune checkpoint protein, PD-1 interaction with PD ligand-1 (PD-L1) is essential for maintaining immunological tolerance. The study aimed to study and compare the levels of PD-1 and PD-L1 in lesional and nonlesional skin of lichen planus (LP) patients and compare these levels to normal healthy controls to assess their role in the pathogenesis of LP. This case-control study involved 30 patients with LP and 30 healthy age-and sex-matched controls. After clinical assessment of the severity by LP severity index score (LPSI), skin biopsies were taken from lesional and nonlesional skin of LP patients and from normal skin in healthy controls for assessment of the tissue levels of PD-1 and PD-L1 by ELISA. The tissue levels of both PD-1 and PD-L1 were significantly higher in healthy controls than in both lesional and nonlesional skin of LP patients (P < 0.001). Also, significantly higher PD-l and PD-L1 levels in nonlesional skin than in lesional skin of LP patients were reported (P < 0.001). No significant correlations were found between lesional and nonlesional PD-1, PD-L1 levels, or LPSI score. Based on the fact that PD-1/PD-L1 interaction is important to maintain tolerance and protection against autoimmune diseases, in addition to our study results that revealed lower levels of PD-1/PD-L1 in LP skin than in healthy skin, we can conclude that PD-1/PDL-1 may be incriminated in the pathogenesis of LP. ClinicalTrials.govID: NCT04892381.

Assessment of serum levels of anti-gliadin (IgA and IgG) antibodies in patients with lichen planus: A pilot study.

Despite the fact that anti-gliadin antibodies (AGA) play a key role in coeliac disease (CD) screening, elevated AGA levels have been reported in several immune-mediated cutaneous conditions even in the absence of gastrointestinal disease clinical manifestations. A gluten-free diet led to improvements in some of these disorders. The link between oral lichen planus (LP) and CD was revealed, but there is currently no information available regarding the association between cutaneous LP and gluten sensitivity. This study aimed to assess the AGA (IgA and IgG) serum levels in LP patients compared to controls and to determine their correlation with LP severity. The study included 20 patients with cutaneous LP and 20 age- and sex-matched controls, both free of CD manifestations. The enzyme-linked immunosorbent assay (ELISA) technique was utilized for the evaluation of AGA (IgA and IgG) serum levels. Hepatitis C virus (HCV) antibodies in LP patients were evaluated qualitatively using a chromatographic immunoassay. In LP patients, AGA (IgA and IgG) serum levels were significantly elevated compared to controls (p = 0.015 and p=0.016, respectively). A significant positive correlation between AGA (IgG) serum levels and the age of patients (p= 0.024), duration of disease (p= 0.02), and LP severity index (p< 0.0001) was found. AGA serum levels were insignificantly different between HCV-positive and HCV-negative LP patients (p= 0.054). In conclusion, the significant elevation of serum AGA levels in LP patients reflects a possible link between LP and occult CD. Serum AGA (IgG) levels can be used as a marker of LP severity..

Assessment of health-related quality of life in patients with frontal fibrosing alopecia.

BACKGROUND: Frontal fibrosing alopecia (FFA) is a primary patterned cicatricial alopecia with different manifestations. AIMS: Its incidence is increasing worldwide. Like other types of alopecia, FFA can affect patients' health-related quality of life (HRQOL). However, this effect has been rarely discussed. This study was designed to evaluate HRQOL in patients with FFA. METHODS: In this cross-sectional study, 49 patients with confirmed FFA were asked to complete Dermatology Life Quality Index (DLQI) and the 36-Item Short Form Survey (SF-36) questionnaires. Disease severity was evaluated with the Frontal Fibrosing Alopecia Severity Score Index (FFASI). RESULTS: Significant relation between SF-36 scores and other covariants was not detected. According to the DLQI, most of the patients (54%) had impaired HRQOL, which was of low grade for most of them (84%). Patients with face papules and patients who were in the group of nail, limb, and flexural involvement had significantly lower HRQOL (p-value 0.03). CONCLUSION: We found that FFA negatively impacts HRQOL, which was more pronounced in patients with involvement of other ostensible areas.

Simplifying assessment of dimensions of oral lesions using a syringe and 'impression planimetry' with printer paper.

Two novel methods of measuring the dimensions of oral lesions are described, which would be of help in deciding relative efficacies of different therapeutic agents when used in clinical trials after larger studies quantitatively assessed for inter/intraobserver variability.

Frontal fibrosing alopecia: survey of severity assessment methods in routine clinical practice and validation of the International Frontal Fibrosing Alopecia Cooperative Group measurement guidance.

BACKGROUND: The lack of validated and responsive outcome measures in the management of frontal fibrosing alopecia (FFA) significantly limits assessment of disease progression and treatment response over time. AIM: To understand how FFA extent and progression is currently assessed in UK specialist centres, to validate components of the International FFA Cooperative Group (IFFACG) statement on FFA assessment, and to identify pragmatic advice to improve FFA management in clinic. METHODS: Consultant dermatologists with a specialist interest in hair loss (n = 17) were invited to take part. Preferred FFA assessment methods were explored using questionnaires and clinical scenarios. Participants were asked to identify and mark the current hairline in 10 frontal and 10 temporal hairline images (Questionnaire 1), with assessment repeated 3 months later to assess intraindividual variability (Questionnaire 2) and 12 months later to test whether interindividual accuracy could be improved with simple instruction (Questionnaire 3). RESULTS: All 17 clinicians (100%) completed the questionnaire at each time interval. We identified a wide variation in assessment techniques used by our experts. Measurements were perceived as the most accurate method of assessing frontal recession whereas photography was preferred for temporal recession. Inter-rater reliability between clinicians measuring the frontal hairline scenarios indicated a moderate strength of agreement [intraclass coefficient (ICC) = 0.61; 95% CI 0.40-0.85], yet intrarater reliability was found to be poor with wide limits of agreement (-8.71 mm to 9.92 mm) on follow-up. Importantly, when clear guidance was provided on how the hairline should be identified (Questionnaire 3), inter-rater reliability improved significantly, with ICC = 0.70, suggesting moderate agreement (95% CI 0.51-0.89; P < 0.001). A similar pattern was seen with temporal hairline measurements, which again improved in accuracy with instruction. CONCLUSION: We found that accuracy of measurements in FFA can be improved with simple instruction and we have validated components of the IFFACG measurement recommendations.

Quality of Life and Psychopathology in Lichen Planus: A Neglected Disease Burden.

The disease burden of lichen planus and its impact on patients' quality of life have not been well studied. The aim of this mono-centre cross-sectional study was to investigate these factors. From June to September 2020, an anonymous survey was posted to 253 patients, who were diagnosed with lichen planus in our outpatient clinic from January 2018 to June 2020. Quality of life was evaluated using the Dermatology Life Quality Index (DLQI), the EuroQol 5-dimension 3-level score, and further quality of life indicators. Beck Depression Inventory II was used to evaluate symptoms of depression. A total of 100 patients completed and returned the survey. Lichen planus affected quality of life in 78% of cases. DLQI was higher for multiple localizations (r = 0.454, p < 0.001). Patients with genital lichen planus had a significantly higher DLQI (mean ± standard deviation (SD) 8.68 ± 6.96) than patients who were not affected in the genital area (5.01 ± 5.49; p = 0.009). DLQI was also significantly higher for ungual lichen planus (9.83 ± 7.6; not affected: 5.65 ± 5.84; p-value 0.039), and for cutaneous LP (mean 8.1, SD 6.22; not affected: 5.63 ± 6.12; p-value 0.045). Twenty-nine percent of patients had mild to moderate symptoms of depression, and 6% had severe symptoms of depression. Depression and reduced quality of life are an undetected and relevant burden affecting patients with lichen planus.

Evolución clínica en pacientes tratados con Esencias Florales de Bach y costo del tratamiento / Clinical Evolution and Cost of Treatment in Patients Treated with Bach Flower Essences

Introducción: La Medicina Natural y Tradicional constituye hoy en día una necesidad, no como opción terapéutica, sino por su valor intrínseco, al tratar al paciente de forma holística, además de su inocuidad y bajo costo. Objetivo: Evaluar la evolución clínica en pacientes tratados con Esencias florales de Bach y costo del tratamiento. Métodos: Se realizó un estudio de evaluación de la evolución de pacientes con diagnóstico clínico de Psoriasis, Vitíligo y Liquen plano, los cuales fueron tratados con Esencias florales de Bach en el período de marzo del 2016 a marzo del 2018, en Consulta Multidisciplinaria Dermatología- Medicina Natural Tradicional- Psicología, del Policlínico Docente Héroes del Moncada; del municipio de Cárdenas, Matanzas. Los datos fueron recopilados y procesados en el software Excel, atendiendo a variables demográficas, se tuvieron en cuenta los criterios de inclusión, exclusión y consentimiento informado de pacientes vírgenes de tratamiento convencional. Las esencias florales utilizadas fueron: Crab Apple, Willow, Verbain, Impatiems, Walnut, Cherry Plum, Sweet Chestnut, Chicory, Clematis, Beech, Star of Bethlehem, While Chestnut y Larch de forma oral y tópica. Resultados: En el sexo femenino predominó el Vitíligo y Psoriasis. La ansiedad estuvo presente en 17 pacientes, en cuanto a la evolución, 14 pacientes asintomáticos y 14 mejorados. El costo de las Esencias florales oral fue gratuito y el tópico muy bajo. Conclusiones: La evolución clínica fue favorable y el costo del tratamiento muy bajo, lo cual demostró la efectividad de la terapia floral en la muestra(AU)

Introduction: Natural and traditional medicine is nowadays a necessity, not as a therapeutic option, but because of its intrinsic value, since it allows to treat the patient holistically, in addition to its innocuousness and low cost. Objective: To assess the clinical evolution and cost of treatment in patients treated with Bach flower essences. Methods: A study was carried out to assess the evolution of patients with a clinical diagnosis of psoriasis, vitiligo and lichen planus, who were treated with Bach flower essences in the period from March 2016 to March 2018, at a multidisciplinary consultation of dermatology, traditional natural medicine and psychology from Héroes del Moncada Teaching Polyclinic in Cárdenas Municipality, Matanzas Province. The data were collected and processed in the EXCEL software, taking into account demographic variables, together with inclusion and exclusion criteria, as well as informed consent of patients who had not received any conventional treatment. The flower essences used, orally and topically, were crab apple, willow, verbain, impatiens, walnut, cherry plum, sweet chestnut, chicory, clematis, beech, star of Bethlehem, white chestnut and larch. Results: The female sex predominated in cases of vitiligo and psoriasis. Anxiety was present in seventeen patients. Regarding evolution, fourteen patients were asymptomatic and the same amount achieved improvement. The cost of the oral flower essences was free and that of the topical ones was very low. Conclusions: Clinical evolution was favorable and the cost of treatment was very low, which demonstrated the effectiveness of flower therapy in the sample studied(AU)

Immunofluorescence and histopathological assessment using ex vivo confocal laser scanning microscopy in lichen planus.

Ex vivo confocal laser scanning microscopy (CLSM) provides rapid, high-resolution imaging, fluorescence detection and digital haematoxylin-eosin (H&E)-like staining. We aimed to assess the performance of ex vivo CLSM in identifying histomorphology and immunoreactivity in lichen planus (LP) and comparing its accuracy with conventional histopathology and direct immunofluorescence (DIF). Thirty-three sections of 17 LP patients stained with acridine orange (AO) and FITC-labelled anti-fibrinogen antibody and 21 control samples stained with AO were examined using ex vivo CLSM. Ex vivo CLSM was in perfect agreement with conventional histopathology in identifying interface dermatitis, vacuolar degeneration and band-like infiltration. ROC analysis showed that the presence of vacuolar degeneration, interface dermatitis and band-like infiltration was useful to distinguish LP sections from controls (p < .0001). The detection rates of fibrinogen deposition using DIF and in conclusion ex vivo CLSM were 93.8% and 62.5%, respectively. ex vivo CLSM enables histopathological and immunofluorescence examination in LP with the advantage of digital H&E-like staining.

Assessment of neopterin level and severity in lichen planus patients treated with narrow-band ultraviolet B.

BACKGROUND: Neopterin is a cellular immunity biochemical marker. Serum and saliva neopterin levels have been reported to increase in lichen Planus. Nonetheless, analysis has not yet been made for the direct link between narrow band ultraviolet B and severity of Lichen planus. AIM: We aimed to assess serum neopterin levels in patients who receive narrow band ultraviolet B therapy treatment with lichen planus, paired with the severity of the disease. PATIENTS AND METHODS: The study consisted of 35 lichen planus patients and 30 healthy individuals. A 35 patient group received narrow band ultraviolet B therapy. An enzyme-related immunosorbent assay procedure was used in serum neopterin analysis before and post-therapy. RESULTS: The correlation between the level and severity of the patient group was statistically significant (P = .001). In patients with severe disease, serum neopterin levels were significantly increased. Also, in the severe lichen planus group, the serum neopterin level was statistically higher than that of the mild or moderate groups (P = .001).Also, a significant decrease was seen following therapy according to serum neopterin level. CONCLUSION: Serum neopterin levels are a useful marker for the assessment of the severity and effectiveness of narrow band ultraviolet therapy. Thus, our findings may provide a new approach with the management of disease and follow-up strategies in patients with lichen planus.

Assessment of the Role of Vitamin D in the Treatment of Oral Lichen Planus.

AIM: Lichen planus is an autoimmune disease that can affect the skin and mucous membranes, including the oral mucosa. Vitamin D plays a very important role in the bone health along with boosting immunity. This study was carried out to assess the role of vitamin D in the treatment of oral lichen planus. MATERIALS AND METHODS: A sample size of 450 was taken which included patients showing clinical presentation of oral lichen planus. The patients were equally divided into three different groups based on their vitamin D levels. The data were analyzed using SPSS version 26.0. RESULTS: The patients who were given the vitamin D supplementation showed the maximum improvement. The comparison of the data were found to be statistically significant. CONCLUSION: It was concluded that vitamin D played an important role in the treatment of oral lichen planus. CLINICAL SIGNIFICANCE: The role of vitamin D in lichen planus needs to be explored. This study may be useful in conducting further study to assess the role in vitamin D supplementation in the treatment of oral lichen planus.

Vulvar intraepithelial neoplasia: Classification, epidemiology, diagnosis, and management.

Vulvar intraepithelial neoplasia (VIN) is classified into two entities: differentiated (dVIN) and vulvar high-grade squamous intraepithelial lesions (vH-SIL). dVIN is a premalignant lesion that develops on an existing vulvar lesion such as lichen sclerosus, while vH-SIL is associated with HPV infection. The two entities differ in terms of pathophysiology, background, prognosis, and management. The incidence of VIN in young women is rising and recurrence is common, even after radical surgery, which can cause significant disfigurement. Alternative strategies include topical treatments, ablation, and a watch-and-wait approach. There is currently no consensus on how these lesions should be managed. We review the literature in this field.

Prevalence of skin disorders and associated socio-economic factors among primary school children in the Eastern region of Saudi Arabia.

OBJECTIVE: To identify the prevalent skin disorders among primary school children, awareness of its risk factors and to assess the socio-demographic determinants associated with their development. METHODS: The cross-sectional observational study was conducted in September-December 2016 comprising children from six public and private schools in Wadi Al Dawaser region of Eastern Saudi Arabia. A self-generated self-administered questionnaire was sent through the children to be filled up by their parents. Details on sociodemographic and skin dermatoses conditions were collected. Data were analyzed using SPSS 16.. RESULTS: Of the 710 students approached, 499(70.2%) responded. Of them, 151(30.2%) were boys and 348(69.7%) were girls. The overall mean age was 10.3}1.4 years (range: 3-15 years). The overall prevalence of skin disorders was 118(23.6%). Allergic dermatoses 11(11.3%) and eczema 4(11.8%) were the commonest conditions. Lichen planus 6(5%), acne 9(7.6%), allergic rashes 4(3.3%), and psoriasis 3(2.5%) were also recorded. Sociodemographic and hygiene factors were significantly associated with the disease (p<0.05 each). CONCLUSIONS: A high prevalence of skin disorders was encountered among primary school children in the region studied.

Humanistic burden of chronic pruritus in patients with inflammatory dermatoses: Results of the European Academy of Dermatology and Venereology Network on Assessment of Severity and Burden of Pruritus (PruNet) cross-sectional trial.

BACKGROUND: Chronic pruritus is a multifactorial, challenging symptom of global relevance. OBJECTIVE: The European Academy of Dermatology and Venereology Network on Assessment of Severity and Burden of Pruritus (PruNet) investigation aimed to analyze the severity and humanistic burden of chronic pruritus in patients suffering from inflammatory dermatoses across Europe. METHODS: Prospectively collected routine data on 552 patients (with atopic dermatitis, contact dermatitis, prurigo nodularis, psoriasis vulgaris, lichen planus, or mycosis fungoides [pruritus numeric rating scale score ≥3]) from 9 European centers (in Austria, France, Germany, Italy, Poland, Russia, Spain, Switzerland, and Turkey) were analyzed by univariate and multivariate variance analyses of various itch characteristics and quality of life (as measured by the Dermatology Life Quality Index and the ItchyQoL). RESULTS: Duration, frequency, and intensity of pruritus (according to a numeric rating scale and visual analog scale) and related impairment of quality of life differed between European centers and dermatologic diagnoses (P < .05). The country in which the center was located had a greater impact on how patients evaluated pruritus intensity and quality of life than diagnosis did (P < .001). LIMITATIONS: One center per country was included. CONCLUSION: The humanistic burden of chronic pruritus in patients with inflammatory dermatoses is high. European cross-cultural factors may have a stronger influence than a specific dermatologic diagnosis on how patients rate intensity of pruritus and quality of life.

Clinical Aspects of Itch in Lichen Planus.

Lichen planus (LP) skin lesions are often accompanied by itch, but this symptom has not been thoroughly examined in LP. To better characterize itch in LP, 78 patients with LP were investigated. Itch was present in 94.9% of patients and was usually described as the most vexing symptom of LP. The mean?±?SD severity of itch according to visual analogue scale score was 6.9?±?2.8 points. Most patients experienced itching daily, pruritus episodes lasted longer than 1 min, and most often occurred in the evening. Itch was frequently described as burning and, for many patients, it was considered burdensome and annoying. The following factors most often increased the perceived severity of pruritus: sweating, high temperature, stress and hot water, while cold water and cold air often resulted in itch reduction. In conclusion, itch is the major subjective symptom of LP. Effective treatment of pruritus should be one of the main goals of LP therapy.

Reflectance confocal microscopy for scarring and non-scarring alopecia real-time assessment.

Clinical management of alopecia represents one of the major issues in dermatology. Scalp biopsies are not easily accepted because of the high bleeding and sensitive anatomical area. Trichoscopy is routinely used for diagnosis of alopecia, but in several cases lack to provide sufficient information on the status of the disease. Recently, reflectance confocal microscopy demonstrated its usefulness for the evaluation of several inflammatory skin condition and preliminary reports about alopecia have been proposed in the literature. The aim was to identify the confocal features characterizing scarring and non-scarring alopecia. Reflectance confocal microscopy from 86 patients affected by scarring (28 lichen planopilaris and 9 lupus erythematosus) and non-scarring alopecia (30 androgenic alopecia and 19 alopecia areata), were retrospectively, blinded evaluated. Good concordance between different readers on the confocal criteria has been assessed. Statistical significant features, specific for scarring alopecia and non-scarring alopecia have been identified. In this study, data on reflectance confocal microscopy features useful for the differential diagnosis between scarring and non-scarring alopecia have been identified. Further studies focusing on the use of this non-invasive technique in the therapeutic follow-up and distinction of sub-entities of alopecia are still required.

Extrahepatic Manifestations of Hepatitis C: A Meta-analysis of Prevalence, Quality of Life, and Economic Burden.

BACKGROUND & AIMS: Hepatitis C virus (HCV) infection has hepatic and extrahepatic manifestations with various costs and impairments to health-related quality of life (HRQL). We performed a meta-analysis to determine the prevalence of extrahepatic manifestations in patients with HCV infection, how these impair HRQL, and their costs. METHODS: We performed systematic reviews of the literature using MEDLINE, CINAHL, and the Cochrane Systematic Review Database, from 1996 through December 2014, to identify studies of the following extrahepatic manifestations of HCV infection: mixed cryoglobulinemia, chronic kidney or end-stage renal disease, type 2 diabetes, B-cell lymphoma, lichen planus, Sjögren's syndrome, porphyria cutanea tarda, rheumatoid-like arthritis, or depression. We performed a separate meta-analysis for each condition to determine prevalence rates of extrahepatic manifestations of HCV infection and their effects on HRQL. We determined the annual costs (inpatient, outpatient, and pharmacy) associated with extrahepatic manifestations of HCV infection. RESULTS: In an analysis of data from 102 studies, we found the most common extrahepatic manifestations to be diabetes (in 15% of patients) and depression (in 25% of patients). HRQL data showed that HCV infection had negative effects on overall physical and mental health. Total direct medical costs of extrahepatic manifestations of HCV infection, in 2014 US dollars, were estimated to be $1506 million (range, $922 million-$2208 million in sensitivity analysis). CONCLUSIONS: In a systematic review and meta-analysis we determined the prevalence, risks, and costs associated with extrahepatic manifestations of HCV infection. These estimates should be added to the liver-related burden of disease to obtain a more accurate assessment of the total burden of chronic HCV infection. Prospective, real-world studies are needed to increase our understanding of the total clinical and economic effects of HCV infection and treatment on patients and society.

Quantitative comparison of angiogenesis and lymphangiogenesis in cutaneous lichen planus and psoriasis: immunohistochemical assessment.

Recent experimental studies revealed that angiogenesis and lymphangiogenesis are closely related to chronic inflammation. The present study aims to evaluate quantitative changes of blood and lymphatic microcirculatory beds in cutaneous lichen planus (CLP) and psoriatic lesions using immunohistochemical analysis with antibodies to CD34, D2-40 and VEGF. Morphometric software was used to determine the area of blood and lymphatic vessels (BVA and LVA) and also the VEGF positive area. Statistical analysis of these parameters confirmed a significant enlargement of both the blood and lymphatic microcirculatory beds in psoriatic and CLP lesions. BVA in CLP lesions was increased by 56% however this augmentation was not as great as in psoriatic lesions where BVA was increased by 123%. Interestingly, LVA in psoriatic and CLP lesions was increased equally by 85%. The strongest VEGF expression was detected in psoriatic lesions, with lower, but still significant, overexpression in CLP lesions. VEGF-C was significantly increased in both psoriatic and CLP lesions in comparable level. Noticeably higher VEGF and VEGF-C expression was observed in the epidermis than in the dermis. Finally, our results indicate that the level of angiogenesis is considerably greater in psoriatic lesions than in CLP lesions, but the level of lymphangiogenesis is equal in both psoriatic and CLP lesions.