RESUMO
INTRODUCTION AND OBJECTIVE: Lichen planus is a chronic inflammatory skin disease involving the mucous membrane of the oral cavity. It is postulated that different factors play a role in the occurrence of the disease and may activate the immune system, thus influencing the development of lichen planus. Vitamin D is a steroid prohormone with multiple systemic effects. OBJECTIVE: The aim of this study was to assess oral lichen planus against 25-hydroxy-vitamin D3 serum level. Vitamin D takes an active part in the pathogenesis of immunisation diseases, may have also a beneficial effect on oral health. MATERIAL AND METHODS: The clinical picture of lichen planus was analyzed according to the concentration of 25-hydroxy-vitamin D3. Patients were given a questionnaire interview which included questions about the co-existence of systemic diseases, subjective complaints, and information relating to the individual course of the disease. In the next stage of the study, patients were underwent a physical examination. Laboratory determinations of the concentration of 25-hydroxy-vitamin D3 were also performed. RESULTS: The mean vitamin D concentration in patients with lichen planus in the oral cavity was 14.37 ± 4.95 ng/ml. An insufficient level (10-30 ng/ml) was detected in 84.91% of the examined patients, whereas a deficiency (< 10 ng/ml) was observed in 15.09% of those patients. None of the analyzed patients had vitamin D level in the range of established clinical standards. A substantially lowered vitamin D level was found in patients reporting bleeding and pain of the gums. CONCLUSIONS: The study enhances relationship between reduced levels of vitamin D3 and lichen planus in patients with oral lesions. Thus, vitamin D3 control and supplementation may play an important role in the treatment of lichen planus.
Assuntos
Líquen Plano Bucal , Líquen Plano , Humanos , Líquen Plano Bucal/complicações , Colecalciferol , Líquen Plano/complicações , Vitamina D , Pele , Doença CrônicaAssuntos
Ceratose/complicações , Líquen Plano/complicações , Úlceras Orais/complicações , Sarcoidose Pulmonar/complicações , Doença Crônica , Feminino , Humanos , Ceratose/diagnóstico , Ceratose/tratamento farmacológico , Líquen Plano/diagnóstico , Líquen Plano/tratamento farmacológico , Pessoa de Meia-Idade , Úlceras Orais/diagnóstico , Úlceras Orais/tratamento farmacológico , Terapia PUVA , Indução de Remissão , Sarcoidose Pulmonar/diagnóstico , Pele/patologia , Resultado do TratamentoAssuntos
Avaliação Educacional , Tumor Glômico/diagnóstico , Dermatopatias/diagnóstico , Dermatopatias/terapia , Neoplasias Cutâneas/diagnóstico , Inibidores de 5-alfa Redutase/uso terapêutico , Ainhum/tratamento farmacológico , Calosidades/diagnóstico , Cor , Constrição Patológica/tratamento farmacológico , Dutasterida/uso terapêutico , Finasterida/uso terapêutico , Humanos , Hiperpigmentação/complicações , Hiperpigmentação/diagnóstico , Líquen Plano/complicações , Líquen Plano/diagnóstico , Mastocitoma/diagnóstico , Mastocitoma/etiologia , Penfigoide Bolhoso/diagnóstico , Fototerapia , Pitiríase Rósea/diagnóstico , Pitiríase Rósea/etiologia , Dermatopatias/etiologia , Doenças das Glândulas Sudoríparas/diagnóstico , Verrugas/patologia , Verrugas/terapiaRESUMO
OBJECTIVES: Biologic therapy such as Etanercept, which is a tumor necrosis factor alpha (TNF-α) inhibitor, has been extensively used as election therapy in rheumatoid arthritis. The purpose of this case presentation was to inform about the possibility that lichen planus lesions could potentially become complicated by secondary infections in patients treated with Etanercept. Furthermore, we aimed at analyzing if the complication of the cutaneous lesion was coincidental or it was due to the immunosuppressive systemic therapy, and whether the infected lesion would respond to antibiotic therapy. CASE SUMMARY: The patient was a 59-year-old woman with rheumatoid arthritis and that have had lichen planus lesions for approximately 25 years. Only recently, she had been received immunosuppressive therapy (Etanercept and Methotrexate). Further on, the lichen planus flared up with a secondary infection determined by a Methicillin-sensitive Staphylococcus aureus. Uncommon myocardial complications were also characteristic of this case. RESULTS: While a case report described already the appearance of lichen planus following Etanercept therapy (Battistella M et al., 2008), the possibility that the lesion could become secondary complicated following this therapy was never reported before, according to our knowledge. Additionally, we describe in this case the interplay between Etanercept therapy and hypertrophic cardiomyopathy. CONCLUSIONS: Our case is not a lichen planus induced by Etanercept, but it is aggravated and secondary infected with Methicillin-sensitive Staphylococcus during the therapy. The additional cardiac complication (hypertrophic cardiomyopathy) may represent solely an evolutive sign of rheumatoid arthritis and therefore not influenced by Etanercept.
Assuntos
Artrite Reumatoide/tratamento farmacológico , Terapia Biológica/efeitos adversos , Líquen Plano/induzido quimicamente , Líquen Plano/complicações , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/patologia , Ecocardiografia , Feminino , Humanos , Líquen Plano/diagnóstico por imagem , Líquen Plano/patologia , Pessoa de Meia-IdadeRESUMO
Lichen planus is an uncommon inflammatory mucocutaneous disorder affecting the skin and its appendages, as well as oral and genital mucosa. Involvement of the esophageal mucosa is rare and causes significant morbidity, with dysphagia and risk of long-term complications, such as esophageal strictures and stenosis. Esophageal lichen planus is an underreported condition in the spectrum of lichenoid tissue reactions, presenting the risk of systemic manifestations. We describe a patient with severe, long-standing esophageal lichen planus, which had led to marked weight-loss, malnutrition syndrome and chronic respiratory distress due to recurrent aspiration pneumonia. Diagnosis was confirmed by the presence of concomitant muco-cutaneous lesions and characteristic endoscopic and histological findings. Systemic therapy with cyclosporine A and micronutrient supplementation led to rapid clinical improvement. Early diagnosis of esophageal lichen planus as well as effective systemic immunosuppressive treatment is crucial in order to prevent short- and long-term complications.
Assuntos
Doenças do Esôfago/complicações , Líquen Plano/complicações , Biópsia , Ciclosporina/uso terapêutico , Suplementos Nutricionais , Doenças do Esôfago/diagnóstico , Doenças do Esôfago/tratamento farmacológico , Feminino , Humanos , Imunossupressores/uso terapêutico , Líquen Plano/diagnóstico , Líquen Plano/tratamento farmacológico , Desnutrição/etiologia , Pessoa de Meia-Idade , Pneumonia Aspirativa/etiologia , Recidiva , Resultado do TratamentoRESUMO
Lichen planus (LP) is a papulosquamous eruption of the skin, scalp, nails, and mucous membranes. Although LP is more common in adults, it has become an established pediatric disorder. Its classic presentation is characterized by 4 p's: purple, polygonal, pruritic papules. Histopathologic examination reveals characteristic interface dermatitis. Although its pathogenesis is not fully understood, there is evidence that an imbalance of immunologic cellular reactivity is central. Lichen planus usually resolves within a few months. Treatment that primarily consists of topical and/or oral steroids will expedite recovery and alleviate symptoms. Resolution of this cutaneous disease often is accompanied by postinflammatory hyperpigmentation. Long-term sequelae of LP in the pediatric population are rare, but cutaneous atrophy and pterygium unguis may occur.
Assuntos
Glucocorticoides/uso terapêutico , Líquen Plano/diagnóstico , Líquen Plano/tratamento farmacológico , Administração Oral , Administração Tópica , Biópsia , Criança , Diagnóstico Diferencial , Glucocorticoides/administração & dosagem , Humanos , Imunossupressores/uso terapêutico , Líquen Plano/complicações , Líquen Plano/patologia , Fototerapia/métodosRESUMO
Lichen planus (LP) is a relatively common papulosquamous disorder that is characterized by pruritic, polygonal papules in a characteristic distribution. We present a case of a 71-year-old man with erythroderma, who was ultimately diagnosed with severe, generalized LP. Treatment of severe LP is challenging, and there are few, robust, clinical trials in the literature to guide the selection of appropriate treatment. We discuss the treatment options for generalized LP and the evidence in support of these agents.
Assuntos
Dermatite Esfoliativa/etiologia , Líquen Plano/diagnóstico , Idoso , Calafrios , Glucocorticoides/uso terapêutico , Humanos , Fatores Imunológicos/uso terapêutico , Itraconazol/uso terapêutico , Úlcera da Perna/etiologia , Úlcera da Perna/microbiologia , Líquen Plano/complicações , Líquen Plano/tratamento farmacológico , Masculino , Metronidazol/uso terapêutico , Terapia PUVA , Prurido/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Retinoides/uso terapêutico , Infecções Cutâneas Estafilocócicas/complicações , Talidomida/uso terapêuticoRESUMO
A 40-year-old white woman with a history of diabetes mellitus, hypothyroidism, irritable bowel syndrome, and Turner's syndrome presented with widespread lichen planus. She also had extensive erosions of her oral and vaginal mucosa, along with diffuse noncicatricial alopecia. The patient's condition was refractory to most topical therapies, and improved with oral psoralen/ultraviolet A. Previous associations of lichen planus with other medical disorders have been described, yet its occurrence with Turner's syndrome is yet unrecognized.
Assuntos
Doenças do Sistema Endócrino/complicações , Líquen Plano/complicações , Líquen Plano/tratamento farmacológico , Terapia PUVA , Síndrome de Turner/complicações , Adulto , Feminino , Humanos , Líquen Plano/patologiaRESUMO
Oral lichen planus is a chronic mucocutaneous disease that is relatively common. Although many patients are asymptomatic and require no therapy, those who exhibit atrophic and erosive lesions are often a challenge to treat. All therapies are palliative, and none is effective universally. Currently employed treatment modalities include corticosteroids administered topically, intralesionally, or systemically. Alternative therapies include topical and systemic retinoids, griseofulvin, Cyclosporine, and surgery. Other medical treatments and experimental modalities, including mouth PUVA, have been reported to be effective. Controversy concerning the efficacy of all these treatments suggests that oral lichen planus is a heterogeneous disorder. Eliminating lichenoid drug eruptions, candidiasis, trauma, contact mucositis, and emotional stress may play a role in the management of these patients. This article is a review of the many treatments and measures that have been employed in the management of patients with oral lichen planus.
Assuntos
Líquen Plano/terapia , Doenças da Boca/terapia , Administração Tópica , Corticosteroides/administração & dosagem , Corticosteroides/uso terapêutico , Antibacterianos/uso terapêutico , Antifúngicos/uso terapêutico , Antivirais/uso terapêutico , Candidíase Bucal/etiologia , Criocirurgia , Ciclosporina/uso terapêutico , Humanos , Líquen Plano/complicações , Líquen Plano/etiologia , Mucosa Bucal/patologia , Terapia PUVA , Fenitoína/uso terapêutico , Retinoides/administração & dosagem , Retinoides/uso terapêuticoRESUMO
A case of simultaneous occurrence of lichen planus (LP) and hepatitis C in the same patient is presented. The patient had received treatment with interferon alpha for her chronic liver disease, and the association between LP, hepatitis C and interferon alpha treatment is discussed.
Assuntos
Hepatite C/complicações , Hepatite Crônica/complicações , Líquen Plano/complicações , Feminino , Humanos , Interferon-alfa/uso terapêutico , Pessoa de Meia-Idade , Terapia PUVA , PrevalênciaRESUMO
A 49-year-old patient with concomitant solar urticaria (SU) and lichen planus (LP) is presented. The sunlight- and UV-A-provoked wheal and flare SU reactions were interpreted as an antigen-antibody reaction, probably involving a reaginic antibody, because SU was passively transferred by a serum factor utilizing the Prausnitz-Küstner reaction. The reduced percentage of suppressor cytotoxic T-cell subset in peripheral blood typical of active LP may facilitate the increased production of reaginic antibodies after presentation of antigen by sunlight. Not only was the usual immunological reaction of LP (similar to graft-versus-host reaction) suppressed by PUVA treatment, but increased tolerance to sunlight was also achieved.
Assuntos
Líquen Plano/complicações , Transtornos de Fotossensibilidade/complicações , Urticária/complicações , Biópsia , Complemento C3/metabolismo , Imunofluorescência , Humanos , Imunoglobulina M/metabolismo , Líquen Plano/imunologia , Líquen Plano/patologia , Masculino , Pessoa de Meia-Idade , Terapia PUVA , Transtornos de Fotossensibilidade/imunologia , Transtornos de Fotossensibilidade/patologia , Pele/patologia , Linfócitos T/imunologia , Urticária/imunologia , Urticária/patologiaRESUMO
Keratosis lichenoides chronica may be seen clinically and histologically as a variant of lichen planus. One in three patients have nail involvement with changes that may superficially resemble psoriasis, but pitting and pustulosis do not occur. Hyperkeratotic hypertrophy of the periungual tissues is a distinctive feature. Psoralens and UV-A therapy as well as etretinate have improved some cases.