Combination of actinic, hypertrophic and typical forms of lichen planus in one patient

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Abstract

Lichen planus is a chronically occurring dermatosis of a multifactorial nature, which is characterized by the appearance of flat polygonal itchy papules on the skin and mucous membranes. Dermatosis is often associated with diabetes mellitus and diseases of the gastrointestinal tract, extremely rarely with oncological diseases. Antimalarial drugs with photoprotective, anti-inflammatory, weak immunosuppressive effect are recommended for treatment.

Actinic and hypertrophic forms of lichen planus are atypical forms of the disease. Actinic or tropical lichen planus is rare in the Russian Federation, mainly in the countries of the Middle and Near East, Central Asia, Africa. The actinic form of lichen planus is characterized by localization in open areas of the skin (face, neck). The hypertrophic form of lichen planus is characterized by large papules with a bumpy surface that do not look like a typical form. The rare occurrence of dermatosis and unusual localization leads to difficulty in making a diagnosis.

The article presents a clinical case of a combination of actinic, hypertrophic and typical forms of lichen planus in a patient born in the Caucasus, but having lived in Russia for a long time. The skin process in the patient was widespread, was localized throughout the skin, including the face, neck, mucous membranes of the oral cavity; only the skin of the palms and soles remained free from rashes. The rash was represented by flat polygonal papules, bluish-pink in color, the size of a lentil, and a whitish Wickham mesh on the surface.

Localization in open areas of the skin, combination with hypertrophic papules, outdoor work, severe itching with excoriations led to an incorrect diagnosis, and the ongoing therapy had no effect. To clarify the diagnosis, a histological examination was carried out, which revealed pronounced hyperkeratosis, uneven granulosis, massive papillomatosis, in the papillary and sub-papillary layers of the dermis (stripe-shaped moderate infiltrate of lymphoid elements, histiocytes, minor edema, vasodilation). Adequately selected drug therapy (dexamethasone intramuscularly; chloropyramine intramuscularly; antimalarial agent; nicotinic acid; external ointment dermatol), as well as acupuncture sessions with the second inhibitory method of therapy, led to an improvement in the patient’s condition.

Upon completion of treatment, the patient is recommended photoprotective external agents on exposed skin and a repeated course of acupuncture.

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About the authors

Svetlana N. Shchava

Volgograd State Medical University

Author for correspondence.
Email: snchava@rambler.ru
ORCID iD: 0000-0002-4946-6624
SPIN-code: 7449-7277

MD, Cand. Sci. (Med.), Associate Professor

Russian Federation, Volgograd

Irina N. Ivanova

Volgograd State Medical University

Email: derma_19@mail.ru
ORCID iD: 0000-0003-3201-6026
SPIN-code: 2122-8683

MD, Cand. Sci. (Med.)

Russian Federation, Volgograd

Elena A. Serdyukova

Volgograd State Medical University

Email: eas171@yandex.ru
ORCID iD: 0000-0002-2109-3723
SPIN-code: 3974-3787

MD, Cand. Sci. (Med.), Associate Professor

Russian Federation, Volgograd

References

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Supplementary files

Supplementary Files
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1. Fig. 1. Patient A., 47 years old. Diagnosis: Lichen planus typical, actinic and hypertrophic forms. Flat polygonal papules, bluish-pink in color, the size of a lentil, with a whitish Wickham mesh on the surface of the skin of the abdomen.

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2. Fig. 2. The same patient. Hypertrophied papules, bluish-pink in color, protrude significantly above the surface of the skin, are enlarged in size in the forehead area.

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3. Fig. 3. The same patient. Papules are brown in color, the size of a pea, rounded in shape with an uneven surface and indistinct contours in the lumbar region.

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4. Fig. 4. The same patient. Papules enlarged to the size of a pea are brown in color, rounded in shape, with an uneven surface and indistinct contours, excoriation and hemorrhagic crusts in the area of the outer surface of the elbow joints.

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5. Fig. 5. Histological examination: pronounced hyperkeratosis (1), uneven granulosis (2) of the epidermis, massive papillomatosis (3). Staining with hematoxylin-eosin, ×100.

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6. Fig. 6. Histological examination: pronounced hyperkeratosis (1), uneven granulosis (2) of the epidermis. Staining with hematoxylin-eosin, ×400.

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7. Fig. 7. Histological examination: in the papillary and sub-papillary layers of the dermis, there is a strip-like moderate infiltrate of lymphoid elements, histiocytes (1). In the dermis, there is slight edema, vasodilation (2). Staining with hematoxylin-eosin, ×400. DOI: https://doi.org/10.17816/dv106183

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