Perforating Lichen Planus in an Adolescent Boy: A Rare ... · features resembling verrucous...
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Correspondences 100 Indian Journal of Dermatology 2017; 62(1) variant of this disease with features of both LP and transepidermal elimination in histopathology. [1,2] A very few cases of perforating LP have been reported till date in the literature. A 14-year-old Indian boy presented with gradually progressive pruritic lesions over both lower legs for 6 months. On examination, we found multiple, hyperpigmented, keratotic papules and plaques over the anterior, posterior, and lateral sides of distal parts of both lower extremities [Figure 1a and b]. The mucosae, nail, hair, and systemic examinations were noncontributory. There was no history of any drug intake before the eruption. The patient also had no history of jaundice in the past. A provisional diagnosis of lichenoid dermatosis was considered. A 4-mm punch biopsy was performed including the keratotic central part of a lesion. On histopathological examination, we found hyperkeratosis, focal hypergranulosis, irregular acanthosis, basal cell degeneration, Civatte bodies, and dense band-like lymphocytic infiltrate mixed with histiocytes in the upper dermis with features of transepidermal elimination [Figure 2a and b]. The wide perforating channel was filled with dense lymphohistiocytic infiltrate [Figure 3a and b]. On the basis of these clinical and histopathological findings, the diagnosis of perforating LP was made. LP is an immune-mediated disorder classically presenting as faintly erythematous to violaceous, polygonal, flat-topped papules usually distributed symmetrically and bilaterally over the extremities. Many variations in the clinical presentations according to the morphology, configuration, or distribution have also been described. [1] The classical epidermal changes of LP include hyperkeratosis, wedge-shaped hypergranulosis, and irregular elongation of rete ridges in sawtooth pattern. There is basal cell damage, and multiple apoptotic cells (colloid-hyaline bodies or Civatte bodies) are seen in the dermoepidermal junction. Eosinophilic colloid bodies are found in the papillary dermis. [1,2] There is a band-like dense lymphocytic infiltrate mixed with histiocytes in the papillary dermis. [2] Perforating LP is a rare variant of LP which clinically presents as keratotic papules and plaques. On histopathology, there is transepidermal elimination with other features of LP. [1,2] There are very few cases of perforating LP reported in the literature. Hanau and Sengel [3] reported a case in a 52-year-old woman in 1984. Histopathology of that case showed typical features of LP with an area of perforation of epidermis with a rectilinear channel containing hyaline bodies, inflammatory cells, melanophages, and fibrillar material. [3] Gutte and Khopkar [4] described a case of perforating LP in a 38-year-old man with histological features of LP 3. Tsuji T, Sawada H. Eccrine angiomatous hamartoma with verrucous features. Br J Dermatol 1999;141:167-9. 4. Jorge-Finnigan C, Conejero C, Hernández-Martín A, Sánchez-Gómez J, Noguera-Morel L. Congenital erythematous plaques and papules on the right arm. Eccrine angiomatous hamartoma. Pediatr Dermatol 2015;32:285-6. 5. Tennant LB, Mulliken JB, Perez-Atayde AR, Kozakewich HP. Verrucous hemangioma revisited. Pediatr Dermatol 2006;23:208-15. 6. Cheong SH, Lim JY, Kim SY, Choi YW, Choi HY, Myung KB. A case of eccrine angiomatous hamartoma associated with verrucous hemangioma. Ann Dermatol 2009;21:304-7. 7. Galan A, McNiff JM. Eccrine angiomatous hamartoma with features resembling verrucous hemangioma. J Cutan Pathol 2007;34 Suppl 1:68-70. 8. Pelle MT, Pride HB, Tyler WB. Eccrine angiomatous hamartoma. J Am Acad Dermatol 2002;47:429-35. 9. Castilla EA, Schwimer CJ, Bergfeld WF, Skacel M, Ormsby A. Eccrine angiomatous hamartoma in a neurofibromatosis Type-1 patient. Pathology 2002;34:378-80. 10. Oh JG, Yoon CH, Lee CW. Case of Cowden syndrome associated with eccrine angiomatous hamartoma. J Dermatol 2007;34:135-7. 11. Chokoeva A, Wollina U, Lotti T, Tana C, Tchernev G. Nevus depigmentosus associated with nevus spilus: First report in the world literature. Georgian Med News 2015;248:73-6. Access this article online Quick Response Code: Website: www.e‑ijd.org DOI: 10.4103/0019‑5154.198034 This is an open access article distributed under the terms of the Creative Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non‑commercially, as long as the author is credited and the new creations are licensed under the identical terms. How to cite this article: Yamamoto T, Hirano M, Ueda K. Eccrine angiomatous hamartoma in a patient with nevus depigmentosus and nevus spilus. Indian J Dermatol 2017;62:99‑100. Received: May, 2016. Accepted: November, 2016. Perforating Lichen Planus in an Adolescent Boy: A Rare Phenomenon Arghyaprasun Ghosh, Deblina Bhunia 1 , Olympia Rudra, Megha Agarwal From the Department of Dermatology, R. G. Kar Medical College, Kolkata, West Bengal, 1 Department of Dermatology, Mata Gujri Memorial Medical College and LSK Hospital, Kishanganj, Bihar, India. E-mail: [email protected] Indian J Dermatol 2017:62(1):100-101 Sir, Lichen planus (LP) is a common autoimmune disorder with variable presentation. Perforating LP is a rare
Transcript of Perforating Lichen Planus in an Adolescent Boy: A Rare ... · features resembling verrucous...
Correspondences
100Indian Journal of Dermatology 2017; 62(1)
variant of this disease with features of both LP and transepidermal elimination in histopathology.[1,2] A very few cases of perforating LP have been reported till date in the literature.
A 14-year-old Indian boy presented with gradually progressive pruritic lesions over both lower legs for 6 months. On examination, we found multiple, hyperpigmented, keratotic papules and plaques over the anterior, posterior, and lateral sides of distal parts of both lower extremities [Figure 1a and b]. The mucosae, nail, hair, and systemic examinations were noncontributory. There was no history of any drug intake before the eruption. The patient also had no history of jaundice in the past. A provisional diagnosis of lichenoid dermatosis was considered. A 4-mm punch biopsy was performed including the keratotic central part of a lesion. On histopathological examination, we found hyperkeratosis, focal hypergranulosis, irregular acanthosis, basal cell degeneration, Civatte bodies, and dense band-like lymphocytic infiltrate mixed with histiocytes in the upper dermis with features of transepidermal elimination [Figure 2a and b]. The wide perforating channel was filled with dense lymphohistiocytic infiltrate [Figure 3a and b]. On the basis of these clinical and histopathological findings, the diagnosis of perforating LP was made.
LP is an immune-mediated disorder classically presenting as faintly erythematous to violaceous, polygonal, flat-topped papules usually distributed symmetrically and bilaterally over the extremities. Many variations in the clinical presentations according to the morphology, configuration, or distribution have also been described.[1]
The classical epidermal changes of LP include hyperkeratosis, wedge-shaped hypergranulosis, and irregular elongation of rete ridges in sawtooth pattern. There is basal cell damage, and multiple apoptotic cells (colloid-hyaline bodies or Civatte bodies) are seen in the dermoepidermal junction. Eosinophilic colloid bodies are found in the papillary dermis.[1,2] There is a band-like dense lymphocytic infiltrate mixed with histiocytes in the papillary dermis.[2]
Perforating LP is a rare variant of LP which clinically presents as keratotic papules and plaques. On histopathology, there is transepidermal elimination with other features of LP.[1,2]
There are very few cases of perforating LP reported in the literature. Hanau and Sengel[3] reported a case in a 52-year-old woman in 1984. Histopathology of that case showed typical features of LP with an area of perforation of epidermis with a rectilinear channel containing hyaline bodies, inflammatory cells, melanophages, and fibrillar material.[3]
Gutte and Khopkar[4] described a case of perforating LP in a 38-year-old man with histological features of LP
3. Tsuji T, Sawada H. Eccrine angiomatous hamartoma with verrucous features. Br J Dermatol 1999;141:167-9.
4. Jorge-Finnigan C, Conejero C, Hernández-Martín A, Sánchez-Gómez J, Noguera-Morel L. Congenital erythematous plaques and papules on the right arm. Eccrine angiomatous hamartoma. Pediatr Dermatol 2015;32:285-6.
5. Tennant LB, Mulliken JB, Perez-Atayde AR, Kozakewich HP. Verrucous hemangioma revisited. Pediatr Dermatol 2006;23:208-15.
6. Cheong SH, Lim JY, Kim SY, Choi YW, Choi HY, Myung KB. A case of eccrine angiomatous hamartoma associated with verrucous hemangioma. Ann Dermatol 2009;21:304-7.
7. Galan A, McNiff JM. Eccrine angiomatous hamartoma with features resembling verrucous hemangioma. J Cutan Pathol 2007;34 Suppl 1:68-70.
8. Pelle MT, Pride HB, Tyler WB. Eccrine angiomatous hamartoma. J Am Acad Dermatol 2002;47:429-35.
9. Castilla EA, Schwimer CJ, Bergfeld WF, Skacel M, Ormsby A. Eccrine angiomatous hamartoma in a neurofibromatosis Type-1 patient. Pathology 2002;34:378-80.
10. Oh JG, Yoon CH, Lee CW. Case of Cowden syndrome associated with eccrine angiomatous hamartoma. J Dermatol 2007;34:135-7.
11. Chokoeva A, Wollina U, Lotti T, Tana C, Tchernev G. Nevus depigmentosus associated with nevus spilus: First report in the world literature. Georgian Med News 2015;248:73-6.
Access this article onlineQuick Response Code:
Website: www.e‑ijd.org
DOI: 10.4103/0019‑5154.198034
This is an open access article distributed under the terms of the Creative Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non‑commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Yamamoto T, Hirano M, Ueda K. Eccrine angiomatous hamartoma in a patient with nevus depigmentosus and nevus spilus. Indian J Dermatol 2017;62:99‑100.
Received: May, 2016. Accepted: November, 2016.
Perforating Lichen Planus in an Adolescent Boy: A Rare
PhenomenonArghyaprasun Ghosh, Deblina Bhunia1,
Olympia Rudra, Megha AgarwalFrom the Department of Dermatology, R. G. Kar Medical College, Kolkata, West Bengal, 1Department of Dermatology, Mata Gujri Memorial Medical College and LSK Hospital, Kishanganj, Bihar, India. E-mail: [email protected]
Indian J Dermatol 2017:62(1):100-101
Sir,Lichen planus (LP) is a common autoimmune disorder with variable presentation. Perforating LP is a rare
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101 Indian Journal of Dermatology 2017; 62(1)
Financial support and sponsorshipNil.
Conflicts of interestThere are no conflicts of interest.
References1. Daoud MS, Pittelkow MR. Lichen planus. In: Goldsmith LA,
Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K, editors. Fitzpatrick’s Dermatology in General Medicine. 8th ed. New York: McGraw-Hill; 2012. p. 296-312.
2. Weedon D. Weedon’s Skin Pathology. 3rd ed. London: Churchill Livingstone Elsevier; 2010.
3. Hanau D, Sengel D. Perforating lichen planus. J Cutan Pathol 1984;11:176-8.
4. Gutte R, Khopkar U. Perforating lichen planus. Indian J Dermatol Venereol Leprol 2011;77:515-7.
5. Gutte R, Khopkar U. Predominant palmoplantar lichen planus: A diagnostic challenge. Indian J Dermatol 2014;59:343-7.
and perforation of epidermis along with acrosyringeal accentuation of infiltrate. The perforating channel was made up of a parakeratotic plug, and also abundant colloid bodies were seen below the invagination of epidermis by a parakeratotic plug.[4,5] In our case, there was no feature of parakeratosis or acrosyringeal accentuation.
We prescribed oral acitretin in a dose of 25 mg/day to our patient. After 6 weeks, the lesions started regressing, but he was lost to follow-up.
Presentation of perforating LP in an adolescent boy with distinct histopathological features made our case a rare one. This case emphasizes the role of histopathological examination in any atypical presentation of LP for its proper diagnosis and management.
Access this article onlineQuick Response Code:
Website: www.e‑ijd.org
DOI: 10.4103/0019‑5154.198040
This is an open access article distributed under the terms of the Creative Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non‑commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Ghosh A, Bhunia D, Rudra O, Agarwal M. Perforating lichen planus in an adolescent boy: A rare phenomenon. Indian J Dermatol 2017;62:100‑1.
Received: July, 2016. Accepted: November, 2016.
Generalized Bullous Drug Eruption to Faropenem ‑ Hitherto
UnreportedAnusree Gangopadhyay, Olympia Rudra,
Arghyaprasun Ghosh, Surajit Kumar BiswasFrom the Department of Dermatology, R. G. Kar Medical College, Kolkata, West Bengal, India. E-mail: [email protected]
Indian J Dermatol 2017:62(1):101-103
Sir,A 45-year-old homemaker presented to us with pruritic bullous eruption over her body for 2 days. A meticulous history taking revealed that the lesions appeared 24 h after consuming faropenem, an oral antibiotic prescribed to her by her physician for an acute attack of urinary tract infection. She could not recall any instance of
Figure 3: (a and b) Photomicrographs showing the perforating channel containing dense lymphohistiocytic infiltrate (H and E, ×400)
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Figure 2: Photomicrographs showing hyperkeratosis, irregular acanthosis, basal cell degeneration, and dense band-like lymphohistiocytic infiltrate at the papillary dermis with features of transepidermal elimination at the center ([a]: H and E, ×40, [b]: H and E, ×100)
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Figure 1: Multiple, hyperpigmented, keratotic papules and plaques over the posterior and lateral sides of both lower legs (a: right, b: left)
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