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Diffuse infiltration infiltration of the upper dermis

5  Non-tumorous skin diseases

5.5  Diffuse infiltration infiltration of the upper dermis

5.5.1  Lichen ruber planus

Etiology, pathogenesis:

  • idiopathic, probably autoimmune

Clinical signs:

  • predilection sites: the wrists, shins, ankles of the lower extremities, sacral region, mouth, genitals
  • polygonal, flat, shiny papule
  • pink, red colour, hyperpigmented brownish-red variants
  • pruritus
  • variants: hypertrophic, bullous, linear, actinic, erythematosus, planopilaris and other
  • nail dystrophy

Pictures

Lichen planus, generalised dissemination:
Lichen planus, developed, CLINIC (792)
Lichen planus, developed, CLINIC (1065)

Lichen planus, Köbner's phenomenon:
Lichen planus, developed, CLINIC (793)
Lichen planus, developed, CLINIC (1066)

Lichen papule, detail:
Lichen planus, developed, CLINIC (794)

Lichen planus, hypertrophic, dorsa of the hands:
Lichen planus, developed, CLINIC (795)

Lichen planus of the wrists and palms:
Lichen planus, developed, CLINIC (796)
Lichen planus, developed, CLINIC (1067)

Lichen planus of the wrists and palms:
Lichen planus, developed, wrist, CLINIC (3074)
Lichen planus, developed, wrist, CLINIC (3075)
Lichen planus, developed, CLINIC (3076)

Lichen planus, lips:
Lichen planus, developed, Macro (3846)

Lichen planus of the oral mucosa:
Lichen planus, developed, CLINIC (791)
Lichen planus, developed, CLINIC (1064)

Lichen planus, oral:
Lichen planus, oral, CLINIC (3071)
Lichen planus, oral, CLINIC (3072)
Lichen planus, developed, Macro (3848)
Lichen planus, oral, CLINIC (3073)

Lichen planus, lips:
Lichen planus, developed, Macro (3985)

Lichen planus:
Lichen planus, developed, CLINIC (5715)
Lichen planus, developed, CLINIC (5716)
Lichen planus, developed, CLINIC (5717)
Lichen planus, developed, CLINIC (5718)

Lichen planus, skin and nails:
Lichen planus, nails, CLINIC (5719)
Lichen planus, nails, CLINIC (5720)
Lichen planus, nails, CLINIC (5721)

Lichen planus, lichen nitidus:
Lichen planus and lichen nitidus, CLINIC (5708)
Lichen planus and lichen nitidus, CLINIC (5709)
Lichen planus and lichen nitidus, CLINIC (5710)
Lichen planus and lichen nitidus, CLINIC (5711)
Lichen planus and lichen nitidus, CLINIC (5712)
Lichen planus and lichen nitidus, CLINIC (5713)
Lichen planus and lichen nitidus, CLINIC (5714)

Further examples of lichen planus:

Histology:

Hyperkeratosis (without parakeratosis), focal hypergranulosis, dense, bandlike inflammatory lymphocytic infiltrate in upper dermis attacking basal layer of epidermis, causing obscuring of dermoepidermal junction (lichenoid infiltrate), saw shape irregular acanthosis, scattered melanophages apoptotic keratinocytes (Civatte bodies); immunofluorescence: lace like deposits of fibrin

Pictures

Lichen planus:
Lichen planus, HE 40x (3561)

Another case:
Lichen ruber planus, HE 10x (153)

Another case:
Lichen ruber, HE 40x (154)

Another case:
Lichen ruber planus, HE 10x (155)

Another case:
Lichen ruber planus, HE 20x (156)
Lichen ruber planus, HE 40x (157)

Another case:
Lichen ruber planus, HE 10x (158)
Lichen ruber planus, HE 20x (159)
Lichen ruber planus, HE 40x (160)

Another case:
Lichen ruber planus, HE 100x (505)

Another case:
Lichen planus, developed, HE 20x (4532)  [zoomify]

Another case:
Lichen planus, developed, HE 100x (4927)  [zoomify]

Another case:
Lichen planus, developed, HE 40x (3667)

Another case:
Lichen planus, developed, HE 20x (5350)

Another case:
Lichen planus, developed, HE 40x (12701)

Another case:
Lichen planus, HE 40x (12612)

Another case:
Lichen planus, HE 40x (12613)

Another case:
Lichen planus, HE 40x (12614)

Another case:
Lichen planus, HE 60x (10754)

Another case:
Lichen planus, developed, HE 60x (12080)

Another case:
Lichen planus with Civatte bodies, HE 40x (12904)

Lichen planus linearis:
Lichen planus linearis, HE 20x (4338)  [zoomify]

Palmoplantar lichen planus, hyperkeratotic:
Lichen palmoplantaris hyperkeratoticus, HE 20x (4335)  [zoomify]

Vesicular lichen ruber (lichen planus pemphigoides):
Lichen planus pemphigoides, HE 20x (4340)  [zoomify]

Lichen planus actinicus:
Lichen planus actinicus, HE 20x (4337)

Lichen planus, vulva:
Lichen planus, vulva, HE 60x (13778)

Lichen planus, burned out:
Lichen planus atrophic, HE 20x (4436)  [zoomify]

Lichen planus, immunofluorescence:
Lichen planus, anti-IgM, FITC, Evans 20x (574)
Lichen planus, developed, FITC, Evans 20x (2141)
Lichen planus, anti-IgM, FITC, Evans 40x (575)
Lichen planus, anti-IgM, FITC, Evans 40x (576)

Lichen planus, oral mucosa, fluorescence:
Lichen planus, gingiva, anti-fibrin, FITC 40x (560)
Lichen planus, mucous membrane, anti-fibrin, FITC, Evans 20x (610)

Another case:
Lichen planus, HE 40x (2707)

Another case:
Lichen ruber, HE 100x (5474)

Another case:
Lichen planus, HE 40x (2707)

Lichen planus, tongue:
Lichen planus, tongue, HE 60x (6294)

Lichen planus of the buccal mucosa:
Lichen planus of the buccal mucosa, HE 60x (10685)

Lichen planus, plantar:
Lichen planus, sole, HE 60x (13834)

Alopetia, lichen ruber:
Lichen planopilaris, HE 20x (5190)

5.5.1.1  Lichen verrucosus (hypertrophicus)

Clinical signs:

  • verrucous and hyperkeratotic variant of lichen planus
  • long lasting lichen ruber is combined with lichen simplex chronicus (caused by scratching)
  • location: the shins
  • pink, red colour, hyperpigmented brownish-red variants
  • pruritus
  • risk of squamous carcinoma in long standing lesions

Histology:

Prominent acanthosis, enlarged follicles, hyperkeratosis, focal increase of granular layer, lichenoid lymphocytic infiltrate.

5.5.1.2  Lichen ruber, vesicular

Introduction:

Artificial subepidermal clefts are often seen in lichen ruber (Max-Joseph spaces). However, sometimes real vesicles do develop, with small amount of proteinous exudate. Another vesicular variant occurs on (oral) mucous membrane.

5.5.1.3  Lichen planopilaris

Introduction:

Lichen planus variant, where the infiltrate is perifollicular. The disease progresses with follicular destruction and scarring alopecia (pseudopelade Brocq)

Graham-Little-Piccardi-Lassueur syndrome: cicatrical alopecia, follicular keratoses, alopecia of pubic and axillar regions; rare.

Histology:

The picture corresponds to that in lichen, but the infiltration is perifollicular.

5.5.2  Lichen planus like keratosis (benign lichenoid keratosis)

Introduction:

Group of diseases, mimicking lichen ruber planus. Caused by regression of a skin tumor, remnants of which can be sometimes found on a periphery of the lesion (solar lentigo, simplex lentigo and others).

Histology:

Solitary lesion, mimicking lichen ruber closely. Parakeratosis is often present.

5.5.3  Lichenoid drug reaction

Introduction:

Some drug reactions have lichenoid appearance

5.5.4  Lichen nitidus

Clinical signs:

  • reddish papules, size about 3 mm
  • usually asymptomatic
  • age: usually children, young adults
  • location: often trunk, upper extremities, penis

Histology:

Roundish foci of dense intrapapillary infiltrate, consisting of lymphocytes and epithelioid histiocytes, forming tiny granulomas. Sometimes there is slight epidermotropism, rarely transepidermal perforation. Rete ridges are bent around the infiltrate. Parakeratosis is often present.

5.5.5  Lichen striatus

Etiology, pathogenesis:

  • not known

Clinical signs:

  • relatively rare disease
  • affects children and young adults
  • predilection sites: the extremities, asymetrically
  • small erythematous, scaly papules in linear arrangement
  • pruritus occasionally
  • healing in weeks up to one year

Histology:

Lymphohistiocytic infiltration superficially, sometimes deeper. Exocytosis, parakeratosis, focal spongiosis. Variable acanthosis, often mild, sometimes none. Infiltrate is lichenoid, sometimes with multinuclear histiocytes. Necrotic keratinocytes single or in groups within epideris.

5.5.6  Erythema dyschromicum perstans

Introduction:

Chronic condition, where destruction of the basal layer leads to release of pigment into the upper dermis. If active, process is characterized by superficial chronic lymphocytic infiltrate and basal layer vacuolization. Later only melanophages in the upper dermis remain. The process is not specific, pigment incontinence can be seen in many other processes (eg. lichen ruber, fixed druh reaction).

Clinical signs:

  • irregular pigmented macules, sometimes in oblique lines
  • pigmented patches
  • slow progress
  • greyish color (ashy dermatosis)
  • discoloration persists
  • trunk, arms, face
  • lasts years

Histology:

vacuolar degeneration of the basal layer, superficial lymphocytic infiltrate; later scattered melanopgages in the upper dermis.

Etiology, pathogenesis:

  • unknown

5.5.7  Poikiloderma Rothmund Thomson

Clinical signs:

  • rare, autosomal recessive genodermatosis
  • poikiloderma (skin atrophy, irregular pigment distribution and hypopigmentation, vascular dilatation)
  • sometimes increased incidence of malignancies
  • extracutaneous signs:
    • nail dystrophy
    • dystrophic teeth
    • cataracta
    • hypogonadism
    • bone defects

Histology:

Skin atrophy, pigment incontinence, basal layer keratinocytes are apoptotic.

Pictures

Poikiloderma Rothmund Thomson:
Poikiloderma congenitale Rothmund Thomson, HE 40x (5183)

5.5.8  Poikiloderma vasculare atrophicans

Clinical signs:

  • areas of hyper- or hypopigmented skin areas
  • dilatations of superficial blood vessels
  • types:
    • idiopathic
    • secondary (lupus erythematosus, lymphomas, irradiation, cold, genodermatoses)
  • distribution:
    • local
    • generalized

Histology:

Dilatated superficial blood vessels, skin atrophy, sometimes pigment incontinence. Variabilní zánětlivý lymfocytární infiltrát.

In secondary type in addition the signs of the primary disease (e.g. lymphoma) are present.

Pictures

Poikiloderma vasculare atrophicans, secondary (skin lymphoma, MF):
Poikiloderma vasculare atrophicans, HE 20x (5239)
Poikiloderma vasculare atrophicans, HE 20x (5240)


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