UNASSIGNED: Lichen linear planus is a rare variant of lichen planus that appears as pruritic, polygonal, purple papules in a blaschkoid distribution. This review critically assesses all reported cases of linear lichen planus (LLP) for proposed etiology, clinical and histologic traits, treatment options, and recurrence. A PubMed search from inception through March 2023, followed by article screening and full-text review, identified 51 unique cases of LLP. Data from each case including the sex of the patient, anatomic distribution of lesions, biopsy results, proposed etiology, treatment, and recurrence were recorded. LLP did not show a significant gender or age predilection, most frequently presented unilaterally with pruritus, and involved numerous anatomic regions. Various triggers including metal implants, vaccinations, infections, malignancy, and pregnancy were identified. The most common histopathologic descriptions included band-like lymphocytic or lichenoid infiltrate, basal liquefactive, vacuolar degeneration, hypergranulosis, hyperkeratosis, civatte or colloid bodies, melanin incontinence, and orthokeratosis. Treatment options, duration of treatment, and recurrence rate of LLP lesions were variable. Although LLP is rare, dermatologists should be aware of this presentation and appropriate diagnostic and treatment options because swift diagnosis can reduce patient morbidity.

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Diseases in which cutaneous plasma cell infiltrates predominate are rare and usually of unknown etiology, including those that transition from benign to malignant, such as cutaneous plasmacytosis, multicentric Castleman disease, and extramedullary plasmacytoma. These diseases may present as purplish, reddish-brown cutaneous plaques or nodules. Here, we report an exceptional case of lichen planus (LP) in which the patient had classic histopathological features, but the infiltrating inflammatory cells were plasma cells with restricted light chain expression. The patient presented with severe rashes, including purplish-red plaques and nodules, erythema, and erosions in the palmoplantar area, verrucous hyperplasia of the oral mucosa, and anonychia of the toes. These findings suggest a possible role of plasma cells with restricted light chain expression in the LP. Clinicians should closely follow patients for changes in their rash, perform repeat biopsies if necessary, and regularly conduct multisystemic evaluations.

Adalimumab, an anti-tumor necrosis factor-α (TNF-α), is widely prescribed for many autoimmune diseases and chronic inflammatory skin diseases such as hidradenitis suppurative, psoriasis, etc. We report a case of lichenoid drug eruption secondary to adalimumab, a rare side effect, in a 62-year-old female with ulcerative colitis. The skin eruption appeared two weeks after initiating adalimumab. A skin biopsy was taken, and the histopathological findings correlated with a lichenoid drug eruption. Although rare, drug-induced lichen planus has been associated with adalimumab. Early recognition and a high index of suspicion are key in the prompt management of these cases. The discontinuation of adalimumab must be carefully weighed against its therapeutic benefits, as the discontinuation might trigger a severe form of inflammation in the primary autoimmune disease being treated. Extreme caution, early intervention, and a multidisciplinary approach are best for the overall well-being and optimal care of the individual.

Lichen sclerosus (LS) is a chronic inflammatory dermatosis primarily affecting the genitalia, commonly characterized by pearly-white papules and plaques. Although predominantly affecting females, LS can manifest across all age groups, with a bimodal distribution observed in prepubescent girls and postmenopausal women. This case report presents an unusual instance of exclusive extragenital LS in a 10-year-old girl, showcasing hyperpigmented patches and wrinkled plaques resembling lichen planus on her forearms and lower legs. Histopathological analysis confirmed LS, revealing distinctive epidermal changes and lymphocytic infiltrates. The absence of mucosal involvement and unique clinical presentation differentiated this case from typical LS manifestations. Treatment with topical clobetasol propionate demonstrated significant improvement in pruritus. Extragenital LS is infrequent, particularly among children, and its diagnosis necessitates a comprehensive clinicopathological correlation. The reported case contributes valuable insights into this uncommon variant, emphasizing the importance of accurate diagnosis and tailored treatment strategies. Additionally, it highlights the efficacy of high-potency topical corticosteroids in managing this condition.

Lichen planus is a chronic auto-inflammatory disease that primarily affects mucocutaneous regions. There are many variants of lichen planus including cutaneous, oral, nail, follicular, and erosive forms. Without any disease-specific treatment options, multi-variant lichen planus can be a challenging disease to manage. We present a 61-year-old woman with multivariant lichen planus that was refractory to numerous systemic and topical therapies. Subsequently, her cutaneous and vulvovaginal lesions improved with the use of oral baricitinib and the erosive oral lesions improved with topical ruxolitinib.

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Background and Objectives: An oral lichen planus (OLP) chronic lesion refers to a group of oral potentially malignant disorders (OPMDs) that still lack a proper understanding from the point of view of relevant biomarkers for diagnostics and prognosis. The aim of the study was to assess the salivary histamine levels in patients with oral lichen planus lesions. Materials and Methods: The study included a group of 76 patients with oral lichen planus. General diseases and medication taken, smoking habits, severity of pain assessed using a visual analogue scale (VAS), oral hygiene status, and duration of OLP were evaluated. ELISA diagnostics for histamines in saliva levels were assessed. Results: The histamine levels in the OLP group were higher (0.468) in comparison with the control group (0.056), without a statistically significant value p = 0.090 (Mann-Whitney U Test). The median age of 76 OLP patients was 63 years (min 22.0-max. 81), with the biological sex being 80.3% females and 15 19.7% males. The average duration of OLP lesion presence was 29.4 months (SD 37.1) and the median value was 14.5 months. The median of the VAS was 3.0. OLP assessment in accordance with the Malhotra methodology showed the highest frequency-30.3% for only two of the point areas involved and 17.1% for three points. Clinical assessment of the different OLP grades, severity, and oral site involvement and the VAS in correlation with histamine salivary levels showed a lack of statistical significance in the investigated population. Conclusions: Undertaking further research could provide further possibilities for searching for general factors in OLP development.

The diagnosis of oral lichen planus (OLP) poses many challenges due to its nonspecific clinical symptoms and histopathological features. Therefore, the diagnostic process should include a thorough clinical history, immunological tests, and histopathology. Our study aimed to enhance the diagnostic accuracy of OLP by integrating direct immunofluorescence (DIF) results with clinical data to develop a multivariate predictive model based on the Artificial Neural Network. Eighty patients were assessed using DIF for various markers (immunoglobulins of classes G, A, and M; complement 3; fibrinogen type 1 and 2) and clinical characteristics such as age, gender, and lesion location. Statistical analysis was performed using machine learning techniques in Statistica 13. The following variables were assessed: gender, age on the day of lesion onset, results of direct immunofluorescence, location of white patches, locations of erosions, treatment history, medications and dietary supplement intake, dental status, smoking status, flossing, and using mouthwash. Four statistically significant variables were selected for machine learning after the initial assessment. The final predictive model, based on neural networks, achieved 85% in the testing sample and 71% accuracy in the validation sample. Significant predictors included stress at onset, white patches under the tongue, and erosions on the mandibular gingiva. In conclusion, while the model shows promise, larger datasets and more comprehensive variables are needed to improve diagnostic accuracy for OLP, highlighting the need for further research and collaborative data collection efforts.

UNASSIGNED: Onychoscopy is a noninvasive method helpful in diagnosing nail disorders. The aim of the study was to review literature on the usability of onychoscopy in nail psoriasis, nail lichen planus, and nail lichen striatus.
UNASSIGNED: Onychoscopic features of nail psoriasis are pitting, onycholysis with erythematous border, salmon patches, splinter hemorrhages, dotted vessels in lateral and proximal folds, and hyponychium. Onychoscopic features of nail lichen planus are onychorrhexis, onycholysis, longitudinal melanonychia, and red lunula. The literature on the usability of onychoscopy in nail lichen striatus is scarce.
UNASSIGNED: Onychoscopy facilitates evaluation of nail abnormalities compared to the clinical examination. Lunular alterations, salmon patches, erythematous border of onycholysis as well as splinter hemorrhages in nail psoriasis are better visualized with onychoscopy compared to the naked eye. Onychoscopy enhances detection of melanonychia, dyschromia, and lunular changes in nail lichen planus. Onychoscopic features are different in fingernails and toenails.
Onychoscopy (nail dermoscopy) is a noninvasive method used in diagnosing of nail disorders. In this review, we evaluated if onychoscopy may be helpful in diagnosing inflammatory nail disorders such as psoriasis, lichen planus, and lichen striatus. Nail psoriasis can be characterized with the presence of pitting, salmon patches, splinter hemorrhages, onycholysis with or without erythematous border and dilated vessels in the hyponychium on onychoscopy. Onychoscopy of nail lichen planus shows the presence of longitudinal ridging and splitting (onychorrhexis), splinter hemorrhages, longitudinal melanonychia as well as red lunula (distal part of nail matrix). The data on onychoscopy in nail lichen striatus are scarce. Onychoscopy is a helpful tool in visualization of nail abnormalities, with most of the features better visualized with onychoscopy compared to the naked eye.