clobetasol and Lichen-Planus

Although influenza vaccine is thought to be effective and safe, it occasionally causes systemic reactions such as toxic epidermal necrolysis, bullous pemphigoid, lichen planus (LP), etc. The period of increased risk of developing these events was different depending on the immune responses induced by the vaccination. We report 3 cases of LP which appeared after an influenza vaccination. Our cases indicate that the period of increased risk of developing vaccine-related LP was concentrated within 2 weeks after vaccination, and that the vaccine alone represents a triggering factor necessary for immune alteration sufficient for the development of LP. Because these adverse events tend to develop over a predictable time course, the time of onset may give an important clue to the diagnosis of vaccine-related diseases. We suggest that a history of recent vaccination should be sought in all patients presenting with linear LP.

Topics: Aged; Anti-Inflammatory Agents; Buttocks; Clobetasol; Dexamethasone; Diflucortolone; Female; Humans; Influenza Vaccines; Leg; Lichen Planus; Middle Aged

Topics: Adrenal Cortex Hormones; Adult; Age of Onset; Anti-Inflammatory Agents; Clobetasol; Contraindications; Diabetes Complications; Female; Humans; Hypertension; Lichen Planus; Obesity; Ointments; Pemphigoid, Bullous

In May 1996, as part of his routine antihepatitis B (hepB) vaccination plan, a 28-year-old HbsAg-negative man, hospital worker, received his first dose (20 microg) of a recombinant vaccine (EngerixB-B, Smith Kline and Beecham, Belgium), administered via deltoid injection. The patient was otherwise healthy and taking no medication. Thirty days after the 2nd booster dose, several pruritic, polygonal, purple, papules appeared on the volar aspect of the patient's wrists. New lesions gradually spread to the arms and trunk (Fig. 1). The clinical diagnosis of lichen planus (LP) was confirmed by histology, which revealed hyperorthokeratosis, hypergranulosis, vacuolar degeneration of the basal layer cells and a dense, band-like lymphocytic infiltrate in the superficial dermis. The disease started to heal after treatment with topical clobetasol propionate 0.05% and sun exposure during the following summer. Five days after the 3rd booster dose, in November 1996, the dermatosis relapsed on the forearms, trunk, and legs. On that occasion, routine laboratory tests, including a complete blood count, blood chemistry and liver function tests, were within normal limits. Screening serologic tests for autoantibodies including antinuclear antibodies, antidouble-stranded DNA, anti-SS-A, anti-SS-B and anti-Sm were all negative. As a result of the inadequate levels of antihepatitis B antibodies, less than 10 IU/l in May 1998, in a high-risk patient who was frequently exposed to blood and its products, an additional booster dose was performed. Three days later a new recurrence of disseminated lichen planus occurred. The patient was successfully treated with prednisone 1 mg/kg/day for 2 weeks. There was no recurrence the following year.

Topics: Adult; Clobetasol; Glucocorticoids; Hepatitis B Vaccines; Humans; Lichen Planus; Male; Prednisone; Recurrence; Treatment Outcome

Lichen planus is an inflammatory mucocutaneous condition with characteristic violaceous polygonal flat-topped papules and plaques. Pruritus is often severe. Skin lesions may be disfiguring, and involvement of the oral mucosa or genital mucosa in severe cases may be debilitating. Oral lichen planus may predispose to the development of squamous cell carcinoma within lesions. Involvement of the scalp and the nails may also occur. While most cases of lichen planus are idiopathic, some may be caused by the ingestion of certain medications (e.g., gold, antimalarial agents, penicillamine, thiazide diuretics, beta blockers, nonsteroidal anti-inflammatory drugs, quinidine and angiotensin-converting enzyme inhibitors) or linked to hepatitis C virus infection. Patients with localized lichen planus are usually treated with potent topical steroids, while systemic steroids are used to treat patients with generalized lichen planus.

Topics: Acitretin; Anti-Inflammatory Agents; Betamethasone; Clobetasol; Diagnosis, Differential; Humans; Keratolytic Agents; Lichen Planus; Patient Education as Topic; Prednisone; PUVA Therapy; Risk Factors; Teaching Materials

Lichen planoplaris (LPP) is one of the most common causes of inflammatory cicatricial alopecias. There is no definitive cure for the disease and most of the available therapeutic options can potentially lead to serious complications following their use for extended durations. In this study, we aimed to evaluate the efficacy, safety and tolerability of N-acetylcysteine (NAC) and pentoxyfillin (PTX), as adjunctive therapies, in the management of LPP. In a randomized, assessor- and analyst-blinded controlled trial, patients with proven LPP were randomly assigned to three groups of 10. Group I (the control group) received clobetasol 0.05%lotion; Group II, a combination of clobetasol 0.05% lotion and oral PTX; Group III, a combination of clobetasol lotion 0.05% and oral NAC. Lichen planopilaris activity index (LPPAI), the possible side effects, tolerability and patients satisfaction were assessed before and two and four months after the initiation of the treatments. Thirty patients, 96.7% women, with a mean age of 46.8 ± 13.3 years old, were included in the study. Four months into the treatments, the overall LPPAI and the severity and/or frequency of most of its determinants significantly decreased in all groups. In a comparison among the groups, patients who received either of the combination therapies showed more decline in their LPPAI than those receiving only clobetasol. The decline was more noticeable and statistically significant only in the NAC group. Three patients in the PTX group developed complications that were not statistically significant when compared with the other groups. There were no substantial differences in the tolerability of the treatments among the study arms. The use of oral NAC and PTX added to the therapeutic efficacy of topical clobetasol in the treatment of LPP, suggesting that they might be beneficial and safe adjuvant therapies and add to the efficacy of topical treatment without any noticeable impact on the adverse effects experienced by patients.

Topics: Acetylcysteine; Administration, Topical; Adult; Clobetasol; Female; Humans; Lichen Planus; Male; Middle Aged; Patient Satisfaction; Pentoxifylline; Personal Satisfaction; Treatment Outcome

Lichen planopilaris (LPP) is a scarring alopecia for which no treatment with remarkable effect has been identified. Pioglitazone has been reported as a possible therapeutic option. To compare the efficacy and safety of pioglitazone with clobetasol in LPP. This randomized, double-blind, parallel-group was conducted at Razi hospital. Patients were treated either with pioglitazone 15 mg/daily or clobetasol lotion 0.05% once at night for 6 months. Patients were visited every 2 months to assess the lichen planopilaris activity index (LPPAI) and record probable adverse events. Forty patients (mean age: 43.6 years; 62.5% female) were randomized 1:1. The mean of LPPAI at baseline and last session were 4.68 ± 1.97 and 2.59 ± 0.97 in the clobetasol group and 5.01 ± 1.71 and 3.04 ± 1.36 in the pioglitazone group, respectively. Both treatments significantly decreased the LPPAI over the two-month interval visits (p < 0.001). No significant difference in the LPPAI reduction was detected between groups. Regarding the safety profile, three clobetasol-treated patients developed folliculitis, and two in the pioglitazone group developed mild headaches. Pioglitazone effectively controlled the signs and symptoms of the LPP with no serious side effects. It can be considered a treatment option for LPP, although it was not superior to clobetasol.

Topics: Adult; Alopecia; Clobetasol; Female; Humans; Lichen Planus; Male; Pioglitazone; Treatment Outcome

Lichen planopilaris (LPP) is one of the important causes of cicatricial alopecia. We aimed to evaluate the efficacy and safety of low-dose naltrexone (LDN) in the setting of a clinical trial in patients with LPP.. We included patients with LPP between 2018 and 2020. Patients were allocated to two groups. The first group received topical clobetasol plus oral low dose naltrexone (3 mg) while the second received topical clobetasol plus placebo. The assessment was made for the disease severity by lichen planopilaris activity index (LPPAI) instrument and the safety of the drug in 2-month intervals up to 6 months. To compare both groups, we used the ANOVA test for repeated measures. Clinical trials registry code: IRCT20180809040747N1.. Thirty-four patients were analyzed in an intention-to-treat fashion. There was a decrescendo pattern on LPPAI scores that was statistically significant within the LDN (. Low-dose naltrexone (3 mg) failed to improve the severity of the LPP more than what is achievable with topical clobetasol.

Topics: Alopecia; Cicatrix; Clobetasol; Humans; Lichen Planus; Naltrexone

Lichen planopilaris (LPP) is the most common cause of inflammatory immune-mediated cicatricial alopecia. If not diagnosed and treated properly, it may lead to irreversible hair loss with a devastating impact on quality of life. However, treatment can be a challenge. In an area lacking these sorts of studies, we conducted a randomized controlled trial (RCT) to study the tolerability and therapeutic effects of topical clobetasol versus systemic mycophenolate mofetil (MMF).. A randomized, assessor- and analyst-blinded controlled trial was conducted in 60 patients with LPP in Razi Dermatology Hospital, Tehran, Iran, between February and December 2013. Patients were treated with clobetasol lotion 0.05 % applied at night or oral MMF 2 g/day and were followed for 6 months. The Lichen Planopilaris Activity Index (LPPAI) was the primary measure of response to treatment.. Systemic MMF and topical clobetasol were equally effective in reducing the LPPAI over 6 months of treatment. Treatment tolerability was excellent in both groups and no serious irreversible adverse effects were detected. Satisfaction with treatment rose in the MMF group over time; however, it declined in the clobetasol group.. Given the similar efficacy profiles, topical clobetasol seems to be a more suitable and reasonable choice for treatment of LPP than MMF.

Topics: Administration, Cutaneous; Administration, Oral; Adult; Anti-Inflammatory Agents; Clobetasol; Female; Follow-Up Studies; Humans; Immunosuppressive Agents; Lichen Planus; Male; Middle Aged; Mycophenolic Acid; Patient Satisfaction; Single-Blind Method; Time Factors; Treatment Outcome

Genital erosive lichen planus (GELP) in women is a chronic inflammatory disease characterized by painful vulval and vaginal erosions. Topical photodynamic therapy (PDT) is increasingly used in premalignant and malignant diseases and may have an effect in inflammatory diseases.. To assess the feasibility, efficacy and safety of hexyl 5-aminolevulinate-hydrocloride (HAL)-PDT in GELP.. Forty women, diagnosed with GELP at a specialized vulva clinic, were randomized to one session HAL-PDT in vulva and/or vagina (n = 20) or daily applications of clobetasol propionate 0·05% ointment in vulva and optional hydrocortisone acetate 1·0% foam in vagina for 6 weeks (n = 20). After 6 weeks, all patients were allowed to use topical corticosteroids as needed. Clinical examinations were performed at weeks 0, 6 and 24, using a clinical score developed for the study. All patients wrote a weekly log on pain, topical corticosteroid use and adverse events.. Three patients, all in the corticosteroid group, withdrew from the study after 1-3 weeks. The mean reduction in clinical scores was similar in the PDT group and the corticosteroid group; 25% vs. 22% after 6 weeks (P = 0·787) and 35% vs. 38% after 24 weeks (P = 0·801). The mean reduction in pain visual analogue scale scores was 38% vs. 55% after 6 weeks (P = 0·286) and 39% vs. 12% after 24 weeks (P = 0·452). Patients in the PDT group reported significantly less topical corticosteroid use during weeks 7-24 than those in the corticosteroid group. No major adverse events were reported.. Vulvovaginal HAL-PDT seems to be an effective and safe treatment for GELP.

Topics: Administration, Cutaneous; Administration, Intravaginal; Aminolevulinic Acid; Clobetasol; Dermatologic Agents; Feasibility Studies; Female; Glucocorticoids; Humans; Hydrocortisone; Lichen Planus; Middle Aged; Photochemotherapy; Treatment Outcome; Vaginal Creams, Foams, and Jellies; Vaginal Diseases; Vulvar Diseases

The paper describes a study carried out in 40 patients affected by lichen sclerosus (LS) of the vulva. The mean age of patients was 60.9 years (range 27-83) and 31 were in menopause. Patients were divided randomly into two groups of 20. The symptoms (itching, burning, pain, dyspareunia), clinical aspects (atrophy, hyperkeratosis, sclerosis) and histological alterations (atrophy of the epithelium, edema, inflammatory infiltrate, fibrosis) were quantified in each patient by a score. The mean scores relating to the three parameters examined were then calculated for each group. One group was treated with testosterone propionate 2% and the other with a strong synthetic corticosteroid, clobetasol dipropionate 0.05%. After 24 weeks of treatment patients were again evaluated in relation to clinical (symptoms and clinical aspects) and histological parameters, following the procedure used before the start of treatment. The mean scores obtained were then compared with those before the start of treatment. Statistical analyses were performed using Student's t-test. Testosterone was found to be effective in relation to symptoms but no significant change was observed in relation to clinical aspects and histological alterations. It also caused major secondary effects which led to the suspension of treatment in one patient. Clobetasol was shown to be highly effective both in relation to symptoms and in terms of clinical aspects and histological alterations, and did not cause any noteworthy collateral effects, especially contact dermatitis. In the context of the objective parameters examined in this study, sclerosis and hyperkeratosis were easily modified by corticosteroid treatment in comparison to atrophy, especially in those patients with a longer duration of disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aged; Clobetasol; Drug Evaluation; Female; Humans; Lichen Planus; Middle Aged; Sclerosis; Testosterone; Vulvar Diseases

Clobetasol propionate (Temovate), a novel high-potency topical corticosteroid, was used in open trial from 1987 to 1988 on 24 patients with persistent oral vesiculoerosive disease of at least 1 month's duration. Fourteen women and 10 men, ranging in age from 27 to 76 years (mean 48 years), participated. Nine patients had erosive lichen planus, one had benign mucous membrane pemphigoid, three had pemphigus vulgaris, seven had persistent major recurrent aphthous stomatitis, and four had chronic oral erythema multiforme. Fifteen patients had complete remission of signs and symptoms, seven had excellent response of signs and complete remission of symptoms, and two failed to respond. All other topical therapy was suspended before and during the study. All patients responded to two or three applications daily of medication. Side effects were minor and reversible, and included localized candidiasis (three patients), stomatopyrosis (two), and hypogeusia (one). Clobetasol propionate ointment in adhesive paste (Orabase) thus seems to be an effective topical steroid alternative to other less potent topical and systemic drugs for recalcitrant oral vesiculoerosive disease.

Topics: Adult; Aged; Clobetasol; Female; Humans; Hydrocortisone; Lichen Planus; Male; Middle Aged; Mouth Diseases; Pemphigoid, Benign Mucous Membrane; Pemphigus; Stomatitis, Aphthous

Cutaneous lichen planus is a highly pruritic dermatosis with an unmet need in its management. The aim of this study was to evaluate the short-term effect and tolerance of high doses of clobetasol propionate 0.05% in cutaneous lichen planus. We conducted a single-center retrospective cohort study from 2017 to 2021. All adults treated with high-dose (>5 g/day) clobetasol propionate 0.05% for cutaneous lichen planus were included. Patients with less than 10% affected body surface area at initial presentation or who received concomitant systemic therapy were excluded. The primary endpoint was the rate of complete remission by week 16. Secondary endpoints included maximum daily and median cumulative doses, reduction in pruritus and occurrence of adverse events. Fifty-seven patients, 60% female, with a mean age of 48 years (min-max,18-83) were included. Cutaneous lichen planus had been present for a median duration of 2 months at initial presentation (min-max, 1-4) and involved a median body surface area of 27%. Pruritus was reported by 55/57 (96%) patients. At week 16, 41/57 (72%) patients had achieved complete remission without treatment modification, among whom 25/41 (61%) had achieved it at week 6. The median daily and cumulative doses were, respectively, 20 g/day (IQR, 10-20) and 560 g (IQR, 320-925). Three patients experienced mild adverse events. No statistical association was demonstrated between the duration of the disease before treatment initiation and clinical response. In conclusion, high-dose clobetasol propionate 0.05% seems to be an effective, well-tolerated, and easy-to-implement treatment for cutaneous lichen planus.

Topics: Adult; Anti-Inflammatory Agents; Clobetasol; Female; Humans; Lichen Planus; Lichen Planus, Oral; Male; Middle Aged; Pruritus; Retrospective Studies; Treatment Outcome

Lichen planopilaris (LPP) is a scarring alopecia rarely described in men.. To investigate the clinical and histopathologic features of LPP in men.. We performed a retrospective cohort study of male patients with LPP seen at Mayo Clinic between 1992 and 2016.. Nineteen men with biopsy-confirmed LPP were included. The disease most commonly presented with diffuse (42.1%) or vertex scalp (42.1%) involvement. None of the patients had eyebrow or body hair involvement. Perifollicular erythema (94.7%) and pruritus (57.9%) were the most frequent clinical findings. Androgenetic alopecia (AGA) co-occurred in 26.3% of patients. Mucosal lichen planus was found in four patients (21.1%). Thyroid disease occurred in three patients (15.8%). Disease improvement (47.3%) occurred with combination topical and systemic therapy, topical clobetasol monotherapy, and minocycline monotherapy.. LPP in men has similar clinical and histologic presentations as reported in women. Nonscalp hair loss appears less likely in men with classic LPP than reported in men with frontal fibrosing alopecia, while mucosal lichen planus and thyroid disease appear to be more common in classic LPP. Men with AGA can present with new-onset concomitant LPP. Limitations included small study size, variable follow-up, and lack of standardized clinical assessment due the study's retrospective nature.

Topics: Alopecia; Clobetasol; Female; Humans; Lichen Planus; Male; Retrospective Studies; Scalp

Pertuzumab and trastuzumab are monoclonal antibody inhibitors targeting human epidermal growth factor receptor 2 (HER-2) and are increasingly being utilised in the management of HER2-positive breast cancer, having been demonstrated to improve progression-free survival in conjunction with docetaxel. We present a rare presentation of a lichenoid drug eruption, in an annular atrophic variant, in a 35-year-old woman after initiation of HER2-inhibitor (pertuzumab and trastuzumab) therapy for metastatic breast cancer.

Topics: Adult; Antibodies, Monoclonal, Humanized; Antineoplastic Agents, Immunological; Breast Neoplasms; Clobetasol; Female; Glucocorticoids; Humans; Lichen Planus; Receptor, ErbB-2; Trastuzumab

Transforming growth factor-beta1 (TGF-β1) is expressed in normal epidermis. TGF-β1 potently inhibits keratinocyte proliferation and immunomodulatory properties, mainly by suppressing immune responses to self-antigens. Lichen planus (LP) is a form of dermatitis caused by cell-mediated immune dysfunction, but the exact pathogenic pathways are unknown, which poses therapeutic challenges. We report on a 68-year-old man who developed multiple pruritic, discrete, and well-demarcated, flat-topped red-purple papules and macules on the back and upper arms following 4 cycles of treatment with TGF-β receptor I (TGFBR-I) inhibitor, ly3200882, for metastatic chondrosarcoma. The biopsy showed hyperkeratosis, wedge-shaped hypergranulosis, elongation of the rete ridges, and a dense band-like lymphohistiocytic infiltrate admixed with colloid bodies and pigment incontinence, consistent with LP. Temporal correlation suggested that the TGFBR-I inhibitor might be a trigger. Treatment with topical clobetasol and oral metronidazole led to partial resolution of the lesions with postinflammatory hyperpigmentation. We believe this is the first reported case of LP related to TGFBR-I inhibitor therapy. This report expands the list of cutaneous adverse events associated with this novel class of targeted therapy. More importantly, this report supports emerging evidence that failure of TGF-β1 activation/signal transduction is an important mechanism in the pathogenesis of LP and suggests the TGF-β1 pathway as a potential therapeutic target in this disease.

Topics: Administration, Oral; Administration, Topical; Aged; Anti-Bacterial Agents; Anti-Inflammatory Agents; Chondrosarcoma; Clobetasol; Drug Therapy, Combination; Humans; Hyperpigmentation; Lichen Planus; Male; Metronidazole; Transforming Growth Factor beta; Treatment Outcome

Verrucous or hypertrophic lichen planus is a chronic inflammatory skin disease characterized by extremely pruritic thick hyperkeratotic plaques and is resistant to topical treatment.. Herein, we report three clinical cases of hypertrophic lichen planus successfully treated with a combination of topical steroids daily in occlusion and trichloroacetic acid (TCA) 50% with peeling every week.. TCA is involved in regulating inflammation and scarring. Through its keratolytic properties it enhances the efficacy of topical steroids, whose action is hindered by hyperkeratosis.. The combination of TCA and topical steroids offers a good alternative for the treatment of hypertrophic lichen planus.

Topics: Aged, 80 and over; Anti-Inflammatory Agents; Clobetasol; Drug Therapy, Combination; Female; Humans; Hypertrophy; Keratolytic Agents; Lichen Planus; Male; Middle Aged; Pruritus; Trichloroacetic Acid

Topics: Alopecia; Bone Diseases, Metabolic; Clobetasol; Female; Glucocorticoids; Humans; Hydroxychloroquine; Lichen Planus; Middle Aged; Ossification, Heterotopic; Scalp; Scalp Dermatoses; Skin Diseases, Genetic; Treatment Outcome

The aim of this study was to assess the efficacy of a postoperative steroid regimen in maintaining vulvovaginal architecture and vaginal patency following surgical adhesiolysis in severe erosive lichen planus (ELP) and genital graft versus host disease (GVHD). Sixteen women applied potent topical steroids to the vulva and vagina from 48 hours after surgery. Sexual and urinary function and vulvovaginal anatomy were assessed at 6 weeks, 6, 12 and 24 months. All of the patients had failed sexual function due to vaginal stenosis. Eleven patients were unable to have cervical smears and three had associated haematocolpos. Vaginal adhesiolysis achieving complete patency occurred in all patients with stenosis. Fifteen (93.7%) patients were compliant with the regimen. After two years, 12 (75%) patients had maintained complete vaginal patency. Four patients (25%) developed vaginal restenosis. This study demonstrates that the potent topical steroids used post-operatively are very effective in maintaining vaginal patency and function. Impact statement What is already known on this subject? Potent topical steroids are the first line treatment for ELP and GVHD and have been reported to be helpful after surgery to release adhesions. What do the results of this study add? Topical steroids used immediately after surgical adhesiolysis in patients with vulvo-vaginal lichen planus and graft-versus-host disease improves the outcomes and maintains function, which can give a prolonged benefit. What are the implications of these findings for clinical practice and/or further research? The use of potent topical steroids should be considered as routine practice after surgery in erosive inflammatory disease to control inflammation and improve the long term outcomes for these patients.

Topics: Administration, Cutaneous; Anti-Inflammatory Agents; Clobetasol; Female; Graft vs Host Disease; Humans; Hydrocortisone; Lichen Planus; Postoperative Care; Retrospective Studies; Sexual Dysfunction, Physiological; Vaginal Diseases; Vulvar Diseases

Topics: Anti-Inflammatory Agents; Antibodies, Monoclonal, Humanized; Antineoplastic Agents, Immunological; Clobetasol; Humans; Lichen Planus; Male; Melanoma; Middle Aged; Prednisolone

Blastomycosis-like pyoderma (BLP) is a rare reactive skin disease that is most commonly caused by bacterial infection. Herein we present a case of BLP arising in lichen planus, a chronic inflammatory disease. We propose Wolf's isotopic response, or the appearance of a new skin disease at the site of an existing and unrelated disease, as the underlying molecular mechanism responsible for this unusual physical presentation. It is important that clinicians recognize atypical morphologies such as BLP, which mimics squamous cell carcinoma both clinically and pathologically. These similarities highlight the need for a tissue diagnosis to identify infectious etiologies and rule out malignancy when BLP is suspected. J Drugs Dermatol. 2018;17(2):233-235.

Topics: Aged; Anti-Inflammatory Agents; Blastomycosis; Clobetasol; Humans; Lichen Planus; Male; Pyoderma

Topics: Administration, Oral; Administration, Topical; Adrenal Cortex Hormones; Child; Clobetasol; Exanthema; Glucocorticoids; Humans; Lichen Planus; Male; Methylprednisolone; Treatment Outcome

Frontal fibrosing alopecia (FFA) is a lichen planopilaris-variant scarring alopecia that has rarely been described in men.. To characterize the clinicopathologic findings of FFA in men by studying a series of 7 male patients.. We conducted a retrospective review of all cases of male patients with FFA at the Mayo Clinic from 1992 to 2016.. Seven male patients with FFA were identified. The frontal scalp (in 6 of 7 patients), sideburns (in 4 of 7), and temporal scalp (in 4 of 7) were most frequently involved. Three patients had involvement of the eyebrows. One patient had hair loss of the upper cutaneous lip. All patients had biopsy evidence of lichen planopilaris. None of the patients had associated autoimmune or thyroid disease. Two patients had hypogonadism upon testosterone studies.. Limitations include small sample size and varied follow-up.. Although most often reported among postmenopausal women, FFA also occurs among men. The clinical and histopathologic characteristics of FFA in men parallel those described in women with FFA. Unique areas of involvement in men include sideburns and facial hair. Concomitant mucocutaneous lichen planus, autoimmune disease, and thyroid disease are infrequent among men with FFA. Distribution of hair loss and associated hormonal abnormalities aid in the recognition of FFA in men.

Topics: Adult; Aged; Alopecia; Anti-Inflammatory Agents; Cheek; Cicatrix; Clobetasol; Dermatologic Agents; Eyebrows; Forehead; Humans; Hydroxychloroquine; Lichen Planus; Male; Middle Aged; Retrospective Studies; Scalp; Tacrolimus

Lichen planopilaris (LPP) is characterized by lymphocytic infiltrate, fibrosis and potential destruction of the hair follicle. Demographic and clinical studies in LPP are limited, and racial differences have not been thoroughly investigated.. To analyse epidemiological data and clinical profiles of Chilean adults with LPP, and report on the treatments used.. This was a retrospective review of medical records and clinical follow-up of Chilean adults with a clinical and histopathological diagnosis of LPP. Treatment response was categorized clinically as none (with progression of condition), mild or satisfactory.. The study assessed 103 patients with LPP [67 women (mean age 54.1 years) and 36 men (mean age 39.1 years)]. Of the 103 patients, 41 women and 34 men were diagnosed with classic LPP (CLPP) and 26 women and 1 man with frontal fibrosing alopecia (FFA), while Graham-Little-Piccardi-Lassueur syndrome (GLPLS) was identified in 1 man. Men with CLPP had a significantly (P < 0.001) earlier age of onset than women. Scalp dysaesthesia, erythema and peripilar hyperkeratosis were common findings, and 51 (66%) of patients with CLPP had cicatricial patches, most of which were circumscribed in the vertex area. All patients with FFA had band-like scarring in the frontal and temporal hairlines. Morbidities associated with LPP were hypothyroidism, dyslipidaemia, hypertension and depression. For most patients, treatment halted or improved their inflammatory/scarring condition. A sustained combination of at least one topical (clobetasol, minoxidil and salicylic acid) and one systemic (cetirizine, hydroxychloroquine, finasteride, methotrexate and isotretinoin) medication was necessary in all of our patients with LPP.. This investigation is one of the first to describe the demographic, clinical and therapeutic features of LPP in a Latin American population. Similar profiles to previous reports may encourage research in larger multicentre international studies.

Topics: Administration, Topical; Adult; Age of Onset; Alopecia; Cetirizine; Chile; Clobetasol; Drug Therapy, Combination; Female; Glucocorticoids; Humans; Lichen Planus; Male; Middle Aged; Retrospective Studies; Scalp Dermatoses; Sex Distribution; Sex Factors

Topics: Administration, Topical; Clobetasol; Combined Modality Therapy; Glucocorticoids; Humans; Hypertrophy; Lasers, Gas; Lichen Planus; Skin

Topics: Administration, Cutaneous; Administration, Topical; Betamethasone Valerate; China; Clobetasol; Cohort Studies; Diabetes Mellitus; Ethnicity; Female; Glucocorticoids; Humans; Hyperlipidemias; India; Lichen Planus; Malaysia; Male; Middle Aged; Multivariate Analysis; Prognosis; Proportional Hazards Models; Retrospective Studies; Risk Factors; Singapore; Triamcinolone

Topics: Clobetasol; Diagnosis, Differential; Genital Diseases, Male; Glucocorticoids; Hepatitis C, Chronic; Humans; Lichen Planus; Male

Topics: Anti-Inflammatory Agents; Clobetasol; Diagnostic Errors; Herpes Zoster; Humans; Lichen Planus; Male; Middle Aged

Hypertrophic lichen planus (LP), also known as LP verrucosus, is a rare disorder that presents as verrucous plaques, typically on the lower extremities and ankles. This variant differs from the common presentation of LP, which appears as flat, polygonal, pink-purple papules spread diffusely on the flexor wrists, trunk, shins, and dorsal aspects of the feet, frequently involving the oral mucosa. Clinically, hypertrophic LP can be confused with psoriasis and usually does not respond to therapy with biologics. We present a case of hypertrophic LP in a 42-year-old woman who had been treated extensively for psoriasis. Although the morphology and location of the hyperkeratotic plaques mimicked psoriasis, biopsy results exhibited characteristic features of hypertrophic LP, and the lesions responded to treatment with acitretin, clobetasol propionate ointment, hydroxychloroquine, and simple wound care. The hypertrophic variant of LP can be extremely challenging to differentiate from psoriasis. Physicians who treat patients with scaly plaques should think beyond psoriasis and consider the hypertrophic variant of LP as a potential diagnosis.

Topics: Acitretin; Adult; Biopsy; Clobetasol; Dermatologic Agents; Female; Humans; Hydroxychloroquine; Lichen Planus; Psoriasis; Treatment Outcome

Lichen planus is a chronic inflammatory mucocutaneous disorder of the skin including the scalp, the nails, and the oral and genital mucosae. Ocular, oesophageal, bladder, nasal, laryngeal, otic, gastric, and anal involvement has been documented. In this report, we describe a unique case of orogenital lichen planus affecting the external urinary meatus, masquerading as sexually transmitted urethritis and erosive genital disease.

Topics: Adult; Anti-Inflammatory Agents; Clobetasol; Diagnosis, Differential; Humans; Lichen Planus; Male; Sexually Transmitted Diseases; Urethral Diseases

A 44-year-old man who was previously diagnosed with actinic cheilitis was prescribed imiquimod cream 5%, which resulted in thick hemorrhagic crusting of the lower lip after 4 applications. He subsequently noted the development of lichen planus lesions on his arms and legs for the first time in 15 years following imiquimod use. On follow-up he also was noted to have characteristic Wickham striae on his lower lip. Lichen planus is an autoimmune inflammatory condition in which autoreactive T lymphocytes attack keratinocytes. The mechanism of action for imiquimod is upregulation of IFN-alpha and IFN-beta. Treatment with clobetasol cream 0.05% led to resolution of his lichen planus lesions.

Topics: Adjuvants, Immunologic; Administration, Topical; Adult; Aminoquinolines; Anti-Inflammatory Agents; Cheilitis; Clobetasol; Follow-Up Studies; Humans; Imiquimod; Lichen Planus; Lip; Male; Treatment Outcome

Oral hairy leukoplakia (OHL) presents as a white, plaque-like lesion typically occurring on the lateral border of the tongue. This condition is caused by the Epstein-Barr virus, a human herpesvirus that often establishes lifelong, asymptomatic latent infection. OHL, initially described in immunocompromised men infected with the human immunodeficiency virus (HIV), has also been described in other severely immunocompromised patients. Only rarely has OHL been reported in less profoundly immunocompromised patients primarily in the setting of corticosteroid therapy. Here we report on two additional cases of OHL attributable to immunosuppressive medications.

Topics: Aged; Anti-Infective Agents; Anti-Inflammatory Agents; Antifungal Agents; Arthritis, Rheumatoid; Clobetasol; Dapsone; Dermatologic Agents; Dexamethasone; Diabetes Mellitus, Type 2; Epstein-Barr Virus Infections; Female; Fluconazole; Humans; Immunocompromised Host; Leukoplakia, Hairy; Lichen Planus; Methotrexate; Nystatin; Prednisone; Zinc Oxide

Lichen planopilaris (LPP) and discoid lupus erythematosus (DLE) are the most common causes of lymphocytic primary cicatricial alopecia. The management of scarring alopecia can be difficult. The combination of clinical, dermoscopy and reflectance confocal microscopy (RCM), a noninvasive, high-resolution imaging technique, examinations have already been demonstrated to be useful for choosing the correct biopsy site in patients with inflammatory skin disease and obtaining microscopic diagnostic criteria.. We evaluated the usefulness in practice of RCM for the identification of criteria for LPP and DLE involving the scalp and their management during therapeutic follow-up.. Seven white patients with a previously established histological diagnosis of DLE (three) and LPP (four), were included in the study. RCM criteria for primary scarring alopecia were selected: epidermal disarray, spongiosis, exocytosis of inflammatory cells in the epidermis, interface dermatitis, peri- and intra-adnexal infiltration of inflammatory cells, dilated vessels in the dermis, dermal infiltration of inflammatory cells and melanophages and dermal sclerosis. All patients were followed up using RCM during the treatment. During follow-up the RCM evolution of the epidermal, junctional and dermal inflammation were evaluated.. A series of RCM features of scalp LPP and DLE were identified that show correlation with the histopathological evaluation. During the treatment follow-up of the cases RCM was shown to be sensitive for the identification of therapeutic response.. In our preliminary study the effective usefulness of RCM for the diagnosis of scarring alopecia and follow-up seemed to be evident. Moreover, RCM seems to be also promising for differential diagnosis between the different entities.

Topics: Aged; Alopecia; Anti-Inflammatory Agents; Clobetasol; Dermatologic Agents; Female; Humans; Hydroxychloroquine; Keratinocytes; Lichen Planus; Lupus Erythematosus, Discoid; Male; Microscopy, Confocal; Middle Aged; Observer Variation

Individuals who are infected with Human Immunodeficiency Virus (HIV) suffer from numerous dermatoses. These disorders are often more severe than those observed in non HIV-infected persons afflicted with the same diseases. Lichen planus (LP) is a chronic inflammatory papulosquamous skin disorder. Herein, the diagnosis and treatment of a 40-year-old HIV+ Kenyan man afflicted with hypertrophic lichen planus (HLP) is described. In this case, lesions of HLP were widely distributed across the trunk and extremities, having become of such thickness on the dorsal surfaces of the hands and fingers as to make normal use of hands impossible. A significant distinguishing feature of this patient is prior history of tuberculosis, which is a known trigger for lichenoid skin lesions.

Topics: Adult; Anti-HIV Agents; Clobetasol; Drug Combinations; Hand Dermatoses; HIV Infections; Humans; Lamivudine; Lichen Planus; Male; Nevirapine; Pruritus; Stavudine; Treatment Outcome; Tuberculosis, Pulmonary

Topics: Anti-Inflammatory Agents; Child; Clobetasol; Humans; Lichen Planus; Male; Pemphigoid, Bullous

Topics: Administration, Topical; Aged; Anti-Inflammatory Agents; Clobetasol; Drug Resistance; Humans; Immunosuppressive Agents; Lichen Planus; Male; Ointments; Tacrolimus

The ulcerative variant of lichen planus (LP) commonly involves the oral mucosa but is uncommon and difficult to treat when located on other areas. We describe an unusual case of ulcerative LP involving several surfaces, including the palms and scrotum, in a 50-year-old man with hepatitis C. The patient was recalcitrant to treatment with conventional therapy but obtained clearance with a sustained response using low molecular weight heparin (LMWH). This treatment is an option for patients with LP who are not ideal candidates for standard therapy.

Topics: Anti-Inflammatory Agents; Anticoagulants; Clobetasol; Genital Diseases, Male; Hand Dermatoses; Heparin, Low-Molecular-Weight; Hepatitis C; Humans; Immunosuppressive Agents; Lichen Planus; Male; Middle Aged; Scrotum; Skin Ulcer; Tacrolimus

Lichen planus of the nails is a destructive inflammatory onychodystrophy that is often difficult to treat. We report a case of treatment with combined topical therapy of tazarotene gel and clobetasol gel. This modality may be effective for patients with nail lichen planus without the potential adverse affects of systemic treatments.

Topics: Administration, Topical; Aged; Clobetasol; Drug Therapy, Combination; Female; Gels; Humans; Lichen Planus; Nail Diseases; Nicotinic Acids; Palliative Care

Topics: Aged, 80 and over; Catheterization; Clobetasol; Esophageal Diseases; Esophageal Stenosis; Female; Glucocorticoids; Humans; Lichen Planus; Prednisolone

The main aim of our paper was to point out the rare localization of erosive lichen planus in vulvar region and vagina. Moreover, these untreated lesions may be the starting point of squamous cell carcinoma.

Topics: Carcinoma, Squamous Cell; Clobetasol; Female; Glucocorticoids; Humans; Lichen Planus; Lichen Sclerosus et Atrophicus; Middle Aged; Precancerous Conditions; Rare Diseases; Treatment Outcome; Vagina; Vaginal Discharge; Vaginal Diseases; Vulva; Vulvar Diseases; Vulvar Neoplasms; Vulvovaginitis

Topics: Adrenal Cortex Hormones; Anti-Inflammatory Agents; Carcinoma, Squamous Cell; Clobetasol; Emollients; Female; Humans; Lichen Planus; Precancerous Conditions; Vulvar Diseases

Lichen planus with simultaneous oral and genital involvement in males is a quite rare condition and often difficult to diagnose. The prevalence, treatment options, and management for this condition are far from being established, and research in this area primarily relies on anecdotes. We present the clinical features of eight cases of peno-gingival lichen planus and propose a management algorithm for this condition based on the best available published evidence.. Personal medical history was collected for all cases. Following careful examination of the oral and genital mucosae, pathology was obtained, previous treatments and duration of mucosal lesions ascertained, treatment initiated, and response evaluated at 8 weeks on both oral and genital lesions. The first-line drug was topical clobetasol propionate 0.05% cream in all cases; in case of failure, topical cyclosporin was used. A review of the literature on treatment options for this rare condition was performed based upon standard literature review practices.. Five cases presented gingival lesions that clinically resembled lichen planus. Glans penis was involved in all patients. All patients responded to treatment except for one. Oral candidiasis was the only observed side effect.. Genital lichen planus may be suspected in males when atrophic-erosive gingival lichen planus is found. A thorough multidisciplinary medical management and active early treatment are necessary to improve symptoms and prevent genital sequelae and, given the risk of squamous cell carcinoma, as a preventative strategy, although this area still needs investigation. Therapeutic trials relating to the treatment of peno-gingival lichen planus may be undertaken considering that current management relies exclusively on observations of case reports.

Topics: Administration, Topical; Adult; Anti-Inflammatory Agents; Candidiasis, Oral; Cheek; Clobetasol; Cohort Studies; Follow-Up Studies; Gingival Diseases; Glucocorticoids; Humans; Lichen Planus; Lichen Planus, Oral; Lip Diseases; Male; Medical History Taking; Middle Aged; Penile Diseases; Remission Induction; Tongue Diseases; Treatment Outcome

The purpose of this study was to compare patient satisfaction with the topical immune system modulator tacrolimus to topical clobetasol during treatment for vulvovaginal erosive lichen planus.. Subjects who had been diagnosed with vulvovaginal erosive lichen planus between June 2000 and May 2001 received a mail survey regarding clinical satisfaction and response to treatment with clobetasol and tacrolimus. Satisfaction was assessed with a 100-mm visual analogue scale (very unsatisfied, 0; very satisfied, 100). Satisfaction was compared with the use of a paired t-test.. Nineteen subjects met the inclusion criteria; 17 subjects (89%) returned completed surveys. Sixteen of the 17 women reported clobetasol therapy, and 11 of the 17 subjects acknowledged the use of tacrolimus therapy. All but 1 of the women who received tacrolimus had been treated previously with clobetasol therapy. All subjects reported experiencing sexual pain before their initial examination. After treatment with clobetasol, 2 of 16 women reported pain-free intercourse. Two additional women reported pain-free intercourse after switching to tacrolimus therapy. Ten subjects who had used both treatments rated tacrolimus therapy as significantly more satisfactory than clobetasol therapy (63 vs 38 mm; P=.03).. The use of topical tacrolimus improves satisfaction and may result in better clinical outcomes than therapy with clobetasol for the treatment of vulvovaginal erosive lichen planus.

Topics: Administration, Topical; Adult; Aged; Clobetasol; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Follow-Up Studies; Health Care Surveys; Humans; Lichen Planus; Middle Aged; Patient Satisfaction; Probability; Severity of Illness Index; Surveys and Questionnaires; Tacrolimus; Treatment Outcome; Vaginal Diseases; Vulvar Diseases

Topics: Child; Clobetasol; Glucocorticoids; Humans; Lichen Planus; Male

Topics: Clobetasol; Female; Hepatitis C, Chronic; Humans; Lichen Planus; Lichen Planus, Oral; Middle Aged

Three women, aged 46, 48 and 73 years respectively, suffered from erosive genital lichen planus. Vulvar irritation, dyspareunia and vaginal discharge are the prominent signs of this disease. Lichen planus is an inflammatory dermatosis, which can involve skin and oral and genital mucosa. Diagnosis and treatment are difficult. Prolonged local application of a corticosteroid cream, e.g. clobetasol, is usually warranted. Narrowing of the vagina and painful mucosal lesions often prevent sexual intercourse. The combination of oral and genital complaints can help in the diagnosis of lichen planus. Strict follow-up is necessary because of the possible malignant degeneration of the disease.

Topics: Administration, Topical; Aged; Anti-Inflammatory Agents; Clobetasol; Diagnosis, Differential; Dyspareunia; Female; Glucocorticoids; Humans; Lichen Planus; Middle Aged; Mouth Mucosa; Vagina; Vaginal Discharge

Using a highly sensitive polymerase chain reaction (PCR) technique, based on general GP5+/GP6+ PCR primers covering 34 different human papillomavirus (HPV) types, the presence of HPV DNA was studied in paraffin-embedded penile biopsies from 20 men treated topically with corticosteroids. Clobetasol propionate was applied for 2-16 (mean 7) weeks by 19 men (age 18-73; mean 40) with lichen sclerosus. High-risk HPV was detected prior to therapy in three patients (16%) who lacked clinical or histopathological signs of HPV infection. Following therapy high-risk HPV was detected in biopsies from four men (21%), of whom three also exhibited clinical and/or light microscopic signs of HPV infection. Low-risk HPV DNA was not detected in any of these samples. Four biopsies were collected during a 5-year period from a 51-year-old man who was treated repeatedly with topical mild-moderate potent corticosteroids at intervals of up to 10 weeks for penile erosive lichen planus, followed by nine clinical outbreaks of typical condylomas that consistently showed the presence of low-risk HPV DNA only. These observations indicate that long-lasting topical corticosteroid therapy occasionally may be associated with opportunistic reactivation of a latent high- and low-risk mucosotrophic HPV type infection. The importance of clinical follow-up is underlined.

Topics: Administration, Topical; Adolescent; Adult; Aged; Biopsy, Needle; Chi-Square Distribution; Clobetasol; Condylomata Acuminata; Culture Techniques; DNA, Viral; Humans; Lichen Planus; Lichen Sclerosus et Atrophicus; Male; Middle Aged; Papillomaviridae; Papillomavirus Infections; Penile Diseases; Polymerase Chain Reaction; Prospective Studies; Recurrence; Risk Assessment

Involvement of the eye and related structures is rarely reported in lichen planus. Only eleven cases with eyelid involvement are reported in the literature. Lesions on the eyelids may be the only manifestation of lichen planus or it may be a part of the disease process present on other parts of the body. When only eyelids are involved, clinical diagnosis may be difficult. Lichen planus should be considered in the differential diagnosis of erythematous papular lesions on the eyelids.

Topics: Administration, Topical; Adolescent; Adult; Ankle; Anti-Inflammatory Agents; Biopsy; Clobetasol; Dermatitis, Contact; Diagnosis, Differential; Eyelids; Female; Forearm; Glucocorticoids; Humans; Leg; Lichen Planus; Male; Middle Aged; Skin; Triamcinolone Acetonide; Wrist

Vaccination against hepatitis B virus has rarely been associated with lichen planus. We report a case of this kind in a child from Nepal. A 12-year-old boy had developed generalized itchy violaceous papules and plaques six weeks after the second dose of hepatitis B virus vaccine. Serum HBsAg and HBeAb were negative, but HBsAb was positive. New crops of generalized, similar eruptions developed after the booster dose of vaccine. All the lesions resolved within three months of systemic steroid therapy. There was no recurrence after one year of follow up. Awareness of such an association is necessary, especially in children, because vaccination campaigns are increasing.

Topics: Administration, Topical; Anti-Inflammatory Agents; Child; Clobetasol; Glucocorticoids; Hepatitis B Antibodies; Hepatitis B Vaccines; Humans; Lichen Planus; Male; Nepal

Topics: Administration, Topical; Clobetasol; Female; Humans; Infant; Lichen Planus

The treatment of eight patients with histologically verified atrophic or erosive lichen planus are reported. The lesions of WHO-diagnosis code 697.02 were subdivided into three classes: atrophic, minor erosive and major erosive. Clobetasol Propionate ointment was placed in the buccal mucosa under an occlusive DuodermR dressing. Healing with striation was obtained in all of those lesions classified as atrophic or minor erosive, while major erosive lesions showed improvement, but persisted.

Topics: Aged; Clobetasol; Female; Humans; Lichen Planus; Male; Middle Aged; Mouth Diseases

A case of lichen aureus is presented, which is atypical in that a very large area was involved and there was a good response to topical fluorinated steroid therapy. Similarities to other cases reported in the literature are demonstrated.

Topics: Adult; Clobetasol; Diagnosis, Differential; Humans; Lichen Planus; Male; Purpura; Skin

It is now well established that epidermis, like many other tissues, contains a phospholipase A2 that is responsible for the initiation of the arachidonic acid cascade. Here we report that human epidermis also contains a second, quite distinct enzyme of the phospholipase A2 group, which is unique in its extreme activity against phospholipids in true solution. It also differs from the classic cutaneous enzyme in that (a) its activity is not reduced by pretreatment of the skin with corticosteroids in vivo nor by treatment of the epidermal homogenate with alkaline phosphatase in vitro, and (b) its activity is reduced, rather than increased, in the lesions of inflammatory diseases such as psoriasis. The enzyme seems to occur mainly in fully differentiated keratinocytes, its level being low in the basal cell layer of epidermis and in keratinocytes cultured in vitro. On the basis of these observations, we suggest that this new phospholipase A2 is responsible for the degradation of phospholipids that accompanies the terminal keratinization process.

Topics: Alkaline Phosphatase; Cells, Cultured; Clobetasol; Eczema; Epidermis; Humans; Keratins; Lichen Planus; Phospholipases; Phospholipases A; Phospholipases A2; Psoriasis; Skin Diseases; Trypsin