Info

Erythematosus

Lichen Planopilaris

Lymphocytic infiltrate is

Periadnexal lymphocytic infiltrate is

deeper

more superficial

Pathophysiology:

■ The pathogenesis of lichen sclerosus and atrophicus (LS et A) is poorly understood.

■ The inflammatory infiltrate is CD8+, CD57+ T lymphocyte-rich, and it has been speculated that the infiltrate and the resulting alterations in the epidermis and dermis are a response to a virus, as yet unidentified.

■ There is also speculation that LS et A represents a superficial, localized variant of morphea, and is essentially autoimmune in nature.

References:

1. Barker LP, Gross P. Lichen sclerosus et atrophicus of the female genitalia. Arch Dermatol 1962; 85:362-373.

2. Carlson JA, Grabowski R, Chichester P, et al. Comparative immunophenotypic study of lichen sclerosus. Epidermotropic CD57+ lymphocytes are numerous—implications for pathogenesis. Am J Dermatopathol 2000; 22:7-16.

3. Uitto J, Santa Cruz DJ, Bauer EA, Eisen AZ. Morphea and lichen sclerosus et atrophicus. J Am Acad Dermatol 1980; 3:271-279.

Clinical Presentation:

■ Typically presents as sharply demarcated, scaly, erythe-matous patches with comedo-like plugs on the face, ears, and scalp and associated with a scarring alopecia; less commonly, lesions involve the skin below the neck

■ More common in women and blacks

■ Five percent progress to, or are associated with, systemic lupus erythematosus

Histology:

■ Vacuolar alteration of the basal keratinocytes (Fig. 5B)

■ Superficial and deep perivascular and periadnexal infiltrate of lymphocytes (Figs. 5A and C)

■ Altered (thickened) basement membrane (Fig. 5D)

■ Plugged follicular units

Pathophysiology:

■ Deregulated T lymphocytes activate B cells to produce pathogenic autoantibodies which result in cutaneous damage

■ The etiology of this immune deregulation is unknown, but ultraviolet light (UVA and UVB), as well as genetic predisposition are thought to have some role in the pathogenesis of discoid lupus erythematosus

References:

1. Clark WH, Reed RJ, Mihm MC. Lupus erythematosus. Histopathology of cutaneous lesions. Hum Pathol 1973; 4:157-163.

2. Weigand DA. The lupus band test: a reevaluation. J Am Acad Dermatol 1984; 11:230-234.

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