Lichen planus pemphigoides limited to the oral cavity: A case report and literature review
Keywords:
oral lichen planus pemphigoid, lichen planus, direct immunofluorescence, bullous lichen planus, mucous membrane pemphigoidAbstract
Lichen planus pemphigoides (LPP) is a rare autoimmune vesiculobullous disorder and its exclusive presentation in the oral cavity is an even
more remote occurrence. We describe an 85-year-old woman with a symptomatic soft palatal erosion, which compromised her ability to
wear a maxillary prosthesis. She had been diagnosed with and treated for lichen planus affecting her buccal mucosa 3 years prior to the
onset of the lesion on palate. Persistence of the palatal lesion and its lack of response to local steroid therapy prompted a repeat biopsy for
histopathological and direct immunofluorescence examination both of which confirmed LPP diagnosis. In oral lichen planus pemphigoides
treatment is empirical. In this patient, a combination of systemic and topical steroids was effective in resolving the palatal ulceration. This
case report highlights the importance of monitoring patient’s response to therapy and appropriate diagnostic workup when signs and
symptoms persist or change character.
References
References
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lichen planus pemphigoides: a series of four cases. Oral Surg Oral Med Oral
Pathol Oral Radiol. 2015;120:58–68. doi:10.1016/j.oooo.2015.03.012
2. Sami N. Autoimmune bullous diseases: approach and management;
Springer, New York, 2016.
3. Mignogna MD, Fortuna G, Leuci S, Stasio L, Mezza E, Ruoppo E. Lichen
planus pemphigoides, a possible example of epitope spreading. Oral Surg
Oral Med Oral Pathol Oral Radiol Endod. 2010;109:837–843. doi:10.1016/j.
tripleo.2009.12.044
4. Jonkman MF. Autoimmune bullous diseases: text and review; Springer,
2015.
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mucous membrane pemphigoid with clinical features of oral lichen planusâ€
and on the utility of immunofluorescence. Int J Dermatol. 2017;56:1515.
doi:10.1111/ijd.13663
6. Kabuto M, Fujimoto N, Yamaguchi A, Tanaka T. Evaluation of mononuclear
cells in lichen planus pemphigoides. Acta Derm Venereol. 2016;96:276–278.
doi:10.2340/00015555-2191
7. Yamada H, Ishii H, Seto K, Kuwashima Y. Oral mucous membrane
pemphigoid associated with lichen planus: a subtype of lichen planus
pemphigoides? Asian J Oral Maxillofac Surg. 2004;16:135–138. doi:10.1016/
S0915-6992(04)80023-2
8. Skvara H, Stingl G. Lichenoid eruption with single plantar blisters: a very
rare case of lichen planus pemphigoides. J Eur Acad Dermatol Venereol.
2009;23:596–597. doi:10.1111/j.1468-3083.2008.02982.x
9. Powell AM, Black MM. Epitope spreading: protection from pathogens,
but propagation of autoimmunity? Clin Exp Dermatol. 2001;26:427–433.
doi:10.1046/j.1365-2230.2001.00852.x
10. Fujii M, Takahashi I, Honma M, Ishidaâ€Yamamoto A. Bullous lichen planus
accompanied by elevation of serum antiâ€BP180 autoantibody: a possible
transitional mechanism to lichen planus pemphigoides. J Dermatol.
2017;44:e124–e125. doi:10.1111/1346-8138.13732
11. Anand D, Bernardin R, Rubin AI. Blisters and plaques on the extremities.
What is your diagnosis? Lichen planus pemphigoides. Int J Dermatol.
2011;50:147–149. doi:10.1111/j.1365-4632.2010.04722.x
12. Laureano A, Rafael M, Pinto GM, Cardoso J. Lichen planus pemphigoides
possibly induced by hormone therapy. Eur J Dermatol. 2013;23:903–904.
doi:10.1684/ejd.2013.2180
13. Maoz KB, Brenner S. Lichen planus pemphigoides triggered by narrowband
UVB, paracetamol, and ibuprofen, with autoantibodies to 130 kDa antigen.
Skinmed. 2008;7:33–36. doi:10.1111/j.1540-9740.2007.07667.x
14. Rosmaninho A, Sanches M, Oliveira A, Alves R, Selores M. Lichen planus
pemphigoides induced by a weight reduction drug. Cutan Ocul Toxicol.
2011;30:306–308. doi:10.3109/15569527.2011.566234
15. Stoebner P, Michot C, Ligeron C, Durand L, Meynadier J, Meunier L.
Simvastatin-induced lichen planus pemphigoides. Ann Dermatol Venereol.
2003;130:187–190.
16. Harting MS, Hsu S. Lichen planus pemphigoides: a case report and review
of the literature. Dermatol Online J. 2006;12.
17. Bhuiyan I, Hossain MS, Khan MSA, Alam M, Haque M. Lichen planus
pemphigoides: a case report. J Shaheed Suhrawardy Med Coll. 2012;4:
35–37. doi:10.3329/jssmc.v4i1.12002
18. Maceyko RF, Camisa C, Bergfeld WF, Valenzuela R. Oral and cutaneous
lichen planus pemphigoides. J Am Acad Dermatol. 1992;27:889–892.
doi:10.1016/0190-9622(92)70275-K
19. Zhu YI, Fitzpatrick JE, Kornfeld BW. Lichen planus pemphigoides associated
with ramipril. Int J Dermatol. 2006;45:1453–1455. doi:10.1111/j.1365-
4632.2006.02711.x
20. Zaraa I, Mahfoudh A, Sellami MK, Chelly I, El Euch D, Zitouna M, et al. Lichen
planus pemphigoides: four new cases and a review of the literature. Int J
Dermatol. 2013;52:406–412. doi:10.1111/j.1365-4632.2012.05693.x
21. Solomon LW, Helm TN, Stevens C, Neiders ME, Kumar V. Clinical and
immunopathologic findings in oral lichen planus pemphigoides. Oral Surg
Oral Med Oral Pathol Oral Radiol Endod. 2007;103:808–813. doi:10.1016/j.
tripleo.2006.03.020
22. Glick M. Burket’s Oral Medicine; 12th ed.; PMPH-USA, 2015.
23. Huang S-Y, Hsu RC-C, Yu H-S, Chen G-S. Lichen planus pemphigoides: a case
report. Dermatol Sinica. 2001;19:210–216.
24. Schmidgen MI, Butsch F, Schadmandâ€Fischer S, Steinbrink K, Grabbe
S, Weidenthalerâ€Barth B, et al. Pembrolizumabâ€induced lichen planus
pemphigoides in a patient with metastatic melanoma. J Dtsch Dermatol
Ges. 2017;15:742–745. doi:10.1111/ddg.13272
25. Washio K, Nakamura A, Fukuda S, Hashimoto T, Horikawa T. A case of
lichen planus pemphigoides successfully treated with a combination
of cyclosporine a and prednisolone. Case Rep Dermatol. 2013;5:84–57.
doi:10.1159/000350285
1. Sultan A, Stojanov IJ, Lerman MA, Kabani S, Haber J, Freedman J, et al. Oral
lichen planus pemphigoides: a series of four cases. Oral Surg Oral Med Oral
Pathol Oral Radiol. 2015;120:58–68. doi:10.1016/j.oooo.2015.03.012
2. Sami N. Autoimmune bullous diseases: approach and management;
Springer, New York, 2016.
3. Mignogna MD, Fortuna G, Leuci S, Stasio L, Mezza E, Ruoppo E. Lichen
planus pemphigoides, a possible example of epitope spreading. Oral Surg
Oral Med Oral Pathol Oral Radiol Endod. 2010;109:837–843. doi:10.1016/j.
tripleo.2009.12.044
4. Jonkman MF. Autoimmune bullous diseases: text and review; Springer,
2015.
5. Bavarian R, Sultan AS, Mignogna MD. Comments regarding “Four cases of
mucous membrane pemphigoid with clinical features of oral lichen planusâ€
and on the utility of immunofluorescence. Int J Dermatol. 2017;56:1515.
doi:10.1111/ijd.13663
6. Kabuto M, Fujimoto N, Yamaguchi A, Tanaka T. Evaluation of mononuclear
cells in lichen planus pemphigoides. Acta Derm Venereol. 2016;96:276–278.
doi:10.2340/00015555-2191
7. Yamada H, Ishii H, Seto K, Kuwashima Y. Oral mucous membrane
pemphigoid associated with lichen planus: a subtype of lichen planus
pemphigoides? Asian J Oral Maxillofac Surg. 2004;16:135–138. doi:10.1016/
S0915-6992(04)80023-2
8. Skvara H, Stingl G. Lichenoid eruption with single plantar blisters: a very
rare case of lichen planus pemphigoides. J Eur Acad Dermatol Venereol.
2009;23:596–597. doi:10.1111/j.1468-3083.2008.02982.x
9. Powell AM, Black MM. Epitope spreading: protection from pathogens,
but propagation of autoimmunity? Clin Exp Dermatol. 2001;26:427–433.
doi:10.1046/j.1365-2230.2001.00852.x
10. Fujii M, Takahashi I, Honma M, Ishidaâ€Yamamoto A. Bullous lichen planus
accompanied by elevation of serum antiâ€BP180 autoantibody: a possible
transitional mechanism to lichen planus pemphigoides. J Dermatol.
2017;44:e124–e125. doi:10.1111/1346-8138.13732
11. Anand D, Bernardin R, Rubin AI. Blisters and plaques on the extremities.
What is your diagnosis? Lichen planus pemphigoides. Int J Dermatol.
2011;50:147–149. doi:10.1111/j.1365-4632.2010.04722.x
12. Laureano A, Rafael M, Pinto GM, Cardoso J. Lichen planus pemphigoides
possibly induced by hormone therapy. Eur J Dermatol. 2013;23:903–904.
doi:10.1684/ejd.2013.2180
13. Maoz KB, Brenner S. Lichen planus pemphigoides triggered by narrowband
UVB, paracetamol, and ibuprofen, with autoantibodies to 130 kDa antigen.
Skinmed. 2008;7:33–36. doi:10.1111/j.1540-9740.2007.07667.x
14. Rosmaninho A, Sanches M, Oliveira A, Alves R, Selores M. Lichen planus
pemphigoides induced by a weight reduction drug. Cutan Ocul Toxicol.
2011;30:306–308. doi:10.3109/15569527.2011.566234
15. Stoebner P, Michot C, Ligeron C, Durand L, Meynadier J, Meunier L.
Simvastatin-induced lichen planus pemphigoides. Ann Dermatol Venereol.
2003;130:187–190.
16. Harting MS, Hsu S. Lichen planus pemphigoides: a case report and review
of the literature. Dermatol Online J. 2006;12.
17. Bhuiyan I, Hossain MS, Khan MSA, Alam M, Haque M. Lichen planus
pemphigoides: a case report. J Shaheed Suhrawardy Med Coll. 2012;4:
35–37. doi:10.3329/jssmc.v4i1.12002
18. Maceyko RF, Camisa C, Bergfeld WF, Valenzuela R. Oral and cutaneous
lichen planus pemphigoides. J Am Acad Dermatol. 1992;27:889–892.
doi:10.1016/0190-9622(92)70275-K
19. Zhu YI, Fitzpatrick JE, Kornfeld BW. Lichen planus pemphigoides associated
with ramipril. Int J Dermatol. 2006;45:1453–1455. doi:10.1111/j.1365-
4632.2006.02711.x
20. Zaraa I, Mahfoudh A, Sellami MK, Chelly I, El Euch D, Zitouna M, et al. Lichen
planus pemphigoides: four new cases and a review of the literature. Int J
Dermatol. 2013;52:406–412. doi:10.1111/j.1365-4632.2012.05693.x
21. Solomon LW, Helm TN, Stevens C, Neiders ME, Kumar V. Clinical and
immunopathologic findings in oral lichen planus pemphigoides. Oral Surg
Oral Med Oral Pathol Oral Radiol Endod. 2007;103:808–813. doi:10.1016/j.
tripleo.2006.03.020
22. Glick M. Burket’s Oral Medicine; 12th ed.; PMPH-USA, 2015.
23. Huang S-Y, Hsu RC-C, Yu H-S, Chen G-S. Lichen planus pemphigoides: a case
report. Dermatol Sinica. 2001;19:210–216.
24. Schmidgen MI, Butsch F, Schadmandâ€Fischer S, Steinbrink K, Grabbe
S, Weidenthalerâ€Barth B, et al. Pembrolizumabâ€induced lichen planus
pemphigoides in a patient with metastatic melanoma. J Dtsch Dermatol
Ges. 2017;15:742–745. doi:10.1111/ddg.13272
25. Washio K, Nakamura A, Fukuda S, Hashimoto T, Horikawa T. A case of
lichen planus pemphigoides successfully treated with a combination
of cyclosporine a and prednisolone. Case Rep Dermatol. 2013;5:84–57.
doi:10.1159/000350285
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Published
2018-07-02
How to Cite
Koopaie, M., & Fatahzadeh, M. (2018). Lichen planus pemphigoides limited to the oral cavity: A case report and literature review. Journal of Contemporary Medical Sciences, 4(2), 102–105. Retrieved from https://www.jocms.org/index.php/jcms/article/view/422
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