|LETTER TO EDITOR
|Year : 2020 | Volume
| Issue : 1 | Page : 67-68
Lichenoid psoriasis: A distinct morphological entity
Naveen Kumar Kansal, C Divyalakshmi, Aditi Dhanta
Department of Dermatology and Venereology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
|Date of Submission||18-Apr-2019|
|Date of Decision||08-Aug-2019|
|Date of Acceptance||07-Oct-2019|
|Date of Web Publication||06-Jan-2020|
Naveen Kumar Kansal
Room No. 016414, Department of Dermatology and Venereology, All India Institute of Medical Sciences, Rishikesh - 249 203, Uttarakhand
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kansal NK, Divyalakshmi C, Dhanta A. Lichenoid psoriasis: A distinct morphological entity. Clin Dermatol Rev 2020;4:67-8
A 35-year-old female presented with lichenoid, scaly, itchy, papuloplaques over the dorsal aspects of the right fourth and fifth metacarpophalangeal joints [Figure 1] and dorsal aspect of the left wrist [Figure 2]. These lesions had a history of remissions followed by relapses over the past several years. There were no other cutaneous or systemic complaints; any medication history including oral contraceptives was negative. On detailed mucocutaneous examination, the rest of the skin, including hair, nail and mucosa, were within the normal limits. Dermoscopy of the lesions (Dermlite DL4 third-generation dermoscope, original magnification ×10, polarized noncontact) demonstrated bright silvery-white scales, with minute, regularly distributed dotted vessels on a reddish-pink background, in accordance with plaque psoriasis. Diffuse white lines (Wickham's striae) along with violet–brown pigmentation were present in all the lesions, as seen in lichen planus (LP) [Figure 3]. Therefore, our patient having combined morphological and dermoscopic features of both psoriasis and LP was diagnosed as lichenoid psoriasis.
|Figure 1: Erythematous to violaceous scaly, papuloplaques over the dorsal aspects of the right fourth and fifth metacarpophalangeal joints of the right hand|
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|Figure 2: Erythematous to violaceous scaly, papuloplaque over the dorsal aspect of the left wrist|
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|Figure 3: Dermoscopy of lesions. Minute, dotted vessels on a reddish-pink background with bright silvery scales and diffuse white lines (Wickham's striae). Diffuse violet–brown pigmentation is also seen|
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Psoriasis and LP are two of the most prevalent papulosquamous inflammatory cutaneous afflictions. Both have multiple forms and variants which depend on the sites of involvement, morphology, age of onset, precipitating factors, natural history, etc. Lichenoid psoriasis is probably one of the least common described morphologies. This morphology was first described by Rollier and Maury in 1950. Later, Professor John Ingram, in the first Watson Smith Lecture (January 11, 1954), delivered before the Royal College of Physicians, further elaborated on lichenoid psoriasis. He described two distinct types, the first one as “affecting the flexures” and second as “a peculiar intractable type of lichenoid psoriasis, which affects the hand or foot like a glove or sock.” He also noted the exacerbating effect of alcohol in lichenoid psoriasis, though alcohol is now known to have this effect in psoriasis per se later, similar patients were also described by Bolgert et al. and Temime et al. Psoriasiform lichenoid dermatitis was also described in the veterinary literature, but the authors classified the condition as seborrhea on the basis of clinical presentation.,
In our patient, morpho-dermoscopic features of both psoriasis and LP were present. Typical dermoscopic features of both these disorders are well described (plaque psoriasis: Level of evidence II; LP: Level of evidence II). The dermoscopic features of psoriasis reported in the literature are dotted vessels in a regular arrangement over a light red background. The most significant dermoscopic feature in LP is pearly whitish Wickham's striae. Additional features include globular and/or linear vessels and pink-, violet-, brown-, or yellow-pigmented structures (globules and/or reticular or cloud-like areas). These dermoscopic features of both the diseases are seen in our case.
Psoriasis has a prevalence of about 2%–3% in the adult population; the prevalence of LP is approximately 0.5% in the general population. Therefore, it is likely that these two disorders can coexist. However, presentation as a combined morphology is quite rare. Both these facts and other variants of psoriasis were discussed in detail by Professor Ingram. More recently, lichenoid reaction patterns in psoriasis and psoriatic arthritis patients have been described with antitumor necrosis factor-α (etanercept and adalimumab) therapy , and anti-interleukin-17A (secukinumab) therapy  as an adverse drug reaction. Therefore, the purpose of this report is to increase the awareness of lichenoid psoriasis and its diagnosis.
Declaration of patient consent
The informed consent was obtained for participation in the study and publication of data and images for research and educational purposes.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Rollier R, Maury PH. Lichenoid psoriasis. Bull Soc Fr Dermatol Syphiligr 1950;57:333-4.
Ingram JT. The significance and management of psoriasis. Br Med J 1954;2:823-8.
Bolgert M, Fesquet JP, Perin L, Poisson R. New case of lichenoid psoriasis. Bull Soc Fr Dermatol Syphiligr 1956;63:320-2.
Temime P, Tramier G, Dusan J, Privat Y. 2 cases of poikiloderma, one lichenoid and the other cryptogenetic (or lichenoid psoriasis). Bull Soc Fr Dermatol Syphiligr 1961;68:236-8.
Gross TL, Halliwell RE, McDougal BJ, Rosencrantz WS. Psoriasiform lichenoid dermatitis in the springer spaniel. Vet Pathol 1986;23:76-8.
Mason KV, Halliwell RE, McDougal BJ. Characterization of lichenoid-psoriasiform dermatosis of springer spaniels. J Am Vet Med Assoc 1986;189:897-901.
Errichetti E, Stinco G. Dermoscopy in general dermatology: A Practical overview. Dermatol Ther (Heidelb) 2016;6:471-507.
Griffiths CE, Barker J, Bleiker T, Chalmers R, Creamer D, editors. Rook's Textbook of Dermatology. 9th
ed. Chichester: Wiley Blackwell; 2016.
Bovenschen HJ, Kop EN, Van De Kerkhof PC, Seyger MM. Etanercept-induced lichenoid reaction pattern in psoriasis. J Dermatolog Treat 2006;17:381-3.
De Simone C, Caldarola G, D'Agostino M, Rotoli M, Capizzi R, Amerio P. Lichenoid reaction induced by adalimumab. J Eur Acad Dermatol Venereol 2008;22:626-7.
Capusan TM, Herrero-Moyano M, Martínez-Mera CR, Freih-Fraih AW, Dauden E. Oral lichenoid reaction in a psoriatic patient treated with secukinumab: A drug-related rather than a class-related adverse event? JAAD Case Rep 2018;4:521-3.
[Figure 1], [Figure 2], [Figure 3]