|Year : 2000 | Volume
| Issue : 2 | Page : 76-78
An immunopathological study of lichen planus
Anita Nangia, Vijay Kumar, KB Logani
Source of Support: None, Conflict of Interest: None
Twenty-five patients with clinically diagnosed lichen planus were examined for direct immunofluorescence patterns in biopsies. The male to female ratio was 1:1.77. The peak incidence was observed in 11-20 years age group. Most (96%) of the patients presented with moderate to severe itching within two months of onset of symptoms. Sixty percent of the patients had violaceous papules; 20% had both papules and plaques. Simultaneous oral involvement was seen in 4% of cases; 8% showed nail changes. Thirteen patients had classical LP, 9 had lichen planus hypertrophicus, 2 had lichen planus actinicus, and one had lichen planopilaris. Direct immunofluorescence revealed fibrin deposition in 64% of cases as a linear pattern at dermo-epidermal junction, as coarse granular deposits of IgM sub-epidermally in 24 of cases and at the dermo-epidermal junction as C 3 in20% of cases. Civatte bodies were seen in 5 cases with H&E staining, but direct immunofluorescence for IgM, fibrin and C 3 was observed only in two cases. This suggests activation of complement and fibrinogen cascade. Whether this is the cause or effect of pathological processes in lichen planus remains to be determined
Keywords: Lichen planus, Direct immunofluorescence
|How to cite this article:|
Nangia A, Kumar V, Logani K B. An immunopathological study of lichen planus. Indian J Dermatol Venereol Leprol 2000;66:76-8
|How to cite this URL:|
Nangia A, Kumar V, Logani K B. An immunopathological study of lichen planus. Indian J Dermatol Venereol Leprol [serial online] 2000 [cited 2019 Jun 25];66:76-8. Available from: http://www.ijdvl.com/text.asp?2000/66/2/76/4874
| Introduction|| |
Lichen planus.(LP) is a distinctive muco-cutaneous disease of uncertain etiology. A number of clinical and immunofluorescence studies strongly favour an immune pathogenesis. Early studies ,,sub demonstrated the deposition of IgM or C 3 at the dermoepidermal junction (DEJ) in LP and showed deposition of IgG, IgM, IgA, C 1 qsub , C 3 , C 5 on DIF. Recently, much attention has been focussed on deposition of fibrin products at DEJ and in civatte bodies in LP. , sub This allows us to ponder the hypothesis of activation of fibrinogen cascade by immunologic (possibly antibodies) factors. Hence this study was undertaken to examine the direct immunofluorescence immunopathological features and their role in causation of lichen planus, if any.
| Materials and Methods|| |
Twenty - five clinically diagnosed cases of lichen planus were included in this study. A detailed history and thorough clinical examination were carried out. All routine hematological and biochemical examinations were done. An incisional biopsy was taken that included lesional and perilesional areas. The biopsy was bissected; one half was sent in 10% formalin for routine H&E staining, second was transferred in immunofluorescence fixative for DIE The latter was blotted dry in folds of filter paper and cut in a cryostat into 5mm thick tissue sections for imunofluorescence study by a standardised method. sub Sections from each case were stained with fluorescein isothiocyanate (FITC) conjugated anti-human monoclonal antibodies directed against IgG, IgM, IgA,Clq, C 3 and fibrinogen. The conjugates were diluted 1:40; 10ml was layered on the section and incubated in covered Petri dish More Details at 37°c for 1 hour. After several washings in PBS, the slides were mounted in glycerine PBS mixture and viewed in a Nikon trinocular Japan Optiphot - 2 immuno-flurescence microscope. The exact site and intensity of fluorescence were noted.
| Results|| |
The study showed a female preponderance (sex ratio M:F=1:1.77). The disease occurred most commonly in the 2 ndsub decade of life (32%). Most (96%) patients reported moderate to severe itching within 1-2 months of onset. Sixty percent of patients presented with violaceous papules, usually involving multiple sites, while 20% had both papules and plaques. The commonest clinical type of lichen planus observed was classical (52%) followed by hyperthrophicus (36%), atrophic (8%) and lichen planopilaris (4%). Simultaneous oral involvement was seen in 4% and nail changes in 8% of cases.
There was a complete correlation between clinical and histopathological features diagnostic of LP. Civatte Bodies (CB) were seen in 20% of cases on hemotoaxylin and eosin (H&E) staining; 12% of cases were of lichen planus hypertrophicus (LPH) and 8% were of classical lichen planus (LP), mainly in the lower epidermis and in papillary dermis. On direct immunofluores cence (DIF) study, linear fibrin deposition was observed in 64% of the cases [Figure - 1]; in 8% it was seen as focal granular coarse deposits at DEJ. In addition fibrin deposition was also seen in the walls of dermal blood vessels [Figure - 2]; in 12% of cases. IgM was seen as coarse granular deposits at DEJ and sub-epidermally (SE) in 6 cases (24%), out of which 4 were of LPH [Figure - 3]. C 3 deposition was seen as a linear continuous band at DEJ in 20% of cases. Out of 5 cases in which CB'S were seen on H&E staining, only 2 showed DIF, one for fibrin, IgM, and C 3 and the second only for IgM & C 3 . Immunostaining for FITC - conjugated IgG, IgA, and C 1 Q were negative in all cases. The pattern of immunofluorescence in different types of LP is shown in [Table - 1].
| Discussion|| |
Lichen planus is commonly seen in the 30-70 years age group. sub However, in the tropics and subtropics, a younger age group is affected sub as we have observed. Most studies sub have reported a female predominance, as we do; only a few reports sub male predominance.
The clinical features, morphologic types, mucosal involvement, and nail involvement observed by us were similar to other reports. ,,sub In the present study, fibrin deposition was seen in the greatest number of lesions at the dermo-epidermal junction, in Civatte bodies, and in the walls of dermal blood vessels. The intensity of staining was maximal in lesions of less than 3 months duration and those associated with vasodilation and dermal edema. This could be due to breakdown and removal of fibrin fragments by phagocytosis in older lesions. The perivascular deposition. was most likely due to leakage of fibrin following vasodilation.
Civatte bodies showed the presence of IgM,C 3 and fibrin as reported by other authors. ,,sub This could be due to the persistence of these heavy molecules at the site; smaller earlier fragments such as C1q may be absorbed and removed. CB's have been noted in other dermatoses sub but their occurrence in large number in the lower epidermis and upper dermis is characteristic of LP. In our study, CB's were noted in only 20% of cases. This may be due to phagocytosis of these apoptotic bodies in older lesions.
The simultaneous deposition of complement fragments, immunoglobulins and fibrin in lesions of LP point to the activation of complement and a fibrinogen cascade. These products in turn act as chemoattractants for leucocytes leading to the inflammatory response in LP, which perpetuates the basal cell damage. Whether these events are a cause or effect of pathological processes in lichen planus needs to be elucidated.
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[Figure - 1], [Figure - 2], [Figure - 3]
[Table - 1]