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ORIGINAL ARTICLE
Year : 2000  |  Volume : 66  |  Issue : 2  |  Page : 76-78

An immunopathological study of lichen planus




Correspondence Address:
Anita Nangia


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Source of Support: None, Conflict of Interest: None


PMID: 20877032

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  Abstract 

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 Oct 19];66:76-8. Available from: http://www.ijdvl.com/text.asp?2000/66/2/76/4874



  Introduction Top


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 [1],[2],[3]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. [3],[4] 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 Top


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. [5]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 Top


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 Top


Lichen planus is commonly seen in the 30-70 years age group. [6]sub However, in the tropics and sub­tropics, a younger age group is affected [7]sub as we have observed. Most studies [8]sub have reported a female pre­dominance, as we do; only a few reports [9]sub male pre­dominance.

The clinical features, morphologic types, mu­cosal involvement, and nail involvement observed by us were similar to other reports. [8],[9],[10]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. [1],[2],[3]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 [11]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.



 
  References Top

1.Baart de la Faille-Kuyper EH, Baart de la Faille-Kuyper H. An immunofluorescent study of lichen planus. Br J Dermatol 1974; 90 : 365-371.  Back to cited text no. 1    
2.Varclzidis A, Tosca A, Perissions A, et al. Immunohistochemistry in lichen planus. Dermatologica 1969; 159: 137-144.  Back to cited text no. 2    
3.Abell E, Presbury D, Marks R, et al. The diagnostic significance of immunoglobulin and fibrin deposition in lichen planus. Br J Dermatol 1975; 93: 17-24.  Back to cited text no. 3    
4.Dhar S, Kanwar AJ, Dawn G, et al. Paucity of immune complexes in skin lesions of lichen planus. Indian J Dermatol Venereol Leprol 1995; 61:21-25.  Back to cited text no. 4    
5.Gibson LE, Van Hale HM, Schroeter AL. Direct immunofluores­cence for the study of cutaneous drug eruptions. Acta Derm Venereol (Stockh) 1986; 66: 39-44.  Back to cited text no. 5  [PUBMED]  
6.Lacy MF, Reade PC, Hay KD. Lichen planus - a theory of patho­genesis. Oral Surg 1983; 56:521.  Back to cited text no. 6  [PUBMED]  
7.Singh OP, Kanwar Al. Lichen planus in India - An appraisal of 441 cases. Int J Dermatol 1976; 15: 751-756.  Back to cited text no. 7    
8.Scully C, EL-Korn M. Lichen Planus - review and update on patho­genesis. J Oral Pathol 1985; 14: 431-458.  Back to cited text no. 8    
9.Shklar G, McCarthy PL. The lesions of lichen planus - observa­tions on 100 cases. Oral Surg 1961; 14: 168.  Back to cited text no. 9    
10.Sehgal VN, Rege VL. Lichen planus - an appraisal of 147 cases. Indian 3 Dermatol Venereol Leprol 1974; 40 : 104 - 107.  Back to cited text no. 10    
11.Shuttleworht D, Gragam - Brown R, Campbell A. The autoim­mune background in lichen planus. Br 3 Derm 1986; 115: 199-203.  Back to cited text no. 11    


Figures

[Figure - 1], [Figure - 2], [Figure - 3]

Tables

[Table - 1]



 

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