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LETTER TO EDITOR
Year : 2004  |  Volume : 70  |  Issue : 4  |  Page : 242-243

Colocalisation of alopecia areata and lichen planus


Departments of Dermatology, Schieffelin Leprosy Research & Training Centre, Karigiri, Vellore, India

Correspondence Address:
Dept of Dermatology, SLR & TC, Karigiri, India
karbikash@hotmail.com



How to cite this article:
Kar BR, Ebenezer G, Job C K. Colocalisation of alopecia areata and lichen planus. Indian J Dermatol Venereol Leprol 2004;70:242-3


How to cite this URL:
Kar BR, Ebenezer G, Job C K. Colocalisation of alopecia areata and lichen planus. Indian J Dermatol Venereol Leprol [serial online] 2004 [cited 2019 May 22];70:242-3. Available from: http://www.ijdvl.com/text.asp?2004/70/4/242/12365


Sir,
Frequent associations between alopecia areata and immune-mediated cutaneous disorders have been reported.[1] Being common skin disorders, lichen planus and alopecia areata may rarely coexist. We report a case of co-localization of lichen planus and alopecia areata.
A 42-year-old man presented with a single patch of non-scarring hair loss of 4 months' duration over the right parieto-occipital region. Alopecia areata was diagnosed and he was treated with topical betamethasone dipropionate. With that the lesion became static. He had no other lesion on any hair-bearing area.
Three months after the appearance of the initial lesion he developed a solitary violaceous papule in the center of the patch [Figure - 1]. The lesion was pruritic and mildly scaly. No mucosal lesion was present. A biopsy from the patch of alopecia revealed a typical perifollicular “swarm of bees” type lymphocytic infiltrate consistent with a diagnosis of alopecia areata (AA) [Figure - 2]. A biopsy from the central papular lesion showed hyperkeratosis, wedge-shaped hypergranulosis, irregular acanthosis, basal cell liquefaction and a band-like lymphocytic infiltrate and pigment incontinence in the superficial dermis suggestive of a diagnosis of lichen planus (LP) [Figure - 3].
Kanwar et al reported 20-nail dystrophy in a patient of AA due to LP.[2] Brenner et al reported a case of coincidence of five dermatological disorders: vitiligo, AA, onychodystrophy, morphea and LP.[3] Similarly, ulcerative colitis, myasthenia gravis, LP, AA and vitiligo were present in a single patient reported.[4] Patients with AA were found to be at a higher risk for developing LP (RR=2.7; 95% confidence interval, 1.1 to 6.5).[5] However, co-localization is very rare. Dhar et al had reported one child with co-localization of lesions both conditions.[6] The incidence of AA in the Indian population is 0.7%7 whereas it is 0.8% for LP.8 The coexistence of these disorders may be purely coincidental. Gilhar et al found that induction of AA was possible with injection of CD8+ cells cultured with follicular homogenate but not with cultured CD4+ cells.[9] The T lymphocyte is also pivotal in regulating epidermal cell recognition and epithelial destruction in lichen planus. T cells become activated via antigen-presenting cells such as Langerhans cells in conjunction with epidermal keratinocytes and co-stimulatory molecules. Though both CD4+ and CD8+ T cells are found in the lesional skin of LP, progression of disease leads to the preferen-tial accumulation of CD8+ cells.[10] The majority of the lymphocytes in the infiltrate of LP are CD8+ and CD45RO (memory)-positive cells and express the g/d T-cell-receptor. The ensuing immune reaction by CD8+ T lymphocytes against activated keratinocytes results in epidermal cell damage and development of the lichenoid reaction that is the hallmark of lichen planus.
Further studies might clarify whether co-localization of lichen planus and alopecia areata is a mere coincidence or represents a common pathogenic mechanism in these two predominantly CD8+ T lymphocyte-mediated disorders. 

   References Top

1.Madani S, Shapiro J. Alopecia areata update. J Am Acad Dermatol 2000;42:549-66.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Kanwar AJ, Ghosh S, Thami GP, Kaur S. Twenty-nail dystrophy due to lichen planus in a patient with alopecia areata. Clin Exp Dermatol 1993;18:293-4.  Back to cited text no. 2  [PUBMED]  
3.Brenner W, Diem E, Gschnait F. Coincidence of vitiligo, alopecia areata, onychodystrophy, localized scleroderma and lichen planus. Dermatologica 1979;159:356-60.  Back to cited text no. 3  [PUBMED]  
4.Tan RS. Ulcerative colitis, myasthenia gravis, atypical lichen planus, alopecia areata, vitiligo. Proc R Soc Med 1974;67:195-6.  Back to cited text no. 4  [PUBMED]  
5.Epidemiological evidence of the association between lichen planus and two immune-related diseases alopecia areata and ulcerative colitis. Gruppo Italiano Studi Epidemiologici in Dermatologia Arch Dermatol 1991;127:688-91.  Back to cited text no. 5    
6.Dhar S, Dhar S. Colocalization of alopecia areata and lichen planus. Pediatr Dermatol 1996;13:258-9.  Back to cited text no. 6  [PUBMED]  
7.Sharma VK, Dawn G, Kumar B. Profile of alopecia areata in Northern India. Int J Dermatol 1996;35:22-7.  Back to cited text no. 7  [PUBMED]  
8.Singh OP, Kanwar AJ. Lichen planus in India. An appraisal of 441 cases. Int J Dermatol 1976;15:752-6.  Back to cited text no. 8  [PUBMED]  
9.Gilhar A, Ullmann Y, Berkutzki T, Assy B, Kalish RS. Autoimmune hair loss transferred by T-lymphocytes to human scalp explants on SCID mice. J Clin Invest 1998;101:62-7.  Back to cited text no. 9  [PUBMED]  [FULLTEXT]
10.Gadenne AS, Strucke R, Dunn D, Wagner M, Bleicher P, Bigby M. T-cell lines derived from lesional skin of lichen planus patients contain a distinctive population of T-cell receptor gamma delta-bearing cells. J Invest Dermatol 1994;103:347-51.  Back to cited text no. 10  [PUBMED]  

 

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