Scrofuloderma results from the direct extension of the infection from a deep structure e. Pathology of lichen planopilaris top 8 facts dr sampurna. Lichen scrofulosorum, an uncommon tuberculid, is usually seen in children with nodal or skeletal tuberculosis or following bcg vaccination. Stains and cultures for mycobacteria in the skin were negative, and a polymerase chain reaction pcr analysis failed to detect the dna of mycobacterium tuberculosis in a skin biopsy specimen, thus making. Childhood lichen scrofulosorum revisited springerlink. Oral lichen planus a study of associated factors with special reference to thyroid disease jairo robledosierra department of oral medicine and pathology, institute of odontology, sahlgrenska academy at university of gothenburg oral lichen planus olp is one of the most common and debilitating oral mucosal lesions in the adult population. The tuberculids are either lichen scrofulosorum, papulonecrotic tuberculid, or the lichentuberculid. Sarode2 1department of oral pathology, faculty of dental sciences, ms ramaiah university of applied sciences, bengaluru, karnataka, india, 2department of oral. The lesions are usually asymptomatic, closely grouped, skincolored to reddishbrown papules, often perifollicular, and are mainly found on the abdomen. Classic example of a lichenoid dermatitis hyperkeratosis and acanthosis. Lichen scrofulosorum definition of lichen scrofulosorum. Even in countries such as india and china where tb still commonly occurs, cutaneous outbreaks. Lichen sclerosus is a relatively common chronic condition classically associated with the vulva.
Tuberculide is a rare cutaneous disorder but its recognition is important as it is a readily treatable disease. It is commonly associated with tuberculosis of the lymph nodes and. Diagnosis of ls mainly lies on histopathology, tuberculin skin testing. It is thought to be the result of an autoimmune process with an unknown initial trigger. A clinician may recommend medication for the physical symptoms, and may refer the patient for support and therapy for other issues associated with the condition, such as problems with sex. Scrofuloderma associated with granuloma annularelike. We report a case of a young adult with lichen scrofulosorum along with tuberculous lymphadenitis.
Lichen scrofulosorum ls also known as tuberculosis tb cutis lichenoides, is a rare tuberculid that presents as a lichenoid eruption of minute papules in children and adolescents with tb. Tuberculosis tb is a mycobacterial infection that most frequently occurs due to infection with mycobacterium tuberculosis, an acidfast bacillus. A universal diagnostic criteria for oral lichen planus. Lichen scrofulosorum is a rare tuberculid that presents as a lichenoid eruption of minute papules in children and adolescents with tuberculosis. The group with papulo necrotic tuberculids exhibited 96 per cent positive reactions. Diagnosis depends on previous knowledge of systemic andor cutaneous tuberculosis. He showed almost complete resolution of lesions after four months of antitubercular. Perifollicular granulomas and absence of bacilli are the histopathological characteristics. May 01, 2007 read lichen scrofulosorum on the genitalia an unusual presentation, international journal of dermatology on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips.
Histopathological examination typi cally showed epithelioid cell granulomas around hair follicles. Usatine, md, and michelle tinitigan, md, university of texas health science center, san antonio, texas l ichen planus is a chronic, inflam. Lichen scrofulosorum caused by mycobacterium leprae. Mallory stains showed a palerstaining collagen in the upper cutis. Get a printable copy pdf file of the complete article 261k, or click on a page image below to browse page by page. The lesions of lichen scrofulosorum may show crustingwhich isdueto a follicularexudationandhas beenlabelled eczemascrofulosorum. Papulonecrotic tuberculid exhibits ulceration and vshaped areas of necrosis, which include a variable thickness of dermis and the overlying epidermis. In the last three decades, there has been a dearth of literature on the entity in children, despite a global increase in tuberculosis. Although rare, it represents 25% of the cases of cicatricial alopecia. The lesions are usually arranged in clusters on the trunk. Histopathologic study demonstrated granulomas around the hair follicles, although acidfast bacilli stains, immunohistochemical stain for mycobacteria, polymerase chain reaction investigations and cultures failed to. Overlap can occur where superficial and deep changes coexist. Lesions are usually confined to the trunk and present as asymptomatic, firm, follicular or perifollicular flattopped skincolored or reddish brown papules, sometimes with fine scales.
The disease is commonly seen in children and young adults. Sep 10, 20 lichen planus lichen planus lp is a disease of the skin andor mucous membranes that resembles lichens. Histopathological examination of the dorsal lesions revealed focal spongiosis in. Highresolution computerized tomography ct scan of chest showed lymphadenopathy adjacent to aortic arch, aortopulmonary ap window left hilar, subcarinal, and left bronchopulmonary regions along with patchy consolidation in left inferior lingual lobe. Scrofuloderma most commonly develops in children, adolescents and elderly individuals. The inflammatory infiltrate is also seen focally within the papillary dermis, but is predominantly histiocytic forming non caseating epithelioid granulomas.
Lichen scrofulosorum in a saudi adolescent with multifocal. Lichen scrofulosorum ls, the most uncommon variant of tuberculid, is usually associated with m. The non caseating granulomas are typically centred on the hair follicles or sweat ducts. The papulonecrotictuberculid is a largerlesion and always. Granuloma annularelike lichen scrofulosorum was reported once before in an immunocompromised patient in 2007 8. It is usually associated with localized cervical, hilar, or mediastinal lymphadenopathy or with osseous tuberculosis. Lichen scrofulosorum ls, an uncommon cutaneous tuberculous reaction, has been described in children and young adults. The characteristic symptom of the disease is an eruption of miliary papules of pale yellow, brownish red or of the same color as the rest of the skin. Although a rare occurrence, this tuberculid is an important marker. The pathogenesis of lichen scrofulosorum is considered to.
The inflammatory infiltrate is typically sparse and around deep adnexal and vascular structures. The most popular theory is that lichen sclerosus is caused by autoimmune dysfunction but nobody has been able to prove this. Pityriasis rubra pilaris and lichenoid sarcoidosis can be differentiated by their characteristic histology. Lichen scrofulosorum ls, is a tuberculid first described by hebra in 1868. A proposed variant of lichen simplex chronicus is lichen amyloidosis. Ls can go unsuspected because of its waxing and waning course and. However, history of exposure to tuberculosis in the setting of lichen nitidus should be investigated and when appropriate antituberculosis treatment is initiated. True tuberculide mainly consists of three main types, namely, papulonecrotic tuberculide, lichen scrofulosorum and erythema induratum of bazin. Rarely, lichen scrofulosorum can be caused by bacillus calmetteguerin bcg vaccination. Pityriasisrosealike ctb has been reported as a tuberculid. Lichen scrofulosorum was first recognized and described by hebra1 in 1868. Lichen scrofulosorum presenting as pyrexia of unknown origin. Kaposi2 was the first to describe lichen scrofulosorum histologically.
Lichen scrofulosorum is a rare form of tuberculid seen in children and young adults with or without other manifestations of tuberculosis. It tends to be a relapsing and remitting condition and there is no cure. These include lichen scrofulosorum, sarcoidosis and secondary syphilis. Lichen scrofulosorum ls is a rare tuberculid, which usually develops in children and young adults.
Lichen scrofulosorum and verrucose tuberculide europe. Histology shows noncaseating, epithelioid cell granulomas in upper dermis. Description of the cases case report 1 a 55yearold, black, male patient was referred to the oral diagnosis service complaining of rough tongue. The eruption responded to antitubercular therapy with complete clearance of the lesions. Lichen scrofulosorum an overview sciencedirect topics. As treatment is totally different, histopathology is usually required for an early diagnosis, in particular in the endemic areas of tb infection. Unusual presentation of lichen scrofulosorum dandale a. Lichen scrofulosorum on the genitalia an unusual presentation lichen scrofulosorum on the genitalia an unusual presentation gandhi, vijay. Dermoepidermal junction lichen nitidus actinic damage actinic granuloma hair follicles pityrosporum follicultits acne rosacea and related conditions lichen scrofulosorum blood vessels churg strauss wegners granulomatosis nerves leprosy fat erythaema nodosum others erythaema induratimnodular vasculitis interstitial granulomatous drug reaction. Lichen scrofulosorum, also known as tuberculosis cutis lichenoides, is a rare tuberculid that presents as a lichenoid eruption of minute papules in children and adolescents with tuberculosis.
On the vulva is also known as chronic atrophic vulvitis on the glans penis it was referred to as balanitis xerotica obliterans, abbreviated bxo. It is more frequent in women 7080%, with a peak age of onset between 30 and 60 years. In this condition the overlying epidermis and superficial dermis is spared. Lichen scrofulosorum, also known as tuberculosis cutis lichenoides, is a rare. Lichen planopilaris, a subtype of lichen planus, is an inflammatory condition characterized by patchy or diffuse hair loss with erythematous papules and keratotic follicular lesions that evolve to cicatricial alopecia 2 history.
An important diagnostic marker of underlying tuberculosis manish kumar1, tanu satija1 and deepshikha khanna2 1department of pediatrics, chacha nehru bal chikitsalaya, india 2department of dermatology, chacha nehru bal chikitsalaya, india abstract lichen scrofulosorum ls is a rare tuberculid seen in children and young. It is a rarely seen pathology and it presents with a lichenoid rash and a granulomatous. Histopathology of erythema induratum of bazinnodular vasculitistype tb shows typical septolobular panniculitis with necrosis, granulomatous inflammation. Tuberculides, the supposedly immunologic reactions to the products of dead mycobacterium tuberculosis bacilli deposited in the skin from distant foci of tubercular infection, are presently considered to be of two typespapulonecrotic tuberculide and lichen scrofulosorum. Rather, a person senses pruritus in a specific area of skin with or without underlying pathology and causes mechanical trauma to the point of lichenification. In the middle and lower cutis, normallooking elastic fibers are present. Figure 2 histology of lichen scrofulosorum shows the parakeratotic epidermis stretched over a. Lichen amyloidosis is described as lichen simplex chronicus in. Lichen nitidus is a rare benign chronic papular lesion of unknown etiology. Lichen scrofulosorum ls is a rare form of cutaneous tuberculosis tb that affects children and young adults. Histopathology of the papular lesions showed epithelioid granulomas strongly indicating lichen scrofulosorum. Dermatology, oxford lichen sclerosus is a chronic inflammatory skin condition.
Lichen scrofulosorum ls is a manifestation of present or passed systemic tuberculosis. The high prevalence of tb worldwide, its transmissible nature, and the significant morbidity and mortality associated with this infection account for the status of tb as a major public health concern. Unusual presentation of lichen scrofulosorum dandale a, gupta. Ls in any patient should prompt the treating dermatologist to search for evidence of systemic mycobacterial infection. Treatment of ls is the same as that for systemic tuberculosis. Lichen simplex chronicus, abbreviated lsc, a relatively common diagnosis in dermatopathology. Actually, lichen nitidus needs to be distinguished from lichen scrofulosorum. In the oral cavity, it may go by the name benign alveolar ridge keratosis. It was originally regarded as a variant of lichen planus but it is now considered a distinct entity. Feb 15, 2019 lichen simplex chronicus is not a primary process.
Department of histopathology, postgraduate institute of medical education and research pgimer, chandigarh, india. Coexisting scrofuloderma and lichen scrofulosorum has been reported previously only in india 9. Cutaneous tb is a relatively uncommon form of extrapulmonary tb tb infection of other organs and tissues. In some instances the dilutions were low, but as a rule in these cases and in lichen scrofulosorum the reactions were positive in high. Coexistence of papulonecrotic tuberculide with lichen. What is cutaneous tuberculosis cutaneous tuberculosis tb is essentially an invasion of the skin by mycobacterium tuberculosis, the same bacteria that cause tb of the lungs pulmonary tb. Lichen scrofulosorum is a rare tuberculid, characterized by skin coloured to hyperpigmented perifollicular lichenoid eruptions over the trunk, axilla and extremities. Lichen scrofulosorum, otherwise known as tuberculid, is a hypersensitivity reaction to mycobacterium tuberculosis. Lichen scrofulosorum in a child with underlying disseminated tuberculosis. Histopathological findings were consistent with lichen scrofulosorum fig. Full text full text is available as a scanned copy of the original print version. The goals of treatment of lichen sclerosus ls are to relieve bothersome symptoms and to prevent the condition from worsening. Lichen scrofulosorum erythema induratum of bazin cutaneous tuberculosis 193.
The cutaneous form of tuberculosis known as tuberculid is an uncommon disease and is easily misdiagnosed. Lichen scrofulosorum is a rare form of cutaneous tuberculosis. Pdf annular lichen scrofulosorum an unusual presentation of. The lesions are usually asymptomatic, closely grouped, skincolored to reddishbrown papules, often perifollicular and are mainly found on the abdomen, chest, back, and proximal parts of the limbs. Histologie diagnosis was chronic discoid lupus erythematosis, although lichen planus could not be ruled out. Diagnosis of ls mainly lies on histopathology, positive tuberculin skin test and evidence of systemic tuberculosis in the body. Once considered a tuberculoid reaction, lichen nitidus latin nitidus, shiny is currently regarded as a disorder of unknown aetiology. Lichen scrofulosorum definition of lichen scrofulosorum by.
Diagnosis and treatment of lichen planus richard p. Lichen scrofulosorum lesions consist of asymptomatic, skincolored or lichenoid, follicular and parafollicular papules. Early lesions are firm, painless, subcutaneous, redbrown nodules that overlie foci. Accordingly, the presence of a perceptible active or concealed, systemic andor cutaneous focus of tuberculosis is the vital prerequisite for a tuberculid. Lichen planopilaris, also called follicular lichen or follicular lichen planus, was initially described by pringle in 1895. It is usually seen in children or young adults and an important marker of occult tuberculosis. Warty tuberculosis tuberculous verrucosa cutis sites exposed to trauma infected sputum clinically. Where the trigger is known, a lesion is known as a lichenoid lesion. Differential diagnosis of lichen sclerosus pathology. Usually, the eruption appears in children and adolescents with strong immune sensitivity to mycobacterium tuberculosisand consists of tiny follicular papules.
Special stains showed no bacteria, acid fast bacillus or fungus. Letters to the editor ddowns syndrome with lichen owns syndrome with lichen nnitidus and segmental vitiligoitidus and segmental vitiligo sir, downs syndrome trisomy 21 is a multisystem disorder with a birth incidence of approximately 1 in 700 live births, making it the most common autosomal chromosomal disorder causing mental. Photomicrograph of histopathology showing granulomatous. Patients with lichen scrofulosorum have a strongly positive tuberculin reaction.
Although a rare occurrence, this tuberculid is an important marker of occult. The lesions are usually asymptomatic, closely grouped, skincolored to reddishbrown papules, often perifollicular, and are mainly found on the abdomen, chest, back, and proximal parts of the. The authors also found that 20% of cases of malignant transformation involved the gingival mucosa, further reinforcing the importance of histopathology in the final diagnosis of this disease. While there is still much controversy about its relationship with tuberculosis. Lichen scrofulosorum is a rare form of tuberculid seen in children and. There were, however, some pitted scars at the sites of pnt. Lichen scrofulosorum is a tuberculid that is usually seen in children or young adults.
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