Comparative immunological and histopathological study in fifty cases of mucosal/nonmucosal lichen planus
R R Mittal
Dept. of Skin & VD, Rajinder Hospitals, Patiala - 147 001
|How to cite this article:
Mittal R R, Walia R L, Sharma P, Singla A. Comparative immunological and histopathological study in fifty cases of mucosal/nonmucosal lichen planus. Indian J Dermatol Venereol Leprol 2003;69:140-141
AbstractLichen planus is a common disorder and 40-50% of LP patients also reveal mucosal lesions. It is well known that mucosal LP lesions take very long to heal in comparison to cutaneous lesions. Rarely erosive mucosal LP can turn malignant. Both CMI and humoral immunity may play role in aetiopathogenesis of LP.
Present study was conducted to study and compare CMI, Humorol Immunity, histopothology in mucosal and nonmucosal LP.
Lichen planus occurs in 0.9-1.2% of general population and in 40-50% cases both oral and cutaneous lesions are present,′ but oral lesions can be the only manifestation in 15-20%. Probably lichen planus represents a reflection of cell mediated immune response as mononuclear cell infilterate (mainly T Lympocytes) and increased number of Langerhans cells are present in both epidermis and dermis. Humoral immunity could also have possible role in aetiopathogenesis of LP.
HistopathologicaIly, LP shows characteristically hyperorthokeratosis, wedge shaped hypergranulosis, acanthosis, basal cell liquefaction degeneration, saw toothed rete ridges and band like lymphocytic infilterate.
Materials and Methods
A total of fifty cases clinically diagnosed as lichen planus were taken from outpatients department of DermatoVenereology, Ralindra Hospital, Patiala. Detailed clinical history, complete general physical and systemic examinations were done. Peripheral T-lymphocyte counts, serum immunoglobulins (IgG, IgM, IgA) estimation and histopathology (H&E) were done in all the cases.
Statistical analysis and evaluation of differences in cellular immunity (peripheral T-lymphocyte counts), humoral immunity in mucosal/ nonmucosal LP cases.
As shown in [table-I], 39 out of 50 cases had only cutaneous lesions and 11 had mucosal along with cutaneous lesions. LP vulgaris was commonest type (37) and 10 of them had mucosal lesions.
Mucosal lesions were seen as white lacy reticular pattern and descrete yellow papules on inner side of cheeks and lips. All lesions were nonerosive.
[Table-II] reveals statistically highly significant decrease in peripheral T-cell counts in patients with mucosal involvement.
As shown in [table-III], there was a statistical significant decrease in levels of IgG, immunoglobulins while statistically nonsignificant change in levels of IgM and IgA immunoglobulins in patients with mucosal LP
As shown in [table-IV], significant differences in histopathology of mucosal LP were parakeratosis, absence of granular layer, prominent koilocytes, absence of saw toothed rete ridges and lesser number of mononuclear cell in lichenoid infilterate.
The investigations in present study showed statistically highly significant decrease peripheral T -cell counts, in mucosal LP suggesting decreased cellular immunity in them versus cutaneous LP Also levels of IgG immunoglobulins were statistically significantly decreased suggesting more suppression of humoral immunity in mucosal LP.
On histopathology, parakeratosis, absence of stratum granulosum, prominence of koilocytes, absence of saw toothed rete ridges and lesser lichenoid infilteratewere prominent features in mucosal LP versus cutaneous LP.
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