Event Title
Location
Philadelphia, PA
Start Date
3-5-2023 1:00 PM
End Date
3-5-2023 4:00 PM
Description
Introduction
Lichen Planus is a chronic inflammatory condition that affects various body regions. Some of the subtypes of lichen planus include hypertrophic, actinic, annular, atrophic, linear, and follicular. Annular atrophic lichen planus (AALP) is a chronic subtype of lichen planus that classically does not respond to treatment with topical steroids. A dermal lymphocytic infiltrate along with a loss of elastin fibers plays a role in the diagnosis of AALP, but the exact pathogenesis remains unclear.
Case Report
We present the case of a 54-year-old African American female who developed annular, pruritic lesions after receiving multiple vaccines. The lesions began after receiving the shingles vaccine, and then worsened after receiving the COVID vaccine two months later. After one year of failed treatment for suspected lichen planus, repeat biopsy with Verhoeff-Van Gieson (VVG) elastin stain confirmed a diagnosis of AALP. We review potential triggers and associated conditions of AALP that have been reported in the literature.
Discussion
AALP is a rare form of lichen planus with less than 30 cases reported in the literature. Pathophysiology is unclear but there is a clear loss of elastin as a result of superficial dermal inflammation. Many of the cases reviewed in this study were associated with an underlying inflammatory or autoimmune disorder; however, there were numerous instances where AALP developed idiopathically. Furthermore, there were cases of lichen planus after vaccination, but none reported this particular rare variant. The physical exam is notable for annular scaly plaques with atrophic hyper or hypopigmented centers, often resolving with scarring. The clinical differential diagnosis includes other forms of lichen planus, granuloma annulare, and lichenoid drug eruption. Diagnosis is confirmed with VVG elastin staining and treatment often shifts from conservative topical steroids to other systemic agents such as hydroxychloroquine or acitretin. However, no consistent treatment plan has worked to treat this condition.
Conclusion
We present a rare case of AALP believed to be induced by multiple vaccines. To the best of our knowledge, this is the first reported case of AALP following any form of vaccination. Our review of the literature reveals that these unique histopathologic features may result in variable treatment response. In general, topical treatment alone is usually not sufficient. In light of lichenoid dermatitis following shingles and/or COVID vaccination, dermatologists should consider AALP as a potential treatment resistant subtype.
Embargo Period
6-6-2024
Vaccine induced annular atrophic lichen planus
Philadelphia, PA
Introduction
Lichen Planus is a chronic inflammatory condition that affects various body regions. Some of the subtypes of lichen planus include hypertrophic, actinic, annular, atrophic, linear, and follicular. Annular atrophic lichen planus (AALP) is a chronic subtype of lichen planus that classically does not respond to treatment with topical steroids. A dermal lymphocytic infiltrate along with a loss of elastin fibers plays a role in the diagnosis of AALP, but the exact pathogenesis remains unclear.
Case Report
We present the case of a 54-year-old African American female who developed annular, pruritic lesions after receiving multiple vaccines. The lesions began after receiving the shingles vaccine, and then worsened after receiving the COVID vaccine two months later. After one year of failed treatment for suspected lichen planus, repeat biopsy with Verhoeff-Van Gieson (VVG) elastin stain confirmed a diagnosis of AALP. We review potential triggers and associated conditions of AALP that have been reported in the literature.
Discussion
AALP is a rare form of lichen planus with less than 30 cases reported in the literature. Pathophysiology is unclear but there is a clear loss of elastin as a result of superficial dermal inflammation. Many of the cases reviewed in this study were associated with an underlying inflammatory or autoimmune disorder; however, there were numerous instances where AALP developed idiopathically. Furthermore, there were cases of lichen planus after vaccination, but none reported this particular rare variant. The physical exam is notable for annular scaly plaques with atrophic hyper or hypopigmented centers, often resolving with scarring. The clinical differential diagnosis includes other forms of lichen planus, granuloma annulare, and lichenoid drug eruption. Diagnosis is confirmed with VVG elastin staining and treatment often shifts from conservative topical steroids to other systemic agents such as hydroxychloroquine or acitretin. However, no consistent treatment plan has worked to treat this condition.
Conclusion
We present a rare case of AALP believed to be induced by multiple vaccines. To the best of our knowledge, this is the first reported case of AALP following any form of vaccination. Our review of the literature reveals that these unique histopathologic features may result in variable treatment response. In general, topical treatment alone is usually not sufficient. In light of lichenoid dermatitis following shingles and/or COVID vaccination, dermatologists should consider AALP as a potential treatment resistant subtype.
Comments
Winner of PCOM Philadelphia Research Day Division of Research Award for Exceptional Case Reports.