Navigating through the complexities of bullous presentation of cutaneous lichen planus: A comparative study

Introduction: Bullous spectrum of cutaneous lichen planus has two distinct forms lichen planus pemphigoids (LPPs) and bullous lichen planus (BLP). There is paucity of literature on the clinical, histopathological, and immunological profile of this rare presentation. We aim to describe the clinical,...

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Main Authors: Pragya Jain, Priya Yadav, Sonali Dixit, Chander Grover, Sonal Sharma
Format: Article
Language:English
Published: Wolters Kluwer Medknow Publications 2025-04-01
Series:Indian Journal of Pathology and Microbiology
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Online Access:https://journals.lww.com/10.4103/ijpm.ijpm_320_24
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author Pragya Jain
Priya Yadav
Sonali Dixit
Chander Grover
Sonal Sharma
author_facet Pragya Jain
Priya Yadav
Sonali Dixit
Chander Grover
Sonal Sharma
author_sort Pragya Jain
collection DOAJ
description Introduction: Bullous spectrum of cutaneous lichen planus has two distinct forms lichen planus pemphigoids (LPPs) and bullous lichen planus (BLP). There is paucity of literature on the clinical, histopathological, and immunological profile of this rare presentation. We aim to describe the clinical, histological, and immunological features of this distinct form further proposing an algorithmic approach for diagnosis. Methodology: We conducted a retrospective observational study and reviewed cases of LPP and BLP which were diagnosed in the last 10 years (2011–21). Relevant information (clinical presentation, histology, immunofluorescence finding) was noted on pre-structured proforma and was analyzed. Results: Out of 1960 biopsies of cutaneous lichen planus, only 21 cases had clinical suspected bullous presentation while immunofluorescence was received for only 16 cases. BLP was seen in the younger age group in comparison with LPPs (25.7 years vs 36.8 years). Bulla was seen in all cases. Dermo-epidermal junctional split was seen in all cases of BLP and LPP. On direct immunofluorescence (DIF) all the cases of LPP either had 1-2+ IgG and/or C3 while cases of BLP were not immunoreactive or had only colloid bodies. Conclusion: This study describes in detail the clinicopathological profile of BLP and LPP and reiterates the importance of DIF during workup to arrive at a definitive diagnosis.
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spelling doaj-art-ecce1cafa7ce46b99e6e0a9fa53aa2e32025-08-20T02:58:07ZengWolters Kluwer Medknow PublicationsIndian Journal of Pathology and Microbiology0377-49290974-51302025-04-0168233333710.4103/ijpm.ijpm_320_24Navigating through the complexities of bullous presentation of cutaneous lichen planus: A comparative studyPragya JainPriya YadavSonali DixitChander GroverSonal SharmaIntroduction: Bullous spectrum of cutaneous lichen planus has two distinct forms lichen planus pemphigoids (LPPs) and bullous lichen planus (BLP). There is paucity of literature on the clinical, histopathological, and immunological profile of this rare presentation. We aim to describe the clinical, histological, and immunological features of this distinct form further proposing an algorithmic approach for diagnosis. Methodology: We conducted a retrospective observational study and reviewed cases of LPP and BLP which were diagnosed in the last 10 years (2011–21). Relevant information (clinical presentation, histology, immunofluorescence finding) was noted on pre-structured proforma and was analyzed. Results: Out of 1960 biopsies of cutaneous lichen planus, only 21 cases had clinical suspected bullous presentation while immunofluorescence was received for only 16 cases. BLP was seen in the younger age group in comparison with LPPs (25.7 years vs 36.8 years). Bulla was seen in all cases. Dermo-epidermal junctional split was seen in all cases of BLP and LPP. On direct immunofluorescence (DIF) all the cases of LPP either had 1-2+ IgG and/or C3 while cases of BLP were not immunoreactive or had only colloid bodies. Conclusion: This study describes in detail the clinicopathological profile of BLP and LPP and reiterates the importance of DIF during workup to arrive at a definitive diagnosis.https://journals.lww.com/10.4103/ijpm.ijpm_320_24activity indexbullous lichen planuschronicity indexlichen planuslichen planus pemphigoid
spellingShingle Pragya Jain
Priya Yadav
Sonali Dixit
Chander Grover
Sonal Sharma
Navigating through the complexities of bullous presentation of cutaneous lichen planus: A comparative study
Indian Journal of Pathology and Microbiology
activity index
bullous lichen planus
chronicity index
lichen planus
lichen planus pemphigoid
title Navigating through the complexities of bullous presentation of cutaneous lichen planus: A comparative study
title_full Navigating through the complexities of bullous presentation of cutaneous lichen planus: A comparative study
title_fullStr Navigating through the complexities of bullous presentation of cutaneous lichen planus: A comparative study
title_full_unstemmed Navigating through the complexities of bullous presentation of cutaneous lichen planus: A comparative study
title_short Navigating through the complexities of bullous presentation of cutaneous lichen planus: A comparative study
title_sort navigating through the complexities of bullous presentation of cutaneous lichen planus a comparative study
topic activity index
bullous lichen planus
chronicity index
lichen planus
lichen planus pemphigoid
url https://journals.lww.com/10.4103/ijpm.ijpm_320_24
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AT sonalidixit navigatingthroughthecomplexitiesofbullouspresentationofcutaneouslichenplanusacomparativestudy
AT chandergrover navigatingthroughthecomplexitiesofbullouspresentationofcutaneouslichenplanusacomparativestudy
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