[CIS PIDD] Lichen planus

[Paris, Kenneth]

We have a patient with classic Good Syndrome who developed oral/vaginal LP that was recalcitrant to topical steroids.  We've had a decent response with Soriatane, which may be easier to use than thalidomide though maybe less effective (similar risk profile in certain age groups, but doesn't have the stigma or restrictions of thalidomide).  Your patient sounds more severe than our patient, but it may be worth a trial.  
 
Ken
 
Kenneth Paris MD, MPH
Assistant Professor of Pediatrics
A/I Fellowship Training Program Director
Division of Allergy and Immunology
LSU Health Sciences Center
Children's Hospital of New Orleans
 
Mail: 
200 Henry Clay Avenue
Children's Hospital 
Research Institute for Children 4th Floor
New Orleans, LA 70118
Phone:  504-896-9589
Fax:  504-896-9311
Email:  kparis at lsuhsc.edu <mailto:kparis at lsuhsc.edu> 
 
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________________________________

From: pagid-bounces at list.clinimmsoc.org on behalf of Santhosh Kumar/FS/VCU
Sent: Tue 6/26/2012 3:11 PM
To: pagid at list.clinimmsoc.org
Subject: [CIS PIDD] Lichen planus


Hello everyone,
 
Curious to know what the other immunologist around the world think of this case. 
 
Patient is a 64 year old African American lady with hx of lichen planus. It affects her oral cavity and vulvo-vaginal areas. Her vulvo-vaginal area is the worst affected. She has undergone multiple surgeries to keep the orifice open and currently is on Kenalog injection, locally and IM every few months. She came to me seeking as a last resort. I did a basic immune work up and her CBC, Immunoglobulins are within normal limits. Her lymphocyte enumeration is as below:
Absolute lymp- 1.9 10e9/L
CD2 %-           88 % H
CD2 Absolute-  1,672 /mm3
CD3 %-           80 %
CD3 Absolute-  1,520 /mm3
CD4 %-           67 % H
CD4 Absolute-  1,273 /mm3
CD8 %-           11 % L
CD8 Absolute-  209 /mm3
CD4/CD8-        6.1 H
CD19 %-          8 %
CD19 Absolute- 152 /mm3
CD56%-           13 %
CD56 Absolute-  247 /mm3 
 
Essential normal with slightly low percent CD 8 cells and high ratio. We know from studies that there is increased CD8+ T-cells in the lesional skin of lichen planus. Is there any value in pursuing any further work up (immune) for this patient. Any thoughts on treatment options.
 
 
Thank you,
 
Santhosh Kumar, MD
Assistant Professor,
Allergy & Immunology
Virginia Commonwealth University,
Richmond, VA
Ph-  804-628-1605
Fax-804-828-1751

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