Is this case of multiple skin loss and mucosa affected by the patient, is white plug disease?

Clinical case sharing: special skin and mucosal lesions.according to the cases submitted by excellent dermatology colleagues.this is about a 24-year-old woman who was misdiagnosed for multiple skin and mucous membrane involvement. No obvious curative effect was found after treatment. Finally, the diagnosis was confirmed by clinical and pathological connection.this case is of great reference value to our clinicians, because the skin lesions lack sufficient diagnostic specificity, and even easily mislead doctors to diagnose common diseases such as psoriasis, tinea corporis, lichen planus and eczema.in this paper, two sections of "case introduction" and "case study" are used to elaborate the disease and learn together.case history: female, 24 years old. The disease course was 20 months. Br / > the therapeutic effect of buprofezine and buprofezine was lower than that of buprofezine.the past physical fitness, family history is not special.physical examination: multiple pink papules on the face, trunk, flexion side of upper arm, wrist and popliteal fossa, 1 ~ 3mm, with small scales on the surface, partially fused into line and mesh (Fig. 1).multiple superficial ulcers in the upper and lower lip mucosa, buccal mucosa, tongue and left labia magna, with a diameter of 3-10 mm (Fig. 2).the eyelids of both eyes were slightly edematous, the lower eyelid margin was scabby, and the conjunctiva of upper and lower eyelids were congested with dense papillary changes (Fig. 3).the bulbar conjunctiva was not involved, the cornea was clear, and there was no sign of active or old intraocular inflammation.scalp, palm, sole of foot and nail were not affected. (source: doi: 10.1016 / j.jdcr. 2017.02.009) Fig. 2. Superficial erosion / ulcer of lower lip mucosa (source: doi: 10.1016 / j.jdcr. 2017.02.009) Fig. 3 Eyelid conjunctivitis, yellow scab on palpebral margin (source: doi: 10.1016/j.jdcr. 2017.02.009) laboratory examination: antinuclear antibody, anti ro antibody, anti La antibody, anti dsDNA antibody, anti Smith antibody, rheumatoid factor, anti neutrophil cytoplasmic antibody and rapid plasma reagin were normal.ESR and CRP were not increased.histopathological examination: mild interfacial dermatitis, keratosis imperfecta, necrosis of keratinocytes, infiltration of lymphocytes around blood vessels, focal epidermal atrophy and hair follicle plug, no significant mucin deposition (Fig. 4).oral mucosal biopsy also showed lymphocytic interfacial dermatitis.there was no abnormality in direct immunofluorescence and indirect immunofluorescence. (source: doi: 10.1016/j.jdcr. 2017.02.009) diagnosis: combined with the morphology and distribution of skin mucosal lesions, laboratory examination and pathological examination, the final diagnosis was chronic lichenoides (keratosis lichenoides) chronica，KLC）。treatment: Isotretinoin 40mg / D, skin rash was significantly improved, but oral ulcer and eyelid conjunctivitis were not improved. so we adjusted the treatment plan, increased methotrexate 5mg / W, improved oral and ocular lesions, and rapidly reduced and stopped using azathioprine, colchicine, infliximab and methylprednisolone. the patients were followed up for 9 months. case study in 1895, Kaposi described a case of linear, verrucous lichen like rash, and named lichen ruber acuminatus verrucosus et reticularis. since then, many similar cases have appeared in succession, but the nomenclature is confusing. nowadays, chronic bryoid keratosis is usually used to diagnose the disease. this disease is rare, and its epidemiology and pathogenesis are not clear. the basic clinical features are linear and reticular purplish red keratotic mossy papules, which are often symmetrically distributed in the limbs and trunk. another significant feature is a greasy, scaly rash on the upper face, similar to seborrheic dermatitis or psoriasis in the middle of the face. mucosa can be involved, including oral ulcer, genital ulcer and eye (including blepharitis, conjunctivitis, uveitis and iridocyclitis). palmoplantar, nail and scalp can also be involved. chronic lichenoid keratosis is usually asymptomatic, but can also itch. the course of disease is often chronic and progressive, and it is also reported that the disease subsides naturally in summer or with age. Figure 5. Chronic lichenoid keratosis (source: Bolognia, dermatology, 4th Edition) Figure 6. Chronic lichenoid keratosis (source: Bolognia, dermatology, 4th Edition) Figure 7. Chronic lichenoid keratosis (source: doi: 10.1016 / j.jdcr. 2017.11.015) there is no unified diagnostic standard for this disease. the histopathological features were lichen like interface dermatitis, with lymphocyte infiltration around blood vessels and appendages, sometimes accompanied by a small number of plasma cells. the changes of epidermis include atrophy and alternation of spinous layer thickening, focal keratosis imperfecta and hair follicle angle plug. Immunofluorescence is often negative. these histological features are helpful to distinguish chronic lichenoid keratosis from lichen planus, the latter often has no hyperkeratosis and the granular layer is wedge-shaped thickening. however, some researchers believe that chronic lichenoid keratosis is a variant of lichen planus, which is still controversial. when mucous membrane is involved, the disease should be differentiated from Behcet's disease. The rash of Behcet's disease is mainly folliculitis like rash and erythema nodosum, and the ocular lesions are mainly pigmented membrane. The typical papule pustular lesions are mainly neutrophil infiltration. direct immunofluorescence negative, lack of significant mucin deposition and negative autoantibodies can be used to differentiate cutaneous lupus erythematosus. most of the treatments were symptomatic, including local and systemic use of glucocorticoids, methotrexate, cyclosporin, acitretin, oral vitamin A and PUVA. there is often no satisfactory curative effect. a recent study on chronic lichenoid keratosis has shown that retinoids and phototherapy alone or in combination are effective. in this case, azathioprine, colchicine, infliximab and methylprednisolone were not effective at first, but isotretinoin combined with methotrexate was used successfully. however, it is necessary to closely monitor the serological indicators and be alert to adverse drug reactions. conclusion chronic bryoid keratosis is a rare skin and mucosal disease. the clinical features are marked linear and reticular keratotic papules on the trunk and limbs, sometimes involving oral, genital and ocular mucosa. the disease is resistant to a variety of therapies, and the treatment is challenging. References: 1. Alvin w Li, William damsky, Brett a king. Keratosis lichenoides chronica successfully treated with isotretinoin and methotrexate [J]. Jaad case Rep. 2017; 3:205-207.2. Pistoni F, Peroni a, colato C, schena D, Girolomoni G. Keratosis lichenoides chronica: case-based review of treatment options[J]. J Dermatolog Treat. 2016;27:383-388.3.Taberner R, Puig L, Fernandez-Figueras T, Alomar A. Keratosis lichenoides chronica[J]. J Eur Acad Dermatol Venereol. 2001; 15:84-85.4.Boer A. Keratosis lichenoides chronica: proposal of a concept[J]. Am J Dermatopathol. 2006; Novel coronavirus pneumonia. 28:260-275.5. Zhu Xuejun et al. Dermatology, Fourth Edition [M]. Beijing: Peking University medical press.2019. source: skin channel of medical profession: Hello PI review: Tang Qing commissioning editor: Feng He "tell your story", new crown pneumonia, new crowned disease, medical care and then on the battlefield; one side is difficult, the whole nation is supporting! Welcome front-line doctors, nurses, hospital directors, officials, patients, etc. people with stories contact Xiaobian to tell their own stories. Please add wechat: 15811355643, how strong is the infectious power of the virus, which affects everyone's heart. click the original text to view the updated information of the epidemic situation