LE and lichen planus (LP) possess different clinical and histologic pictures and immunologic findings. Copeman et al. (Copeman et al. 1970) reported first in 1970
the coexistence of both diseases in four patients. Additionally, several cases of the coexistence of both diseases have been reported (Baumann 1997, Camisa et al. 1984, Davies et al. 1977, Dimitrova et al. 1982, Piamphongsant et al. 1978, Plotnick and Burnham 1986, Razzaque et al. 1982, Romero et al. 1977). Most of the reported cases are patients with DLE and coexistent LP. In 1982, our group (Dimitrova et al. 1982) described a 55-year-old woman whose disease began with scarring alopecia. Two years later, discoid lesions appeared on her face. One year later, itching papules appeared on her back and wrists. The histologic and immunologic findings were compatible with both diseases. The case reported by Razzaque et al. (Razzaque et al. 1982) had LP associated with SLE. The diagnosis was based on the criteria of the American Rheumatism Association for SLE and on findings from histologic and immunofluorescence studies suggestive of LP. LE discoides and LP verrucosus in the same patient has also been reported (Baumann 1997), and this association is of great clinical importance since categorizing the verrucous forms of both diseases is sometimes very difficult (Uitto et al. 1978). From the reported cases with the association of both diseases it could not be justified which of the diseases is usually preceding. In some reported cases, the clinical, histologic, and immunofluorescence features showed an overlap pattern between LE and LP, as it was in the 11 patients described by Romero et al. On the other hand, Davies et al. (Davies et al. 1977) in 1977, drew attention to the fact that despite the distinctive characteristic of both diseases, they share some common features. Both may show scarring alopecia and development of lesions at the site of trauma (Koebner's phenomenon), may cause atrophy or hypertrophy, and may exhibit photosensitivity. Immunoglobulins, fibrin, and complement are found in LP papules, and colloid bodies are detected in both diseases. In summary, Davies et al. suspected a common pathophysiologic pathway because of the similarities between LE and LP. Some authors use the term "LE-LP overlap syndrome" for cases in which differentiation between the diseases is impossible. In such cases, Camisa et al. (Camisa et al. 1984) in 1984, recommended using the modern immunologic studies as a possible way to distinguish LE from LP in patients with the overlap syndrome. From six patients they described, intensive staining of stratum granulosum was found. The latter is consistent with LP. A third patient developed criteria for the diagnosis of SLE. This overlap syndrome is characterized by chronic livid atrophic patches and plaques, mostly on the extremities. Lichenoid flat papules are generally not observed, and telangiectasias are prominent. In the overlap syndrome, the palms, soles, and nails are involved. Histologically, either a hypocellular (LE) or a hypercellular (LP) type is seen (Shai and Halevy 1992). The immunofluorescence demonstrates ovoid or globular deposits of IgG, IgM, and C3 at the dermoepidermal junction. In addition, lichen actinicus, a distinctive variant of LP, is another point of relation of both diseases. Besides the typical LP papules and photosensitivity, a malar rash resembling LE can be also seen (Isaacson et al. 1981, Pramatarov et al. 1988).
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Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.