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\begin{document}

\title{Actinic lichen planus with lip involvement: an unusual presentation}



\author[1]{Linda Manaa}%
\author[1]{Mouna Korbi}%
\author[1]{Taysir  Medini }%
\author[1]{Leila Njim}%
\author[1]{Hichem Belhadjali}%
\author[1]{Jameleddine Zili}%
\affil[1]{Fattouma Bourguiba University Hospital of Monastir}%


\vspace{-1em}



  
  \date{May 26, 2024}


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\selectlanguage{english}
\begin{abstract}
Oral lichen planus is a common manifestation in patients with lichen
planus (LP). It can affect all regions of the oral mucosa. However, lip
involvement is rarely described, especially in patients with actinic LP.
We report a case of actinic LP associated with a pigmentation of the
lower lip.%
\end{abstract}%



\sloppy


\textbf{Title page}

\textbf{Type of the article:} Clinical image

\textbf{Title} : Actinic lichen planus with lip involvement: an unusual
presentation

\textbf{Authors names:} Manaa L\textsuperscript{1}, Korbi
M\textsuperscript{1*}, Medini T\textsuperscript{2}, Njim
L\textsuperscript{3}, Belhadjali H\textsuperscript{1*}, Zili
J\textsuperscript{1*}

\textbf{Affiliations:} \textsuperscript{1} Dermatology Department,
Fattouma Bourguiba University Hospital, University of Monastir, TUNISIA

\textsuperscript{2} Stomatology Department, Fattouma Bourguiba
University Hospital, University of Monastir, TUNISIA

\textsuperscript{3} Anatomopathology Department, Fattouma Bourguiba
University Hospital, University of Monastir, TUNISIA

\textsuperscript{\textbf{*}} Research Laboratory LR20SP03, University of
Monastir

\textbf{Corresponding author:} Manaa Linda; MD,

Address: Dermatology Department, Fattouma Bourguiba University Hospital,
University of Monastir, 5000 Monastir, TUNIISIA

\textbf{Email address:}\emph{lindamanaa6@gmail.com}; Telephone number:
0021629423218

\textbf{Manuscript count:} 211

\textbf{Figures:} 03, 0 Table

\textbf{Funding} : None, The authors have received no funding from any
agency in the public, private, or not-for-profit sectors.

\textbf{Conflict of interest:} The authors declare that there are no
conflicts of interest in this work.

\subsection*{Acknowledgements:}

{\label{acknowledgements}}

The patient in this manuscript has given written informed consent to the
publication of the case details.

\textbf{Abstract:}

Oral lichen planus is a common manifestation in patients with lichen
planus (LP). It can affect all regions of the oral mucosa. However, lip
involvement is rarely described, especially in patients with actinic LP.
We report a case of actinic LP associated with a pigmentation of the
lower lip.

\textbf{Case presentation:}

A 75-year-old man, with a skin phototype IV, presented with itchy
lesions on the face and the neck, evolving for 1 month. Dermatological
examination revealed multiple purplish-brown annular lesions on
forearms, neck, scalp and face \textbf{(Figure 1)} with involvement of
the lower lip \textbf{(Figure 2)} . Histological examination of biopsy
specimen from the forearm and the lower lip showed the same aspect
characterized by interface dermatitis with band lymphocytic infiltrate
and dermal elastosis \textbf{(Figure 3)} . The clinical presentation,
the predilection of the lesions to the photo-exposed zones and the
histopathological findings were compatible with the diagnosis of actinic
LP.

Actinic LP is a rare variant of LP occurring on photo exposed areas in
dark phototype patients. It mainly affects children and young
adults.\textsuperscript{1} Several forms have been described: the
annular form as in our case, the dyschromic and the melasma-like form.
Unlike LP, mucosal involvement during actinic LP is usually absent and
lip involvement is exceptionally reported.\textsuperscript{1,2}

The involvement of the lower lip in our case is explained by an
increased exposure to ultraviolet which is considered an important
factor in the etiopathogenesis of actinic LP.

The treatment of actinic LP is based on photoprotection and topical
corticosteroids. Other treatments have been proposed with variable
results: hydroxycloroquine, acitretin, general corticosteroids and
cyclosporine.\textsuperscript{2}

\textbf{Authorship:} All authors had access to the data and a role in
writing this manuscript.

\textbf{Author contributions:}

The authors fulfill the ICMJE Criteria for Authorship and contributed
equally.

Dr Linda Manaa, is the guarantor of the content of the manuscript,
included the data and analysis. Dr Mouna Korbi contributed to
interpretation of data and revision of the manuscript. Dr Taysir Medini
contributed to data collection. Dr Leila Njim contributed to analysis
and interpretation of data, revised it critically. Dr Zili Jamaleddine
and Hichem Belhadjali contributed to final approval of the version of
the manuscript to be submitted.

\subsection*{Consent:}

{\label{consent}}

The patient in this manuscript has given written informed consent to the
publication of the case details.

\textbf{References:}

1. Choi E, Tan KB, Chandran NS. Isolated Actinic Lichen Planus of the
Lower Lip. Case Rep Dermatol. 2017;9(1):131-4.

2. Nuzzolo P, Celentano A, Bucci P, Adamo D, Ruoppo E, Leuci S, et al.
Lichen planus of the lips: an intermediate disease between the skin and
mucosa? Retrospective clinical study and review of the literature. Int J
Dermatol. 2016;55(9):e473-81.

\textbf{Figures:}

Figure 1: Multiple purplish-brown annular lesions on the face and scalp

Figure 2: Involvement of the lower lip

Figure 3: Lichenoid lymphocytic infiltrate with interface vacuolar
change (Hematoxylin-eosin \selectlanguage{ngerman}× 400)\selectlanguage{english}
\begin{figure}[H]
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\includegraphics[width=0.70\columnwidth]{figures/Figure-1/Figure-1}

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\end{figure}\selectlanguage{english}
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\includegraphics[width=0.70\columnwidth]{figures/figure-2/figure-2}

\end{center}
\end{figure}\selectlanguage{english}
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\includegraphics[width=0.70\columnwidth]{figures/figure-3/figure-3}

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