PMC5913418_01
White plaque on the skin and the vermilion border of the left upper lip (x1/2).
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Clinical examination revealed asymptomatic white patches with irregular borders on the skin, the vermillion border and the mucosa of the left upper lip (Figure 1).
Intermingled white patches and erythematous areas on the mucosa of the upper lip (x1/2).
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In addition, erythematous areas were observed intermingled with the white lesions on the left labial mucosa (Figure 2).
A = histopathologic examination revealed epithelial atrophy, loss of rete pegs, hyalinization of the lamina propria and deep lymphohistiocytic inflammation (hematoxylin and eosin stain, original magnification x100).
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B = hyalinization and loss of cellularity of the subepithelial lamina propria (hematoxylin and eosin stain, original magnification x200).
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C = hyalinization and loss of cellularity of the subepithelial lamina propria (hematoxylin and eosin stain, original magnification x200).
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D = histochemical Shikata's modified orcein stain revealed loss of elastin fibres in the hyalinized subepithelial area (original magnification x100).
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E = normal deep connective tissue, stained with Shikata's modified orcein stain, showing plenty of brown-coloured elastin fibres in a perivascular orientation (original magnification x100).
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Underneath the acellular zone, a moderate band-like lympohistiocytic inflammatory infiltrate was noticed (Figures 3A - C). Tissue sections of same thickness were further evaluated histochemically with Shikata's modified orcein stain (treated with acidified potassium permanganate, decolourized with 1% oxalic acid, and finally stained with Shikata orcein), which revealed distinctive scarcity or loss of elastin fibres in the hyalinized papillary lamina propria (Figure 3D).
Resolution of the white plaque on the skin and vermillion border after treatment (x1/2).
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Follow-up examination after 2 weeks revealed significant improvement of the lesions (Figures 4 and 5).
Intermingled white patches and erythematous areas on the mucosa of the upper lip (x1/2).
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Follow-up examination after 2 weeks revealed significant improvement of the lesions (Figures 4 and 5).