ABSTRACT
@#Hypertrophic lichen planus (HLP) is a papulosquamous eruption presenting with extremely pruritic hyperkeratotic flat-topped papules, plaques, and nodules. This is a case of 38-year-old male who presented with a 2-month history of generalized erythematous-to-hyperpigmented papules, patches, and plaques topped with white-to-gray oyster shell-like scales on a background of hyperpigmented macules and patches. There was no involvement of the conjunctival, otic, oral, and genital mucosae, and palmar and plantar aspects of the hands and feet. Dermoscopy showed reticular pearly white structures corresponding to the Wickham striae, comedo-like openings, blue-gray dots, brownish-black dots, and scales. Histopathologic examination revealed marked compact hyperkeratosis, wedge-shaped hypergranulosis, irregular saw-toothed epidermal acanthosis, scattered dyskeratotic keratinocytes, and superficial perivascular lichenoid infiltrate of lymphocytes, histiocytes, and melanophages. The patient was managed as a case of HLP. He was started on methotrexate 10 mg per week, bath psoralen photochemotherapy (PUVA) three times a week, betamethasone valerate 1mg/g cream twice a day for 2 weeks alternating with tacrolimus 0.1% ointment twice a day for another 2 weeks, 10% lactic acid, emollients, and sunscreen. After 6 months of treatment, there was almost 80% improvement of lesions and relief of pruritus.
Subject(s)
MethotrexateABSTRACT
El liquen plano hipertrófico generalizado es una enfermedad inflamatoria autolimitada, subaguda o crónica, de origen desconocido, que afecta la piel, las mucosas y los anexos. Clínicamente se caracteriza por pápulaspoligonales, pruriginosas, violáceas o grisáceas, que confluyen formando placas con superficie hiperqueratósica de aspecto verrugoso. Es extremadamente raro en niños y su incidencia mundial es menor al 1%. Comunicamos el caso clínico de un paciente en edad pediátrica con liquen plano hipertrófico generalizado, cuyo interés radica en la peculiar edad de aparición.
Generalized hypertrophic lichen planus is a self-limited subacute or chronic inflammatory disease of unknown etiology that affects the skin, mucous membranes and skin appendages. It is characterized by pruritic, polygonal, purple or grayish papules that converge to form hyperkeratotic plaques with a warty surface. It is extremely rare in children, with a global incidence less than 1%.We report the case of a pediatric patient with generalized hypertrophic lichen planus, the interest of the case lies in reporting the particular age of onset.
Subject(s)
Humans , Male , Child , Hand Dermatoses , Skin Diseases, Eczematous , Lichen Planus , Skin Diseases , Lower Extremity , HandABSTRACT
Lichen planus is a chronic papulosquamous disease that affects the skin and mucous membranes. It is characterized by pruritic violaceous papules that are most commonly seen on the extremities of middle aged adults, but the elderly are rarely affected. Hypertrophic lichen planus usually occurs on the extremities and especially on the shins, and it tends to be the most pruritic variant. An 82-year-old female presented with severe pruritic multiple papules and plaques on the both the upper and lower extremities for 1 year. At first, the lesions began as small, polygonal papules that formed verrucous plaques over several months. Histopathologic examination showed marked hyperkeratosis, irregular acanthosis and wedge-shaped hypergranulosis. The vacuolar alteration and the lymphocytic inflammatory infiltrate were accentuated at the base of the rete ridge. From these findings, we diagnosed these lesions as hypertrophic lichen planus. The lesions were treated with topical steroid and intralesional injection of steroid, and they were slightly improved after 2 months of therapy.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Middle Aged , Extremities , Injections, Intralesional , Lichen Planus , Lichens , Lower Extremity , Mucous Membrane , SkinABSTRACT
Hypertrophic lichen planus is the most pruritic variant of lichen planus, which is characterized by verrucous plaques with variable amounts of scales on the lower extremities, especially the shins. Annular atrophic lichen planus is the most unusual variant of lichen planus, resulting from the combination of both annular and atrophic features in the same lesions. The active border of the lesion shows the typical histopathologic findings of lichen planus, whereas its atrophic center exhibits histopathologic features of regression. A 29-year-old man presented with intermittently pruritic, multiple plaques and papules on the right thigh for 3 months. At first, small, polygonal papules and verrucous plaques developed above the right knee. In a short time, atrophic and hyperpigmented macules with raised and annular borders appeared along the line of Blascho. Histopathologic examination of verrucous plaque and annular atrophic macule revealed hypertrophic and annular atrophic lichen planus, respectively. We, herein, report an unusual case of annular atrophic lichen planus associated with hypertrophic lichen planus along the line of Blascho.
Subject(s)
Adult , Humans , Knee , Lichen Planus , Lichens , Lower Extremity , Thigh , Weights and MeasuresABSTRACT
Hypertrophic lichen planus is rare chronic variant of this disease, usually occurs on the lower extremities especially the shins, and associated with severe itching sensation. We report a case of localized hypertrophic lichen planus with bilateral hyperkeratotic polygonal violaceous papuloplaques on both upper eyelids and dorsa of hands and lace-like patches in oral mucosa. The patient had been treated with triamcinolone acetonide intralesional injection at two week intervals, two times and topical steroid after then the lesion had significantly improved.