A case of erosive lichen planus with plantar involvement

Headnote

Abstract

Lichen planus (LP) affects 0.2-1% of adult population and the etiology is not fully known. Erosive lichen planus (ELP) is a rare form of LP LP characterized by painful erosive plaques involving the oral mucosa and palmoplantar and genital areas, is quite resistant to treatment. Palmoplantar involvement of ELP is very uncommon. Herein, we present an ELP patient with both plantar and dorsal feet involvement in whom the diagnosis of ELP was not established for 7 years. The patient was started on 3 mg/kg/day cyclosporin-A treatment and regression of the lesions was observed during follow-up. Plantar ELP is a condition which needs years of patient monitoring due to treatment resistance, scar tissue formation, recurrence, association of comorbid pathologies, and malignant transformation potential.

Keywords: Erosive lichen planus, palmoplantar, cyclosporin-A

Öz

Liken planus (LP) yetişkin popülasyonda %0,2-1 oranında görülür ve etiyolojisi tam olarak bilinmemektedir. Eroziv liken planus (ELP), LP'nin nadir gözlenen bir formu olup oral mukoza, palmoplantar bölge ve genital bölgede yerleşen ağrılı erode plaklar ile karakterize bir tablodur ve tedaviye oldukça dirençlidir. ELP'de palmoplantar tutulum oldukça nadir görülür. Bu olgu sunumunda yaklaşık yedi yıldır tanı alamamış, dorsal yüzeylerin de tutulduğu her iki plantar yüze yerleşen bir ELP olgusu sunulmuştur. Hastaya 3 mg/kg/gün siklosporin-A tedavisi başlanmış ve takipleri sırasında lezyonların gerilediği saptanmıştır. Plantar ELP tedaviye dirençli olması, skar bırakabilme özelliği, rekürrens gösterebilmesi, komorbid patolojilerle birlikteliği ve prekanseröz özellik göstermesi sebebiyle uzun yıllar takibi gerekli olan bir tablo olması nedeniyle önemlidir.

Anahtar Kelimeler: Eroziv liken planus, palmoplantar, siklosporin-A

Introduction

Lichen planus (LP) is a benign, itchy, chronic inflammatory dermatosis affecting the skin, mucosa, nails and scalp. LP affects 0.2-1% of adults1. Erosive lichen planus (ELP) is a rare form of LP usually involving the oral mucosa and genital area2.

Although the etiology of the disease is not fully understood, autoimmune diseases are thought to be associated with LP35. Psychological and emotional disorders are also thought to have a role4.

Palmoplantar involvement, which is characterized by erosive lesions usually accompanied by intense pain, very rarely observed in ELP2. Severe disease may also lead to nail loss2'6'7. Lesions are also known to be precancerous6.

In this report, we present a case of ELP with plantar involvement which responded to cyclosporine-A treatment.

Case Report

A 65-year-old female patient presented...