Annular atrophic lichen planus

Abstract

A 30-year-old woman presented with a 1-year history of a pruritic eruption on the extremities, characterized by several annular plaques. The patient had been treated unsuccessfully with medium-potency topical steroids. The lesions had an erythematous papular border with an atrophic center (width, 1-4 cm) (Fig. 1). No oral, genital, or nail lesions were observed. A skin biopsy from one of the plaques was performed. Histopathologic examination of the raised border showed hyperkeratosis of the stratum corneum, focal thickening of the granular layer, basal liquefaction degeneration of the epidermis, and a band-like subepidermal infiltration with numerous Civatte bodies. In the center of the lesion, the epidermis became thinner (Fig. 2). Elastic fibers were reduced or absent in the papillary dermis. The patient was treated with high-potency topical steroids for 2 months with clinical improvement.

Oral, Esophageal and Cutaneous Lichen Ruber Planus Controlled with Alitretinoin: Case Report and Review of the Literature

“…Annular atrophic LP is a rare variant of LP and characterized by annular, violaceous plaques with central atrophy. Up to date 10 cases have been described [27,28,29,30,31,32,33,34,35]. Erosive LP is a painful variant of LP with eroded or ulcerated lesions mainly in mucocutaneous sites which is often difficult to treat and may lead to scarring [36,37,38].…”

An atrophic plaque in an Indian lady

“…[1234567] Friedman and Hashimoto first described it 18 years ago in a black, middle-aged male with polygonal, violaceous papules present in an annular or arciform pattern over extremities and hips for 25 years. Topical steroids and UV light were of no help.…”

“…Failure of response to 1% hydrocortisone acetate cream used previously and a good response to topical 0.1% tacrolimus ointment in 4 months also supported the diagnosis as reported earlier. [12345]…”

Isolated annular atrophic lichen planus of the mammary areola

“…It has several clinical forms including actinic, hypertrophic, linear, vesiculobullous, annular, and atrophic variants . AALP is a relatively new entity that was first described by Friedman and Hashimoto in 1991 . Since then, only a few cases have been reported in literature.…”

“…Iatrogenic atrophy induced by prolonged use of topical steroids is another differential diagnosis, which shows a very different histological pattern, with decrease and thinning of collagen bundles and prominent appearance of the elastic fibers . Histopathologically, AALP lesions are identical to LP in the raised border, whereas a flattened epidermis with loss of rete ridges and fibrosis of the dermal papilla can be seen in the atrophic center . It has been argued that the annular and atrophic configuration of the lesions result from the elastolytic activity of the inflammatory cells, with the formation of loci of localized acquired cutis laxa…”