Palmoplantar Lichen Planus Presenting with Vesicle‐Like Papules

Abstract

Palmoplantar lichen planus is a rare, localized variant of the disease that may create difficulty in diagnosis if it is present as an isolated finding. Although several morphological patterns may be seen, plaques or small papules with compact hyperkeratosis are usually observed. We present a 25-year-old woman with a one-month history of slightly pruritic, red papules on her palms and soles. Dermatologic examination revealed numerous, asymptomatic, unscaly, red papules on her palms and soles, some of them resembling vesicles and white reticulate plaques on both sides of the buccal mucosa. The diagnosis was established by the typical histopathological features of lichen planus. Although resistant to topical corticosteroids, she responded well to systemic corticosteroid therapy, and no recurrence was observed during the follow-up period of one year.

Palmoplantar Lichen Planus with Papular Oral Lesions: Case Report and a Brief Review of the Literature

“…5 On the other hand, in the case of Gündüz et al's the vesicle-like lesions were actually LP papules which were also histopathologically confirmed. 3 Our case not only represents the unique combination of erythematous scaly and hyperkeratotic patterns of palmoplantar LP, but also displays papular type oral LP. Papular type oral LP is rarely seen and usually coexists with other variants of oral LP.…”

“…[17][18][19] As we checked through the literature, we have noticed that palmoplantar LP is infrequent, furthermore different patterns occurring together is unlikely, reported almost exclusively for vesicle-like papules accompanying hyperkeratotic variant. 3,5 In addition, our literature search did not reveal any case report with papular type oral LP, which is alreadly an uncommon variety, concurrent with palmoplantar LP. Hence, we think that our case is an exceptional example of palmoplantar LP.…”

“…5 Gündüz et al also reported a patient with white reticular plaques on bilateral buccal mucosa and palmoplantar LP with hyperkeratotic papules, some of which looked alike vesicles. 3 However, Sanchez-Peres et al could not exclude the possibility of coexistence of atopic dermatitis and LP, since the patient had a personal and family history of atopic dermatitis and the vesicular lesions were located on the sides of the fingers and the palms. 5 On the other hand, in the case of Gündüz et al's the vesicle-like lesions were actually LP papules which were also histopathologically confirmed.…”

“…14 Actually, variants of palmoplantar LP, with other clinical manifestations of LP may appear contemporaneously in an individual. [3][4][5]9,15,16 There are case reports indicating hyperkeratotic palmoplantar plaques accompanying oral manifestations and typical cutaneous lesions of LP. 4,15 Likewise, plantar ulcero-erosive lesions of LP have been described with longitudinal melanonychia, reticular oral LP, and post inflammatory hyperpigmentation.…”

Pseudovesikel an Handflächen und Fußsohlen

“…Erschwerend kommt hinzu, dass ein akral lokalisierter LR zumeist nicht in der typischen Form von polygonalen "pyramidenstumpfartigen" abgeflachten Papeln von charakteristischem hell-lividem Farbton mit weißem netzartigem Linienwerk, der WickhamStreifung, auftritt, sondern unterschiedliche Ausprägungen aufweisen kann und so zu einer diagnostischen Herausforderung wird. Unter anderem wurden Effloreszenzen eines akralen LR als erythematös-schuppige, harte und raue, wachsartig durchschimmernde, erosive, vesikulöse oder hyperkeratotische Papeln und Plaques beschrieben, die das Bild einer Keratosis punctata, einer diffusen Palmoplantarhyperkeratose oder eines dyshidrosiformen Ekzems annehmen können [1,2,3,4,5]. Die Differenzialdiagnosen reichen daher von Psoriasis palmoplantaris, Tinea palmoplantaris, hyperkeratotisches Ekzem, Verrucae vulgares, Porokeratose bis zum Palmoplantarsyphilid.…”