Palmo-plantar lichen sclerosus et atrophicus
V K Jain
11/9J, Medical Enclave, Pt. BDS PGIMS, Rohtak - 124 001, Haryana
|How to cite this article:
Aggarwal K, Jain V K, Brahma D. Palmo-plantar lichen sclerosus et atrophicus. Indian J Dermatol Venereol Leprol 2003;69:43-44
AbstractA case of lichen sclerosus et atrophicus (LSA) in a male patient who presented with multiple hypopigmented to depigmented macules, polygonal in shape, distributed in a bilaterally, symmetrical manner over the hands, feet and flexor aspect of wrists is being reported. Histopathology confirmed the diagnosis of LSA.
Lichen sclerosus et atrophicus is an uncommon disease with small, white areas on the skin. It is most common on the vulvar and perianal areas but may be seen anywhere, with the mo: common extra-genital sites being on the trunk an limbs. The extra-genital cutaneous lesions of LSD consist of flat - topped, white macules that tend to coalesce to form white patches. Often, small, comedo-like follicular plugs are seen on their surface. In the later stages, atrophy occurs and the surface of the lesions becomes wrinkled and may actually be depressed.
A 58-year-old man had multiple, asymptomatic, hypopigmented to depigmented guttate macular lesions on the hands and feet for the last 6 months. The lesions initially appeared on the dorsa of hands, gradually increased in size and number and subsequently appeared on the palms, soles, dorsa of feet and flexor surfaces of wrists.
The lesions were of varying size, polygo-nal in shape, angular in out-line, with well-defined mar-gins, atrophic with a wrinkled sur-face and at places, coa lescing to form large lesions. At other places, individual lesions were present in a grouped fashion. Koebner phenomenon was evident in some of the lesions. An erythematous halo surrounded some of the lesions on the dorsa of hands. The anogenital region was uninvolved. The results of the rest o physical examination were normal. Histologic study of lesion revealed the typical feature of LSA. The epidermis was covered by a thick, hyperkeratotic scale with plugging of the adnexal orifices. The rete was thin and there was vacuolation of the basal cells. A broad zone of edema was present in the sub-epidermal area and there was conspicu ous dilation of the thin- walled vessels. Beneath this, in the mid-portion of the corium, there was diffuse, perivascular infiltrate of lymphocytes.
Lichen sclerosus most commonly affect the anogenital area (85-98% of cases)with extra genital lesions 15-20% of patients., Involvement of plams with LSA has been reported by Purres and Krull. but their patient also had wide spread cutaneous involvement. Wustner and Gartmanr recorded palmar and plantar keratotic papules it twins, but these cases also had typical involvement of the genitals. This patient is being reported for the distinctive distribution of the lesions of LSA or hands and feet, which is a rarity in presentation and that LSA should be added to the differentia diagnosis of palmar-plantar eruptions.
Tremaine RDL, Miller RAW. Lichen sclerosus et atrophicus. Ini Dermatol 1989;28:10-16.[Google Scholar]
Lichen sclerosus et atrophicus, ln:Lever's Histopathology of the Skin Edited by Elder D, Elenitsas R, Jaworsky C et al. Lippincort-Rover Publishers, Philadelphia, 1997; 280-283.[Google Scholar]
Meffert JJ, Davis BM, Grimwood RE. Lichen sclerosus. J Am Acac Dermatol 1995;32:393-416.[Google Scholar]
Meyrick Thomas RH, Ridley CM, McGibbon DH, et al. Lichen sclerosu, and autoimmunity- A study of 350 women. Br J Dermatol 1988;114 377-379.[Google Scholar]
Purres J, Krull EA. Lichen sclerosus et atrophicus involving the plams Arch Dermatol 1971;104:68-69.[Google Scholar]
Wustner H, Gartmann H. Palmo-plnterer and genitoanales Licher sclerosus et atrophicus bei eineiigen Zwillinger. ZHautkr 1974;49:841.[Google Scholar]