Combination of actinic, hypertrophic and typical forms of lichen planus in one patient

Lichen planus is a chronically occurring dermatosis of a multifactorial nature, which is characterized by the appearance of flat polygonal itchy papules on the skin and mucous membranes. Dermatosis is often associated with diabetes mellitus and diseases of the gastrointestinal tract, extremely rarely with oncological diseases. Antimalarial drugs with photoprotective, anti-inflammatory, weak immunosuppressive effect are recommended for treatment.

Actinic and hypertrophic forms of lichen planus are atypical forms of the disease. Actinic or tropical lichen planus is rare in the Russian Federation, mainly in the countries of the Middle and Near East, Central Asia, Africa. The actinic form of lichen planus is characterized by localization in open areas of the skin (face, neck). The hypertrophic form of lichen planus is characterized by large papules with a bumpy surface that do not look like a typical form. The rare occurrence of dermatosis and unusual localization leads to difficulty in making a diagnosis.

The article presents a clinical case of a combination of actinic, hypertrophic and typical forms of lichen planus in a patient born in the Caucasus, but having lived in Russia for a long time. The skin process in the patient was widespread, was localized throughout the skin, including the face, neck, mucous membranes of the oral cavity; only the skin of the palms and soles remained free from rashes. The rash was represented by flat polygonal papules, bluish-pink in color, the size of a lentil, and a whitish Wickham mesh on the surface.

Localization in open areas of the skin, combination with hypertrophic papules, outdoor work, severe itching with excoriations led to an incorrect diagnosis, and the ongoing therapy had no effect. To clarify the diagnosis, a histological examination was carried out, which revealed pronounced hyperkeratosis, uneven granulosis, massive papillomatosis, in the papillary and sub-papillary layers of the dermis (stripe-shaped moderate infiltrate of lymphoid elements, histiocytes, minor edema, vasodilation). Adequately selected drug therapy (dexamethasone intramuscularly; chloropyramine intramuscularly; antimalarial agent; nicotinic acid; external ointment dermatol), as well as acupuncture sessions with the second inhibitory method of therapy, led to an improvement in the patient’s condition.

Upon completion of treatment, the patient is recommended photoprotective external agents on exposed skin and a repeated course of acupuncture.