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Predominant palmoplantar lichen planus: a diagnostic challenge
Rameshwar Gutte1, Uday Khopkar1
1Department of Dermatology, Seth G.S. Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India.
Indian Journal of Dermatology
|July 30, 2014
Summary
Palmoplantar lichen planus (LP) presents diagnostic challenges, often missed clinically. Histopathology is crucial for accurate diagnosis and effective treatment of this uncommon LP variant.
Area of Science:
- Dermatology
- Pathology
Background:
- Palmoplantar lesions are an uncommon manifestation of lichen planus (LP).
- Diagnosis of palmoplantar LP is frequently missed due to its unusual presentation.
Purpose of the Study:
- To document the clinical and histopathological features of palmoplantar lichen planus.
- To highlight the diagnostic challenges associated with this condition.
Main Methods:
- A study of 18 patients with predominant or exclusive palmoplantar LP lesions.
- Clinicopathological correlation was used for diagnosis, excluding patients with recent drug intake or widespread LP.
- Analysis of clinical and histopathological features.
Main Results:
- Average age of onset was 38 years, with a male to female ratio of 1:0.6.
- Itching was the most common symptom; hypertrophic variant was the most frequent clinical presentation.
- Histological findings included parakeratosis, spongiosis, and in some cases, absence of melanophages and hypergranulosis. Diagnosis was missed clinically in 3 out of 4 patients with exclusive palmoplantar involvement.
Conclusions:
- Palmoplantar LP presents a diagnostic challenge due to varied clinical presentations.
- Histopathological examination is essential for accurate diagnosis and guiding treatment decisions.
