Plantar ulcerative lichen planus: rapid improvement with a novel triple-therapy approach

Ulcerative lichen planus (ULP) is a rare variant of lichen planus that is characterized by chronic, painful, and disabling ulcerations. Ulcerative lichen planus has been known to be resistant to many treatments, and therapeutic interventions often involve use of aggressive immunosuppressive medications without satisfactory remission of symptoms. We present the case of a 56-year-old man with an 8-year history of painful ulcerations on the right plantar foot as well as a large ulceration of the left lateral tongue. Biopsy confirmed a suspected diagnosis of plantar ULP. The patient developed marked clinical improvement of the cutaneous and oral mucosal lesions with oral and topical steroids, topical tacrolimus, and oral doxycycline after only 4 weeks of treatment. It is important for dermatologists to be aware of the potential diagnosis of plantar ULP, especially in the evaluation of chronic treatment-resistant ulcers that often have been previously misdiagnosed. We introduce this novel therapeutic regimen as a rapidly effective and relatively safe alternative to conventional immunosuppressive agents for long-term management of plantar ULP.