Long-Standing Unilateral Verrucous Papules of the Hand Revealing Hypertrophic Lichen Planus: A Diagnostic Challenge

Lichen planus (LP) is an inflammatory disorder that can involve the skin, nails, hair follicles, and mucous membranes and may present with diverse clinical morphologies that mimic other dermatologic conditions. Hypertrophic (verrucous) LP is a chronic variant characterized by hyperkeratotic lesions that most often affect the lower extremities, which makes isolated hand involvement diagnostically challenging. We report a 65-year-old man with skin-colored, dermally embedded verrucous papules confined to the right hand with extension to the wrist, evolving for more than 40 years. He denied pruritus, pain, and functional limitation. Mild nail atrophy was noted, and there was no mucosal involvement. Skin biopsy revealed pseudoepitheliomatous acanthosis consistent with cicatricial-stage verrucous LP. Treatment with a very potent topical corticosteroid (clobetasol propionate) under occlusion was initiated, though adherence was poor, and weekly trichloroacetic acid sessions were planned. Clinicopathologic correlation supported the diagnosis in this atypical unilateral presentation and guided management and follow-up.