Zosteriform Lichen Planus in a Young Woman: A Case Report of the Diagnostic Challenges and Psychodermatologic...

Lichen planus (LP) is a chronic T-cell-mediated inflammatory dermatosis affecting the skin, mucous membranes, nails, and scalp. Zosteriform lichen planus (ZLP) is a rare clinical variant characterized by a unilateral dermatomal distribution that closely mimics herpes zoster, creating a significant diagnostic challenge. We report the case of a 22-year-old woman who presented with pruritic, hyperpigmented papules distributed along the left L3 dermatome. Because histopathologic confirmation was unavailable, the diagnosis was established clinically by the treating dermatologist based on the characteristic lesion morphology, dermatomal distribution, chronic-relapsing course, therapeutic response, and exclusion of the principal differential diagnoses. Following dermatologic evaluation, the patient underwent formal psychological assessment by a licensed psychologist using the 10-item Perceived Stress Scale (PSS-10), which demonstrated moderate perceived stress (15/40), predominantly related to academic and personal life stressors. Treatment with topical clobetasol propionate 0.05% resulted in marked clinical improvement, while subsequent recurrences remained temporally associated with periods of increased perceived stress and responded to reintroduction of topical corticosteroid therapy together with stress-management strategies. This case highlights the diagnostic challenges of clinically diagnosed ZLP in a resource-limited setting and demonstrates the importance of systematic clinical reasoning when biopsy is not feasible, while reaffirming that histopathologic confirmation remains the preferred method whenever available. It also supports formal psychosocial assessment as a valuable adjunct to the multidisciplinary management of selected patients with recurrent, stress-associated inflammatory skin disease.