Atypical Orogenital Lichen Planus in a Young Male: A Case Report

Lichen planus is a chronic inflammatory ailment with a wide range of symptoms that can mimic other dermatological and sexually transmitted conditions, especially when affecting the genitalia. Such overlap might make diagnosis difficult, particularly in uncommon circumstances.

We present a 21-year-old Middle Eastern male with a one-year history of progressive papular lesions that started in the glans penis and advanced to the oral mucosa, where they extended to the gingiva. The lesions were non-ulcerated, well-defined, dome-shaped papules ranging from pink to skin-colored, with some hypertrophic and pigmented characteristics. Clinically, it was misconstrued as a sexually transmitted disease, leading to a diagnostic dilemma. The patient complained of burning oral pain and paresthesia described as electric-like sensations in the genitals, which were accompanied by serious psychological distress and sexual discomfort. Histopathological confirmation was not obtained due to the patient's refusal based on sociocultural concerns. The patient did not respond to topical corticosteroids but did improve slightly with topical tacrolimus 0.1%.

This case demonstrates a unique presentation of lichen planus in a young male, with genital-to-oral development and diagnostic confusion in the absence of biopsy. It highlights the need for clinically identifying non-venereal dermatoses in genital lesions and the impact of psychological factors on treatment and diagnosis choices.