Erosive lichen planus involving the glans penis alone

A 71-year-old white man was first seen in September 1978. He complained of an asymptomatic recurrent red patch, which had been slowly enlarging for two months on the glans penis. The patient stated he had a similar lesion a year before, which disappeared completely after one month of treatment with a topical corticosteroid. Physical examination revealed a single, glistening, erythematous, round patch, 1.5 cm in diameter, on the dorsal surface of the glans penis. The central area seemed somewhat depressed with minute erosions scattered over the lesion (Fig. 1). The inguinal nodes were not enlarged and nothing was found on the skin or other mucous membranes. The diagnoses entertained at that time were plasma cell balanitis, erythroplasia of Queyrat, fixed drug eruption, lichen planus, erosive balanitis and solitary plasmocytoma. Laboratory studies were normal. A biopsy of the lesion showed: ulcerated or atrophic epidermis; hypergranulosis; hydropic degeneration of the basal layer; many Civatte bodies within the lower epidermis and the upper zone of papillary dermis; occasional clefts between the epidermis and the dermis; a band-like infiltrate in the papillary dermis, which composed almost entirely of plasma cells, seemed to impinge on the epidermis (Fig. 2). The lesion was diagnosed as lichen planus, erosive type. The patch disappeared in about 4 weeks with topical steroids. No relapse has occurred after a year.