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Case Reports

Abstract

Lichen planus is a chronic, idiopathic inflammatory condition which can manifest on both cutaneous and mucosal surfaces. The classic appearance of cutaneous lichen planus is characterized by the “Six P’s”: planar, polygonal, pruritic, purple, plaques and papules. There are numerous subtypes of cutaneous lichen planus with distinct presentations; a rather uncommon subtype is hypertrophic lichen planus, also known as lichen planus verrucous. The typical presentation of hypertrophic lichen planus is slightly-raised, hyperkeratotic plaques associated with pruritus, which often appear bilaterally on the shins, ankles, or wrists. Diagnosis is usually made based on clinical appearance, although biopsy demonstrating lichenoid infiltration around the dermal-epidermal junction may help confirm uncertain cases. Here we present the case of a 48 year-old African-American woman, medical history pertinent for ichthyosis vulgaris, with a striking presentation of hypertrophic lichen planus due to marked exophytic growth. The patient presented to the clinic with four dark-gray, mound-like lesions on her shins bilaterally, associated with intense pruritus and pain. The largest of these lesions protruded 4.4 cm out of the right shin. A shave biopsy was performed on this lesion, with histology demonstrating a band of lichenoid infiltration around the dermal epidermal junction consistent with a diagnosis of hypertrophic lichen planus. The exophytic nature of these lesions is unusual for hypertrophic lichen planus; upon a review of the literature, another case with lesions of similar height was not found.