Lichen ruber verrucosus L43.81

Author: Prof. Dr. med. Peter Altmeyer

Co-Autor: Dr. med. Jeton Luzha

All authors of this article

Last updated on: 29.10.2020

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Synonym(s)

hypertrophic lichen planus; Hypertrophic lichen planus; Hypertrophic Lichen ruber; Hypertrophic lichen ruber planus; lichen planus hypertrophicus; lichen ruber hypertrophicus; lichen ruber verrucosus; Verrucous lichen planus; Verrucous Lichen planus; Verrucous Lichen ruber; Verrucous lichen ruber planus

Definition
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Extremely therapy-resistant, eminently chronic and (selectively) very itchy, mostly symmetrically localized, verrucous "variant" of the classic Lichen planus, which occurs particularly in the area of the lower extremities; less frequently on the back of the hand.

A verrucous transformation can also occur secondarily in the case of years of Lichen-planus efflorescence.

Etiopathogenesis
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S.u. Lichen planus. In most cases, the oversubscribed component is probably the expression of a special form of reaction due to an orthostatic factor.

Localization
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Mainly extensor sides of the lower legs, ankle region.

Clinical features
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Localized or disseminated, rarely in linear arrangement, 0.2-3.0 cm in size, sometimes up to 10 cm in size, coarse, grey-white, also red or reddish-brown, sometimes dirty brown, sharply delimited, soiled papules, plaques, which can conglomerate into large, wart-like foci.

Leading clinical symptom is a very unpleasant, permanent itching, which is described as piercing or piercing. The constant reactive scratching of the lesions may be a triggering factor for the verrucous component of the lichen planus verrucosus. This mechanism is called the itch-scratch-cycle. Sometimes scarring areas are visible in the plaques.

Quite often, triggering factors can be held responsible for the verrucous transformation of the lichen planus. Thus, chronic venous insufficiency as well as constant scratching can be considered as an entertaining trigger factor for the lichen planus verrucosus of the lower leg.

Histology
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Image of the lichen planus with striking compact orthohyperkeratosis, with massive irregular epidermal hyperplasia. The infiltrate is differently dense, tending to be rather sparse with a focus on the tips of the reteleases. In contrast to the non-verrucous lichen planus, the verrucous variant may have a relevant number of eosinophil granulocytes. Rarely also plasma cells.

Differential diagnosis
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External therapy
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potent glucocorticoids (e.g. class IV glucocorticoids) under occlusion (2 times/day 2-4 hours).

Alternatively: Vit D3 - analogues under occlusion.

Supplementary: Inject the foci with glucocorticoids such as triamcinolone crystal suspension 10-40 mg (e.g. Volon A): Draw up suspension with 2-4 ml 1% scandicain in a syringe and apply intrafocally.

Supplementary: Consistent wearing of compression bandages in the presence of chronic venous insufficiency.

Radiation therapy
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PUVA bath therapy can be tried.

Internal therapy
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In severe cases, systemic therapy, if necessary, according to the lichen planus.

Progression/forecast
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Eminently chronic course. The average duration of the disease is 6 years. Complications can develop after years of existence intralesional keratoacanthomas or squamous cell carcinomas (Campanati A et al. 2003).

Literature
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  1. Alomari A et al (2014) The significance of eosinophils in hypertrophic lichen planus. J Cutan catholic 41:347-352
  2. Audhya M et al (2014) Verrucous lichen planus: a rare presentation of a common condition. Dermatol Reports 3:5113
  3. Campanati A et al (2003) A case of hypertrophic lichen ruber planus of the leg complicated by a squamous cell carcinoma. Int J Dermatol 42: 415-416
  4. Castano E et al (1997) Verrucous carcinoma in association with hypertrophic lichen planus. Clin Exp Dermatol 22: 23-25
  5. De Paola M et al (2014) Unilateral hypertrophic lichen planus successfully treated with topical calcipotriol. G Ital Dermatol Venereol 149: 274-276

  6. Dossi Cataldo MT et al (2015) Pigmentosus hypertrophic lichen planus with blaschkoian distribution, 3 clinical subtypes in a single patient. Med Clin (Barc) doi:10.1016

  7. Giesecke LM et al (2003) Giant keratoacanthoma arising in hypertrophic lichen planus. Australas J Dermatol 44: 267-269
  8. Ghosh S et al (2014) Squamous cell carcinoma developing in a cutaneous lichen planus lesion: a rarecase
    .Case Rep Dermatol Med doi: 10.1155/2014/205638.
  9. Musumeci ML et al (2014) Multiple reactive keratoacanthomas in a patient with hypertrophic lichen planus treated with cyclosporine: successful treatment with acitretin. Indian J Dermatol Venereol Leprol 80: 374-376

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Last updated on: 29.10.2020