Psoriasis in the mouth is very rare, in contrast to lichen planus, another common papulosquamous disorder that commonly involves both the skin and mouth. Biopsy from lesion showing typical features of lichen planus viz, hyperkeratosis, acanthosis. Palmoplantar lichen planus is an uncommon limited variant of lichen planus. Apr 16, 2019 lichen planus may cause an erythematous, scaly ppk or a punctate, yellow, warty keratosis. Hyperkeratotic pitted plaques on the palms and soles khandpur. Lichen planus is a benign, inflammatory and itchy dermatosis that is incurred by skin, skin extensions and mucosa. The rashes created by the infection are characterized with flat topped and manysided bumps which grow together to form scaly patches on the skin. We can classify hereditary palmoplantar keratodermas as isolated, complex or syndromic. Palmoplantar lichen planus pplp is an uncommon, localized variant of lichen planus lp. Key points cutaneous lichen planus represents a relatively uncommon dermatosis, affecting dec 29, 2016 palmoplantar keratoderma ppk is a group of skin conditions characterized by thickening of the skin on the palms of the hands and soles of the feet. Palmoplantar keratoderma is also sometimes known as keratosis palmaris et plantaris. Certain medications, particularly lithium, may be associated with the.
Palmoplantar keratoderma as a variant of lichen planus. Our purpose was to discuss all treatment modalities proposed and tested for palmoplantar lichen planus in the literature. Palmoplantar lichen planus is a localized and uncommon variant of. Diffuse palmoplantar keratoderma is a type of palmoplantar keratoderma that is characterized by an even, thick, symmetric hyperkeratosis over the whole of the palm and sole, usually evident at birth or in the first few months of life. Because stratum corneum is thicker in palmoplantar region, yellowish le. According to the site of involvement, lichen planus can be subdivided into palmoplantar, mucosal, nail, or scalp types. Dermis keratosis palmoplantaris information on the diagnosis. Lichen planus lp is an inflammatory skin condition with characteristic clinical and histopathological findings. Palmoplantar lichen planus pplp is an uncommon variant of lichen planus that affects the palms and soles. Lichen planus lp and lichen nitidus ln present with varied morphology on the palms and soles. Jan 18, 2014 hyperkeratotic eczema of the palms, a common yet somewhat neglected entity, is characterized by chronic, scaly, hyperkeratotic, fissureprone, erythematous plaques on the palms and palmar surfaces of.
Case study palmoplantar keratoderma as a variant of lichen. Clinical findings are varied although they have been conceptualized into two large groupings, an erythematous scaly pattern and a hyperkeratotic pattern. Lichen simplex is more likely than hyperkeratotic palmar dermatitis to improve with topical corticosteroids 5. Palmoplantar lichen planus is a localized and uncommon variant of lichen planus which is mostly resistant to treatment. Palmoplantar lichen planus is a form rarely described in the literature, with. What you should know about lichen planus podiatry today. Learn vocabulary, terms, and more with flashcards, games, and other study tools. After 2 months, the skin lesions were in complete remission. Multiple clinical presentations of pplp may be seen, the erythematous scaly form is most common and other clinical presentations include vesiclelike and petechialike lesions, which are rare variants. In some cases, the presence of a positive family history is not observed. Palmoplantar lichen planus, hyperkeratotic variant. Hyperkeratotic variant of palmoplantar lichen planus is a very rare type of lichen planus it can be commonly mistaken with common skin conditions like warts and corns.
Classic lp typically presents as pruritic, polygonal, violaceous flattopped papules and plaques. Hyperkeratotic eczema psoriasis of the palms springerlink. Lichen planus can be described as a recurrent rash which occurs from inflammation. A case of palmoplantar lichen planus mimicking secondary syphilis. Feb 28, 2010 a diagnosis of generalized lichen planus with palmoplantar involvement was made based on clinical and histological features. Acrokeratoelastoidosis costa 10 arsenic keratoses 4 congenital dyskeratosis 12 focal acral hyperkeratosis 12 hyperkeratotic fissured hand and foot eczema 8 lichen planus 102 pachyonychia congenita hereditaria 10 pityriasis rubra pilaris devergie 44 progeria adultorum 3 psoriasis palmoplantaris 12 sezary syndrome 15 verruca.
Transient palmoplantar keratoderma has also been described as a marker of a distinct, severe subtype of treatmentresistant bullous pemphigoid. Palmoplantar involvement may be characteristic of this syndrome fig. Classification of keratodermas depends on whether or not it is inherited, and its clinical features. Ppk and nail dystrophy have been seen in lichen nitidus. Palmoplantar refers to the skin on the soles of the feet and palms of the hands. After one year follow up, there was no evidence of recurrence. Many tiny raindrop keratoses involve the palmoplantar surface. Ppk can be either acquired during the lifetime more commonly. Various known morphological presentations of palmoplantar lichen planus pplp include hypertrophic variant, diffuse scaly variant, punctuate keratoses, diffuse keratoderma, erosive or ulcerative lesions, pigmented macular variant, vesicular lesions, keratotic plaques with pits and umbillicated papules.
Hypertrophic variant with symmetric lesions on bilateral palms. Palmoplantar lichen planus is a rare subtype of lichen planus which may. Palmoplantar lichen planus lp, hyperkeratotic variant. Hyperkeratotic plaques on the palms and solesdiagnosis.
How to diagnose and manage hereditary palmoplantar. The current case describes palmoplantar lichen planus, a rare variant of this disease that can easily be misdiagnosed. Other dermatological conditions which may give rise to hyperkeratosis include lichen planus and pityriasis rubra pilaris. Lichen planus lp is a chronic inflammatory skin disease commonly seen by dermatologists. A closer look at the types of hereditary palmoplantar keratodermas. Palmoplantar lichen planus is a rare localized variant of lichen planus. When psoriasis involves the oral mucosa the lining of the mouth, it may be asymptomatic, but it may appear as white or greyyellow plaques. Case study palmoplantar keratoderma as a variant of. The tendency to psoriasis is inherited, but what causes it to localise on the palms and soles is unknown. Update on lichen planus and its clinical variants sciencedirect. Hyperkeratotic palmoplantar lichen planus in a child. Links abreu velez am, yi h, googe pb jr, mihm mc jr, howard ms.
We started treatment with oral antihistamines, topical steroids and 1% pimecrolimus cream. Jan 01, 2015 under current access and supply, podiatrists are only able to access mildly potent topical corticosteroids 1% hydrocortisone and so referral will be necessary to obtain the more potent steroid preparations. Lichen planus is a common skin disease, affecting 0. Atrophic lichen planus is a rare annular variant with. Sep 27, 2016 keratoderma climactericum is a type of acquired palmoplantar keratoderma. Treatment modalities of palmoplantar lichen planus. Lichen planus can be a challenging condition to diagnose. A biopsy from the patient, however, was diagnostic of lichen planus.
There are several clinical variants of lichen planus including hypertrophic. Nov 20, 2019 lichen nitidus is a relatively rare, chronic skin eruption that is characterized clinically by asymptomatic, flattopped, skincolored micropapules see image below. Yellowish discoloration of nails with subungual hyperkeratosis and nail dystrophy was seen. Current concepts in diagnosing and treating keratoderma. Palmoplantar lesions in lichen planus lp are uncommon. Lichen planus have actinic, annular, atrophic, bullous, hypertrophic, follicular, linear and ulcerative variants. Palmoplantar lesions in lichen planus lp are less common the clinical presentation may not be typical of lp the histopathology is usually compatible or consistent with lp and is a very useful tool in diagnosing such patients. It may be triggered by an injury to the skin, an infection, or another skin condition such as hand dermatitis. There was no lymphadenopathy and, except that the plantar lesions caused significant discomfort, he felt well.
Autoantibodies to melanocytes and characterization of melanophages in patients affected by a new variant of endemic pemphigus foliaceus. Due to the sheer breadth of this topic, i will be focusing on the isolated varieties. Lichen planus is a chronic inflammatory disease that affects skin, mucous membranes, hairs, and nails. Punctate ppk presents as asymptomatic, tiny, hyperkeratotic punctate papules on the palmoplantar surface. Childhood lichen planus with palmoplantar involvement. Lichen nitidus mainly affects children and young adults. Mar 29, 2008 the current case describes palmoplantar lichen planus, a rare variant of this disease that can easily be misdiagnosed. We present four unusual cases of palmoplantar lp and ln manifesting as hyperkeratotic plaques with pits. Epidermolytic hyperkeratosis is a descriptive term which refers to specific microscopic features i. Since stratum corneum in palmoplantar lichen planus is extremely thick, lesions can be yellow colored instead of the purple colored papules that are classic lesions. Clinically the most common variant was hypertrophic. The successful treatment of palmoplantar hyperkeratotic. Pdf hyperkeratotic palmoplantar lichen planus in a child. As a general rule, palmoplantar presentations are exceedingly difficult to diagnose.
Request pdf on nov 1, 2004, adam m rotunda and others published hyperkeratotic plaques on the palms and soles. The plaques are crossed by fine white lines called wickham striae. The successful treatment of palmoplantar hyperkeratotic lichen planus with enoxaparin sirin yasar 1, zehra asiran serdar 1, fatih goktay 1, nurhan doner 1, ceyda tanzer 1. This case describes a patient that presented with multiple papules on his hands and plantar feet that had previously been diagnosed as tinea manum and psoriasis. Lichen simplex chronicus lichen simplex is usually intensely itchy. Jan 06, 2019 punctatetype palmoplantar keratoderma is a type of palmoplantar keratoderma that is caused by genetic abnormalities that may be inherited in an autosomal dominant or autosomal recessive manner. It may first occur during a period of psychosocial stress. The current case describes palmoplantar lichen planus, a rare variant of this disease that can easily be. Individual lesions often consist of yellow and hyperkeratotic papules, and plaques.
In our cases, there was only a single plaque lichen planus on the foot, a rather rare variant of lichen planus 7. Isolated palmoplantar keratodermas are the most common and primarily involve the palms and soles. A 72yearold african man presented with tender, welldefined hyperkeratotic plaques on his soles and palms figure 1 and figure 2. Subtle features like presence of violaceous border suggests lp and plugs within the pits suggest ln. Palmoplantar lichen planus, hyperkeratotic variant find, read and cite all the. Palmoplantar hyperkeratotic plaques dermatology jama. Lichen planus rarely show palmoplantar involvement. Verrucous plaques a clinicians guide to dermatologic. Hypertrophic lichen planus is one of the rare clinical variants. Palmoplantar lesions of lichen planus sinha s, sarkar r. Ppk can also be a feature of various underlying syndromes.
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