Clinical Challenge: Hyperpigmented Lesions With Raised Borders

Clinical Challenge: Hyperpigmented Lesions With Raised Borders

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A 62-year-old black man presents for evaluation of a rash on his leg. The condition has been present for several months and is mildly pruritic. The patient currently takes oral medications for control of diabetes and hypertension, and he tests positive for hepatitis C virus infection. Examination reveals scattered hyperpigmented annular lesions with slightly raised borders.

Lichen planus is a pruritic inflammatory disorder believed to be triggered by an exaggerated immune response.1  Potential precipitating factors include hepatitis C virus infection,2 as well as medications including β-blockers, nonsteroidal anti-inflammatory drugs, and angiotensin-converting enzyme inhibitors.3 The condition classically presents as...

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Lichen planus is a pruritic inflammatory disorder believed to be triggered by an exaggerated immune response.1  Potential precipitating factors include hepatitis C virus infection,2 as well as medications including β-blockers, nonsteroidal anti-inflammatory drugs, and angiotensin-converting enzyme inhibitors.3 The condition classically presents as violaceous papules on the wrists and ankles. Lichen planus most commonly affects middle-aged individuals and occurs with equal frequency in men and women.4

Subtypes of lichen planus include actinic, atrophic, eruptive, follicular, hypertrophic, inverse, linear, palmoplantar, pigmentosus, ulcerative, vesiculobullous, vulvovaginal, and annular.5 Annular LP is an uncommon variant that presents as well-demarcated, circinate lesions with elevated borders.6 Topical steroids are first-line therapy; refractory cases may respond to hydroxychloroquine and dapsone.7

Stephen Schleicher, MD, is director of the DermDox Center for Dermatology, as well as an associate professor of medicine at Commonwealth Medical College and a clinical instructor of dermatology at Arcadia University and Kings College.

References

1. Hussein MR. Evaluation of angiogenesis in normal and lichen planus skin by CD34 protein immunohistochemistry: preliminary findingsCell Biol Int. 2007;31(10):1292-1295.

2. Shengyuan L, Songpo Y, Wen W, Wenjing T, Haitao Z, Binyou W. Hepatitis C virus and lichen planus: a reciprocal association determined by a meta-analysisArch Dermatol. 2009;145(9):1040-1047.

3. Halevy S, Shai A. Lichenoid drug eruptionsJ Am Acad Dermatol. 1993;29(2 pt 1):249-255.

4. Bhattacharya M, Kaur I, Kumar B. Lichen planus: a clinical and epidemiological studyJ Dermatol. 2000;27(9):576-582.

5. Riahi RR, Cohen PR. Hypertrophic lichen planus mimicking verrucous lupus erythematosus. Cureus. 2018;10(11):e3555.

6. Reich HL, Nguyen JT, James WD. Annular lichen planus: a case series of 20 patients. J Am Acad Dermatol. 2004;50(4):595-599.

7. Lee JB, Wi HS, Han JH, Kim SJ, Yung SJ.  A case of generalized annular lichen planusJ Am Acad Dermatol. 2011;64(2, Supplement 1):AB162.