• palmoplantar lichen planus
• review
• treatment

Lichen planus is a common inflammatory disease but its perforating variety is not so common and it has been described in small number of text and articles. Here we reported a case of plantar lichen planus where there was a history of discharge of dark grains from the sole of foot and diagnosing the disease as eumycetoma of dark grains repeated antifungal therapy could not resolve the lesions and histopathologically it showed the classical pictures of lichen planus. Collaborating the clinical and histological features we have diagnosed the case as perforating lichen planus but Verhoeff-Van Gieson stain could not elucidate the perforating channel which ot difficult to delineate and often missed. So, we have put the diagnosis of plantar lichen planus and treated with intramuscular triamcinolone and the lesions resolved.

• Plantar lichen planus
• Masquerading eumycetoma
• Perforating lichen planus

Palmoplantar lesions in lichen planus (LP) are uncommon. In such cases, diagnosis is usually missed. This study was conducted to document various clinical and histopathological features of palmoplantar LP.

A total of 18 patients from our outpatient department with lesions of LP, either predominantly or exclusively on palms and/or soles were studied. Patients with history of drug intake in recent past and patients with classical acute widespread LP with a few lesions on palms or soles were excluded. In each patient, diagnosis was made on clinicopathological correlation. Various clinical and histopathological features were analyzed.

Average age of onset was 38 years. Male: female ratio was 1:0.6 and average disease duration was 11 months. Exclusive palm or sole involvement was seen in 4/18 patients. Itching was the most common symptom. Clinically the most common variant was hypertrophic. Histologically presence of parakeratosis, spongiosis, lack of melanophages, and lack of hypergranulosis in some cases was seen in addition to classical features of LP. In 3 out of 4 patients with exclusive palmoplantar involvement diagnosis of LP was missed clinically.

Involvement of palms and soles in LP poses a diagnostic challenge due to variable presentations. Histopathology is of vital importance for correct diagnosis and treatment.

• Clinico-pathological study
• lichen planus
• palm
• sole

• Collagenosis
• Perforating
• Prurigo
• Pseudoperforation
• Transepidermal

• Adult
• Collagen/metabolism
• Connective Tissue Diseases/diagnosis
• Connective Tissue Diseases/pathology
• Diabetes Mellitus
• Diagnostic Errors
• Epidermis/pathology
• Female
• Humans
• Male
• Middle Aged
• Prurigo/diagnosis
• Prurigo/pathology
• Skin/pathology

Lichen planus (LP) is a pruritic, benign, papulosquamous, inflammatory dermatosis of unknown etiology that affects either or all of the skin, mucus membrane, hair and nail. It presents with varied morphology on the palms and soles. Here we present a case of unusual acrosyringeal variant of LP on palm. The diagnosis was confirmed histologically.

• Acrosyringeal
• lichen planus
• palm

Lichen planus (LP) is a chronic inflammatory skin disease characterized by polygonal, violaceous papules commonly involving flexural areas of the wrists, legs, and oral and genital mucous membranes. This report describes a patient who presented with asymptomatic black colored patches on both palms simulating Tinea nigra, a superficial fungal infection. She was previously diagnosed as allergic contact dermatitis and was being treated with potent topical steroid i.e. clobetasol propionate 0.05% and white soft paraffin. Dermatoscopy of the lesion showed brownish pigmentation along ridges of the dermatoglyphics. A biopsy from the lesional skin showed findings of lichen planus. Our case highlights the potential diagnostic confusion that can occur with unusual variants of palmoplantar lichen planus and importance of histopathology in diagnosis of such unusual lesions.

• Differential diagnosis
• lichen planus
• palmoplantar lichen planus
• tinea nigra