Erosive lichen planus: a therapeutic challenge

Abstract

Erosive lichen planus is an uncommon variant of lichen planus. Chronic erosions of the soles, accompanied by intense and disabling pain, are some of its most characteristic manifestations. We present the case of a woman who developed oral and plantar erosive lichen planus associated with lichen planus pigmentosus and ungueal lichen planus that were diagnosed after several years. The patient failed to respond to multiple therapies requiring longstanding medication but remained refractory. Knowledge of the treatment options for erosive lichen planus is insufficient. Further research is required to clarify their effectiveness, ideally adopting an evidence-based methodology.

A case of erosive lichen planus with plantar involvement

“…Moreover, high level of stress after menopause in women may contribute to development of the disease. Plantar involvement in ELP starts with painful, erythematous and bullous lesions on the calcaneus bone 2,12 that were also present in our case. Lesions have a tendency to spread to the plantar side and the nails 2,9,12 .…”

“…Plantar involvement in ELP starts with painful, erythematous and bullous lesions on the calcaneus bone 2,12 that were also present in our case. Lesions have a tendency to spread to the plantar side and the nails 2,9,12 . Koebner phenomenon is known to be positive in LP and lesions may take 2 years to develop after trauma 13 .…”

“…ELP is a LP subtype affecting mainly the oral and genital mucosa and palmoplantar areas as well as nails 2,9 . Autoimmune processes are thought to be the cause of ELP 3-5 and these reactions are more frequent in women than in men 10 .…”

“…LP affects 0.2-1% of adults 1 . Erosive lichen planus (ELP) is a rare form of LP usually involving the oral mucosa and genital area 2 . Although the etiology of the disease is not fully understood, autoimmune diseases are thought to be associated with LP [3][4][5] .…”

“…Psychological and emotional disorders are also thought to have a role 4 . Palmoplantar involvement, which is characterized by erosive lesions usually accompanied by intense pain, very rarely observed in ELP 2 . Severe disease may also lead to nail loss 2,6,7 .…”