Successful treatment of pediatric lichen planus with topical Crisaborole

Abstract

Lichen planus (LP) is a chronic inflammatory disorder affecting skin, mucous membranes, hair follicles and nails. The treatment of LP in children is challenging due to limited therapeutic options. Here, we present one child with linear LP and nail involvement, who exhibited complete response to topical Crisaborole treatment. A 5-year-old girl presented with a 3-year history of progressive dark red papules and plaques along the Blaschko's line on right lower limb.The rash affected the right shank at first, then extended to the dorsum of right foot along a line, and 6 months later toenail of the first right toe was affected, with longitudinal ridging, fissuring, and distal splitting (Figure 1A). No related family history or trauma were reported. The patient received topical corticosteroids and tacrolimus with partial response, while the lesions relapsed when the medications discontinued. Onychomycosis was ruled out by direct microscopic examination and fungal culture. Dermoscopy revealed F I G U R E 1 The skin lesions of the child. Toenail: longitudinal ridging, fissuring and distal splitting. Dark red papules and plaques on dorsum of foot (A). Lesions began to improve 2 months later (B), improved significantly after 5 months (C), and completely resolved after 10-month treatment (D).Hongzheng Lu and Rui He contributed equally to this work.