Ulcerative lichen planus of the sole: excellent response to topical tacrolimus

Abstract

Ulcerative lichen planus of the sole is a rare variant of lichen planus, characterized by chronic painful disabling ulceration of the soles. Despite many treatment modalities used to treat ulcerative lichen planus, it is still considered a resistant disease. We report a Saudi female patient with ulcerative lichen planus of the soles resistant to many systemic and topical agents. We used topical tacrolimus 0.1% ointment with excellent response and complete healing in a few weeks as well as good maintenance during a follow-up period of more than 2 years.

Successful Treatment of Nail Lichen Planus with Topical Tacrolimus

“…Topical tacrolimus has been reported as a safe, effective therapy for cutaneous (5,6), oral (7-9) and vulvar lichen planus (LP) (9)(10)(11), even in patients whose lesions have shown recalcitrance to other treatments (7,10). However, topical tacrolimus treatment for NLP has never been reported.…”

Treatment modalities of palmoplantar lichen planus: a brief review

“…In another case report, a Saudi female patient with ulcerative LP of the soles resistant to many systemic and topical agents responded excellently to topical tacrolimus 0.1% ointment. Complete healing was reported in a few weeks as well as good maintenance during a follow-up period of more than 2 years [28]. …”

Palmoplantar Lichen Planus with Papular Oral Lesions: Case Report and a Brief Review of the Literature

“…Unlike to other manifestations, it usually creates a clinical dilemma to diagnose palmoplantar LP, if the other characteristic features of LP is not distinguishable. [5][6][7][8][9] Palmoplantar LP may manifest in several clinical presentations, including hyperkeratotic keratoderma-like plaques, 4,5 ulcerative lesions, 9,10 vesiclelike papules, 3,5 umbilicated papules, 11 diffuse palmar hyperpigmentation, 12 erythematous scaly plaques, 5 punctate keratosis 13 and acrosyringeal variant. 14 Actually, variants of palmoplantar LP, with other clinical manifestations of LP may appear contemporaneously in an individual.…”

“…14 Actually, variants of palmoplantar LP, with other clinical manifestations of LP may appear contemporaneously in an individual. [3][4][5]9,15,16 There are case reports indicating hyperkeratotic palmoplantar plaques accompanying oral manifestations and typical cutaneous lesions of LP. 4,15 Likewise, plantar ulcero-erosive lesions of LP have been described with longitudinal melanonychia, reticular oral LP, and post inflammatory hyperpigmentation.…”

“…4,15 Likewise, plantar ulcero-erosive lesions of LP have been described with longitudinal melanonychia, reticular oral LP, and post inflammatory hyperpigmentation. 9,16 Up to date the most comprehensive investigation regarding palmoplantar LP has been held by Sanchez-Peres et al 5 Although it can't be figured out which combinations of clinical presentations their patients had displayed, they reported that simultaneous appearance rate of LP in the palmoplantar region and elsewhere was 26%. In this study the palmoplantar lesions were classified according to prevailing morphological patterns, as the erythematous scaly variant was the most common type observed, occurring in three-quarters of the patients, and the hyperkeratotic pattern was the second most prevalent one, described in the remaining one-quarter.…”