Palmo-plantar lichen sclerosus et atrophicus

Introduction

Lichen sclerosus et atrophicus is an uncommon disease with small, white areas on the skin. It is most common on the vulvar and perianal areas but may be seen anywhere, with the mo: common extra-genital sites being on the trunk an limbs.[1] The extra-genital cutaneous lesions of LSD consist of flat - topped, white macules that tend to coalesce to form white patches. Often, small, comedo-like follicular plugs are seen on their surface.[2] In the later stages, atrophy occurs and the surface of the lesions becomes wrinkled and may actually be depressed.[1]

Case Report

A 58-year-old man had multiple, asymptomatic, hypopigmented to depigmented guttate macular lesions on the hands and feet for the last 6 months. The lesions initially appeared on the dorsa of hands, gradually increased in size and number and subsequently appeared on the palms, soles, dorsa of feet and flexor surfaces of wrists.

The lesions were of varying size, polygo-nal in shape, angular in out-line, with well-defined mar-gins, atrophic with a wrinkled sur-face and at places, coa lescing to form large lesions. At other places, individual lesions were present in a grouped fashion. Koebner phenomenon was evident in some of the lesions. An erythematous halo surrounded some of the lesions on the dorsa of hands. The anogenital region was uninvolved. The results of the rest o physical examination were normal. Histologic study of lesion revealed the typical feature of LSA. The epidermis was covered by a thick, hyperkeratotic scale with plugging of the adnexal orifices. The rete was thin and there was vacuolation of the basal cells. A broad zone of edema was present in the sub-epidermal area and there was conspicu ous dilation of the thin- walled vessels. Beneath this, in the mid-portion of the corium, there was diffuse, perivascular infiltrate of lymphocytes.

Discussion

Lichen sclerosus most commonly affect the anogenital area (85-98% of cases)with extra genital lesions 15-20% of patients.[3],[4] Involvement of plams with LSA has been reported by Purres and Krull.[5] but their patient also had wide spread cutaneous involvement. Wustner and Gartmanr recorded palmar and plantar keratotic papules it twins,[6] but these cases also had typical involvement of the genitals. This patient is being reported for the distinctive distribution of the lesions of LSA or hands and feet, which is a rarity in presentation and that LSA should be added to the differentia diagnosis of palmar-plantar eruptions.