Lichen planus hypertrophicus

Age: 50 years
Gender: Male
Site: Legs
Duration: 6 months
History: Severe pruritus
Findings:
* Firm, skin-colored and brownish thick plaques with verrucous surface
* Some plaques are discrete and others are confluent
* No other site was involved and no mucous membrane, nail or scalp involvement
Differential diagnosis:
1. LP hypertrophicus
2. Prurigo nodularis
3. Lichen amyloidosis
4. Lichen simplex chronicus
Diagnosis: LP hypertrophicus (clinical and skin biopsy)
Treatment:
Ultra-potent topical CS under occlusion plus oral antihistaminics gave modest improvement. Oral prednisone 30 mg per day was added (discontinued few weeks later because of adverse effects!). Lastly, oral cyclosporine in a dosage of 5 mg per kg body weight per day was given instead of prednisone and the result was excellent. Two months later cyclosporine was reduced to 2.5 mg per kg per day as a maintenance dose.