Hyperkeratotic Palmoplantar Lichen Planus in a child
A 4-year-old male child was brought to our outpatient clinic with multiple pruritic, erythematous to violaceous, flat-topped papules and hyperkeratotic plaques on his both palms and soles since the last 4 months. The parents had also noticed some violaceous raised lesions on the upper back over the same period. There was no history suggestive of hepatitis and the child had not received any vaccination recently. On examination, multiple erythematous to violaceous plane-topped papules were present on the upper back []. Yellowish hyperkeratotic papules and plaques were noticed on both his palms and soles, with a few of the plaques showing a central crateriform depression []. Oral and genital examination was normal for his age. His routine laboratory investigations, including complete blood count (Hb: 13.8 g/dl, total leukocyte count: 5600/mm3), serum chemistry (BUN: 6.0 mg/dl, creatinine: 0.4 mg/dl, SGOT: 53 IU/l, SGPT: 19.0 IU/l), and urinalysis, were normal.\nScreening for hepatitis B and hepatitis C was negative. Dermatoscopy of a papule on his back revealed Wickham striae, whereas dermatoscopy of a plantar plaque showed a well-defined lesion topped with scales [Figures and ]. Skin biopsy was obtained from two sites (upper back and sole). Histopathology of the papule from the back showed a band- like lymphocytic infiltrate along the upper part of the dermis; vacuolar alteration of the basal layer; focal hypergranulosis; and necrotic keratinocytes, with saw tooth- like appearance of rete ridges []. Skin specimen from the plantar plaque showed compact hyperkeratosis, with focal parakeratosis, focal hypergranulosis, and colloid bodies []. A diagnosis of childhood LP with prominent palmoplantar involvement was made.\nThe patient was started on oral dapsone 25 mg (2 mg/ kg) daily, along with twice daily application of clobetasol propionate 0.05% cream and emollients.