Familial Colocalization of Lichen Planus and Vitiligo on Sun Exposed Areas
The daughter is a 23 year old single woman, farmer with a known case of vitiligo for 10 years, presented with a history of pruritic skin eruptions that begun over her hands and feet, and extended to her forearm and face since 6 months earlier. Physical examination showed multiple hypopigmented vitiliginous patches over the hands, feet, posterior of thighs, knees, and arms with multiple pinkish to erythematous plaques over hands and feet. The patches were present over sun-exposed areas confined to depigmented vitiliginous areas with gradual violacious discoloration when extending to normally pigmented skin. There were also few violacious to brownish macules and plaques over the forearm, face and lips ().\nIn both patients oral mucosa and nails were normal and preceding vitiliginous areas including knees, trunk, legs and forearms were free of the new lichen skin lesions. Paraclinical and laboratory examinations including biochemistry tests (blood sugar, blood urea nitrogen, creatinine, electrolytes, liver enzymes, alkaline phosphatase, and bilirubin), the thyroid function test and serology tests of C3, C4, immunoglobulin (Ig)G, IgM, IgA, IgE, hepatitis C virus antibody, hepatitis B-surface antibody, antithyroid peroxidase antibody were all within normal limits except for the high level of IgE in daughter which was 435.90 KIU/L (normal range was up to 150).\nThe skin biopsy of lesions on hands confirmed lichen planus in both patients, showing hyperkeratosis, acanthosis, hypergranulosis, and basal cell liquefaction with civatte bodies associated with band like infiltration of chronic inflammatory cells in the dermis.\nOn the basis of the clinical and histological diagnosis of lichen planus, systemic and topical steroids were initiated. Marked improvement was achieved after one month resulting in lichen planus skin lesions with post inflammatory hyperpigmentation in non-vitiliginous areas and repigmentation of some previous vitiliginous areas as well ().