Atypical Hypertrophic Lichen Planus. Presented by Sidney Barsky, MD, George Engel, MD.
This 52-year-old man stated that his eruption began shortly after an auto accident four years previously. It involved his entire body and was diagnosed by several dermatologists as lichen planus. Within a year, most of the eruption cleared, leaving only small lesions on his forearms and larger lesions on both legs. They continued to enlarge and are neither pruritic nor painful. They occasionally become infected and drain purulent material.Cultures for typical and atypical mycobacteria and fungi were negative. Staphylococcus epidermidis was the only organism recovered. The complete blood cell count, serologic studies, and chest x-ray film were unremarkable. A skin biopsy specimen revealed hyperkeratosis, hypergranulosis, acanthosis, and spotty parakeratosis. The dermal papillae and the adjacent collagen showed edema and chronic inflammatory cell infiltrations, which were somewhat granulomatous in areas.
Dr. Peyton Weary: There is a possibility