Abstract

Lichen planus is commonly seen inflammatory disease that involves the mucosae and skin. The incidence of lichen planus is 0,1-4%. Palmoplantar lichen planus is a rare variant of the disease. Palmoplantar lichen planus has many clinical forms. Erosive or ulcerative palmoplantar lichen planus is a very rare form of classical lichen planus that often involves oral and genital mucosae. A 59-year-old woman presented to our clinic complaining with a painful wound on her right heel that did not heal despite long-term treatments. Biopsy was performed with a initial diagnosis of squamous cell carcinoma. As a result of biopsy, lichen planus was diagnosed. In the dermatological examination of the patient, there was no other skin lesion of lichen planus. The patient was also being followed and treated by rheumatology with the diagnosis of Sjogren's syndrome. She had ANA + in her blood test analysis. Systemic steroid, oral retinoid and PUVA treatments were received to the patient. Partial recovery was achieved in the patient. Erosive plantar lichen planus have been very few reported in the literature. Erosive plantar lichen planus is difficult to treat and its treatment have not been standardized because of rarity. In the literature, ıts associations with autoimmune thyroiditis, primary biliary cirrhosis and Sjögren's syndrome have been reported. Herein, we'd like to present this female case because is rare variant of classical lichen planus and accompanies Sjögren's syndrome.

Keywords

• erosive lichen planus
• plantar
• plantar
• sjögren syndrome
• ulcer
• autoimmunity

Eroziv plantar liken planus: olağan bir hastalığın nadir klinik varyantı

Abstract

Liken planus sık görülen mukoza ve deriyi tutan inflamatuar bir hastalıktır. Liken planus insidansı %0,1-4’tür. Palmoplantar liken planus ise hastalığın nadir görülen bir variantıdır. Palmoplantar liken planus’un birçok klinik formu vardır. Eroziv veya ülseratif palmoplantar liken planus, klasik liken planusun çok ender görülen ve daha ziyade oral ve genital mukozaları tutan bir formudur. 59 yaşındaki kadın hasta kliniğimize, sağ ayak topuğunda uzun süredir uygulanan tedavilere rağmen iyileşmeyen ağrılı yara şikayeti ile başvurdu. Skuamöz hücreli karsinom ön tanısı ile biyopsi yapıldı. Biyopsi sonucunda liken planus tanısı konuldu. Hastanın yapılan dermatolojik muayenesinde liken planusa ait başka bir deri lezyonu yoktu. Hasta aynı zamanda romatoloji tarafından Sjögren tanısı ile takip ve tedavi edilmekte idi. Kan analizlerinde ANA + idi. Hastaya sistemik steroid, oral retinoid ve PUVA tedavileri uygulandı. Hastada kısmi iyileşme sağlandı. Eroziv plantar liken planus literatürde çok az sayıda bildirilmiştir. Eroziv plantar liken planusun tedavisi ender görülmesi sebebiyle zordur ve standardize edilememiştir. Literatürde otoimmün tiroidit, primer bilier siroz ve Sjögren sendromu ile birliktelikler bildirilmiştir. Bu kadın olgumuzu, klasik liken planusun nadir bir varyantı olması ve Sjögren sendromuna eşlik etmesi nedeniyle sunmayı uygun bulduk.

Keywords

• Eroziv liken planus
• plantar
• Sjögren sendromu
• ülser
• otoimmünite

References

1. Usatine RP, Tinitigan M. Diagnosis and treatment of lichen planus. Am Fam Physician. 2011;84:53-60.
2. Sinha S, Sarkar R, Garg VK. Palmoplantar lesions of lichen planus. Indian J Dermatol. 2018;63:57-61. https://doi.org/10.4103/ijd.IJD_161_17
3. Kılıç FA, Baysak S, Eşim AG, Lebe B. A case of erosive lichen planus with plantar involvement, Turkderm-Turk Arch Dermatol Venereology 2017;51:129-132. https://doi.org/ 10.4274/turkderm.48991
4. Likar-Manookin K, Stewart C, Al-Hashimi I, et al. Prevalence of oral lesions of autoimmune etiology in patients with primary Sjogren's syndrome. Oral Diseases. 2013;19:598-603. https://doi.org/10.1111/odi.12044
5. Romero W, Giesen L, Navajas-Galimany L, Gonzalez S: Erosive lichen planus: a therapeutic challenge. An Bras Dermatol 2016;91:84-86. https://doi.org/10.1590/abd1806-4841.20164046
6. Jimenez-Sanchez MD, Ferrandiz L, Moreno-Ramirez D, Vallejo-Benítez A, Camacho-Martinez F: Erosive palmoplantar lichen planus. Actas Dermosifiliogr 2012;103:448-450. https://doi.org/0.1016/j.ad.2011.10.010
7. Bayramgürler D, Demirsoy EO: Zorlu oral hastaliklarda güncel tedavi: oral liken planus, oral lökoplaki. Turkderm 2012;46:110. https://doi.org/10.4274/turkderm.46.s2.20