Atypical lichen myxedematosus: a rare case with complete resolution of skin

Abstract

Lichen myxedematosus (LM) is a rare disorder classified into three categories based on the type and distribution of skin lesions: generalised (scleromyxoedema), localised, and atypical variants. Scleromyxoedema, often associated with monoclonal gammopathy, exhibits multi-organ involvement and necessitates specific treatments such as intravenous immunoglobulin. Localised LM has benign characteristics and typically does not progress to scleromyxodema. The atypical variant does not meet the criteria of the previous two categories and may resolve spontaneously. We present a case of a 45-year-old woman who manifested an erythematous papular lesion on both shins over three months, which spontaneously resolved over one month. A skin biopsy confirmed the diagnosis of Lichen myxedematosus. However, clinical features were not suggestive of either Scleromyxodema or localised LM. The Patient was diagnosed to have an atypical variant of LM because the lesion, which was confined to bilateral shins, completely resolved within a month and was not associated with paraproteinemia. This report highlights the challenges in diagnosing and managing such atypical cases.