Abstract
Zosteriform lichen planus is a variant of cutaneous lichen planus that may develop at the site of healed herpes zoster or may evolve spontaneously with no previous history of herpes zoster or varicella-zoster virus infection. Lichen planus is an immune-mediated disorder that affects the skin and mucous membrane. Nonetheless, its exact etiology remains unclear. The lesion consists of polygonal, pruritic, flat-topped papules that may coalesce to form a plaque. This is a case of a 39-year-old female presenting with a three-month history of pruritic skin lesion over the right side of her trunk. On dermatological examination, there were large, discrete, band-like, hyperpigmented, papular patches following Blaschko’s lines on the right side of the trunk and abdomen. The histological examination of a biopsy taken from the lesion showed hypergranulosis, sawtooth rete ridges, band-like inflammatory infiltrate, confirming the diagnosis of lichen planus and was treated with topical steroids. Based on the findings, a planer, pruritic skin rash that follows Blaschko’s lines distribution rather than dermatomal distribution should raise the suspicion of zosteriform lichen planus.
Highlights
Lichen planus (LP) has many clinical variants based on the morphology, site, and configuration of the lesion, including linear and zosteriform types [1]
There have been more than 20 clinical variants identified for LP based on the morphology, site, and configuration of the lesion [9]
There are two similar types; zosteriform LP, which accounts for 0.2% of lichen planus cases, and linear LP
Summary
Lichen planus (LP) has many clinical variants based on the morphology, site, and configuration of the lesion, including linear and zosteriform types [1]. In addition to LP, differential diagnoses of pruritic and pigmented skin lesion include linear psoriasis, lichen striatus, erythema dyschromicum, linear nevi, macular amyloidosis and post-inflammatory hyperpigmentation [2]. A 39-year-old female presented to our dermatology clinic with a three-month history of moderate pruritic, hyperpigmented patches over the right side of her trunk. No prior consult was sought, and no intervention was previously done Regarding her dermatological examination, it revealed multiple, hyperpigmented papules coalescing together forming a band-like shape over the right side of the trunk and abdomen. The initial list of differential diagnoses included lichen planus, erythema dyschromicum, linear epidermal nevus, macular amyloidosis, post-inflammatory hyperpigmentation. In order to confirm the diagnosis, a punch biopsy was taken from the lesion for a histopathological examination reporting the presence of hypergranulosis, sawtooth rete ridges and a band-like inflammatory infiltrates (Figure 2).
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