Ulcerative lichen planus of the feet. Bullous variant with hair and nail lesions

Abstract

Three cases of an unusual syndrome of lichen planus, characterized by bullae and ulcerations confined to the feet and toes, permanent loss of toenails, and a cicatricial alopecia of the scalp, are presented. Two similar cases and 7 nearly identical cases from the literature are reviewed. How this syndrome might relate to other forms of bullous lichen planus, to the Graham-Little syndrome, and to some of the other unique changes associated with lichenplanus is discussed. The distinctive feature is the chronic, painful, and often disabling ulce ration of the feet. Such ulce ration is a maj or problem of diagnosis unless the relationship of ulcers to lichenplanus elsewhere on the body is apparent. Skin grafting to the affected surfaces has beenasuccessfulform of therapy.