Hypertrophic lichen planus (HLP), also known as lichen planus verrucosis, usually presents as papules or thick symmetrical hypertrophic plaques with purple to gray color in appearance and usually localized on pretibial region or distal parts of the lower extremities especially ankle areas. Hypertrophic lichen planus is more common in black men than whites. Marked thickening of the skin lesion is due to persistent itching. It is usually associated with chronic venous insufficiency.
Diagnosis is usually determined by its morphological characteristics. In some cases biopsy may be need to confirm the diagnosis. Other skin disease resembling hypertrophic lichen planus are lichen simplex chronicus, prurigo nodularis, cutaneous lichenoid amyloidosis.
The treatment of choice for hypertrophic lichen planus is corticosteroids, usually high potency corticosteroids with occlusive therapy or intralesional and systemic corticosteroids. In case of resistance, other therapy like PUVA or NB-UVB phototherapy, immunosuppressive drugs and systemic retinoids like acitretin has also been tried with good results but long term treatment may be required. When hypertrophic lichen planus persists for a long time, squamous cell carcinoma may arise over the lesion, few reports have mentioned. [1,2]
1. Manz B, Paasch U, Sticherling M. Squamous cell carcinoma as a complication of long-standing hypertrophic lichen planus. Int J Dermatol. 2005;44:773-4
2. Sengupta S, Das JK, Gangopadhyay A. Malignant transformation of hypertrophic lichen planus. Indian J Dermatol Venereol Leprol. 2006;72:470.
3. Bordel Gomez, Maria T. Infantile hypertrophic lichen planus An Pediatr (Barc). 2006, 64:396-7. – Vol.64 No. 04