10.5826/dpc.1401a56
text/xml
2160-9381
3636
en
Simone Ribero
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
palms
Clinical and Histopathological Findings in Palmoplantar Lichen Planus Presenting as Diffuse Keratoderma 
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2024-01-31
2023-06-23
2024-01-31
2024-02-21
e2024056
Dermatol Pract Concept
Simone Ribero
2024/01/31
10.5826/dpc.1401a56
e2024056
Department of Medical Sciences, University of Turin, Dermatology Clinic, Turin, Italy
2160-9381
palms
en
e2024056
Gutte R, Khopkar U. Predominant palmoplantar lichen planus: a diagnostic challenge. Indian J Dermatol. 2014;59(4):343-347. DOI: 10.4103/0019-5154.135477. PMID: 25071250. PMCID: PMC4103267.
Clinical and Histopathological Findings in Palmoplantar Lichen Planus Presenting as Diffuse Keratoderma 
https://dpcj.org/index.php/dpc/article/download/3636/2533
               Clinical and Histopathological Findings
              in Palmoplantar Lichen Planus Presenting
                        as Diffuse Keratoderma
Gianluca Avallone1, Isotta Giunipero di Corteranzo1, Rebecca Senetta2, Gabriele Roccuzzo1,
                             Pietro Quaglino1, Simone Ribero1


1 Department of Medical Sciences, University of Turin, Dermatology Clinic, Turin, Italy
2 Pathology Unit, Department of Oncology, University of Turin, Turin, Italy



Key words: lichen planus, palmoplantar lichen planus, lichenoid dermatitis, keratoderma, palms
Citation: Avallone G, Giunipero di Corteranzo I, Senetta R, Roccuzzo G, Quaglino P, Ribero S. Clinical and Histopathological Findings in
Palmoplantar Lichen Planus Presenting as Diffuse Keratoderma. Dermatol Pract Concept. 2024;14(1):e2024056. DOI: https://doi
.org/10.5826/dpc.1401a56
Accepted: August 9, 2023; Published: January 2024
Copyright: ©2024 Avallone et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: Quaglino P, Ribero S. contributed equally to this article and share senior authorship.
Corresponding Author: Gianluca Avallone, MD, Section of Dermatology, Department of Medical Sciences, University of Turin, Via
Cherasco 23, 10121, Turin, Italy. Telephone: +390116335843 Fax number: +390116335034 E-mail: gianluca.avallone2@gmail.com
Acknowledgment: the patients in this manuscript have given written informed consent to publication of their case details




Introduction                                                             was unremarkable and extensive anamnesis failed to iden-
                                                                         tify any suspected drug or potential infectious trigger. The
Palmoplantar lichen planus (PPLP) is a rare and poorly de-               routine laboratory tests were in normal ranges and serol-
scribed entity which frequently does not present the typical             ogy for hepatitis B and C were negative, as well as VDRL
clinicopathological features of lichen planus (LP) [1]. The              and TPPA for syphilis. Upon physical examination, smooth
protean spectrum of manifestations along with its overall                yellowish-orange patches and plaques sparing the nail ap-
rarity make PLPP a challenging clinical scenario [2].                    paratus were seen on the patient soles. Similar lesions were
                                                                         noted over both the palms of the hands. A punch biopsy per-

Case Presentation                                                        formed on the plantar surface of the right medial arch re-
                                                                         vealed hyperkeratosis, focal wedge-shaped hyper-­granulosis,
Herein, we report on a 54-year-old woman referred to our                 irregular acanthosis, saw tooth-shaped epithelial rete ridges,
Dermatology unit for palmoplantar itching appeared two                   sporadic epidermal colloid bodies and lymphohistiocytic
months before. Her medical history was positive for esoph-               ­inflammatory infiltration in the papillary dermis (Figure 1,
ageal candidiasis and biopsy-confirmed vulvovaginal and                  A-D). According to the clinical and histopathological find-
oral lichen planus, successfully treated with high-potency               ings, a diagnosis of PPLP presenting with diffuse kerato-
topical steroids three years before. The patient family history          derma pattern was made.




Research Letter | Dermatol Pract Concept. 2024;14(1):e2024056                                                                          1
Figure 1. (A) Smooth yellowish-orange patches and plaques on the patient soles. (B) Erythematous-yellowish patches and plaques on the
patient palms. (C) Hyperkeratosis, focal wedge-shaped hypergranulosis, irregular acanthosis, areas of spongiosis, and scattered epidermal col-
loid bodies. In the papillary dermis, lymphohistiocytic inflammatory infiltration vaguely arranged in a band-like pattern (H&E 8×). (D) Inter-
face dermatitis with areas of focal epidermal exocytosis and lymphohistiocytic inflammatory infiltration in the papillary dermis (H&E 20x).




Discussion                                                               lesions forming a palm-plantar keratoderma pattern [3].
                                                                         This unreported association of PPLP with oral and genital
To date, several morphological patterns of PPLP lesions have             LP provides further data on this underrecognized clinical
been described: erythematous plaques, punctate keratosis,                condition, with the aim of supporting clinicians in the differ-
diffuse keratoderma and ulcerated lesions [3,4], yet diffuse             ential diagnosis with similar diseases, such as palmoplantar
keratoderma presentation has been described in only few re-              keratoderma. While banded infiltrates and parakeratosis are
ports [1-5]. Such presentation may represent an isolated form            not consistently found in PPLP and not essential features for
or may be associated with a previous history of lichen planus            the diagnosis in the presence of other suggestive ones, the
in other sites. In a study on 18 patients with LP lesions, either        histological assessment remains mandatory to achieve the
predominantly or exclusively on palms and/or soles, the dif-             diagnosis [3]. The reasons why the LP presentation appears
fuse palmar keratoderma presentation was reported only in                atypical only in certain cases, the frequency, clinical course,
one patient. The histology reported compact hyperkeratosis               and possible molecular mechanisms underlying have yet to
with epidermal hyperplasia, hyper-granulosis and a band-like             be established. Albeit rare, this variant should be considered
infiltrate of lymphocytes [5]. Moreover, S­ anchez-Perez et al           when dealing with unusual LP clinical pictures, aiming at
identified 36 patients with LP affecting the palmoplantar                preventing diagnostic delay and at promptly performing
area, two of whom presented with a diffuse hyperkeratotic                suitable diagnostic tests, when needed.



2                                                                            Research Letter | Dermatol Pract Concept. 2024;14(1):e2024056
Conclusions                                                         Sultan Qaboos Univ Med J. 2019;19(1):e79-e80. DOI:
                                                                    10.18295/squmj.2019.19.01.016. PMID: 31198602. PMCID:
In conclusion, we have reported an atypical PPLP case with          PMC6544058.
                                                                 3. Sánchez-Pérez J, Rios Buceta L, Fraga J, García-Díez A. L
                                                                                                                            ­ ichen
diffuse keratoderma pattern associated with typical oral and
                                                                    planus with lesions on the palms and/or soles: prevalence
genital LP. Further research is warranted to shed light on the      and clinicopathological study of 36 patients. Br J ­Dermatol.
pathological mechanisms underlying of this peculiar clinico-        2000;142(2):310-314.DOI: 10.1046/j.1365-2133.2000.03303.x.
pathological picture.                                               PMID: 10730766.
                                                                 4. Landis M, Bohyer C, Bahrami S, Brogan B. Palmoplantar ­lichen
                                                                    planus: A rare presentation of a common disease. J ­Dermatol
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Research Letter | Dermatol Pract Concept. 2024;14(1):e2024056                                                                    3
