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Case Reports
. 2025 Apr 3;17(4):e81641.
doi: 10.7759/cureus.81641. eCollection 2025 Apr.

Lichen Planus Initially Presenting as Poikiloderma: A Challenging Case Report

Mehad Almoqati  1 , Renad Althobaiti  2 , Dai Zafer  1 , Asma S Alabbadi  2 , Razan Alluhaibi  3 , Khalid Al Hawsawi  3
Affiliations
Case Reports

Lichen Planus Initially Presenting as Poikiloderma: A Challenging Case Report

Mehad Almoqati et al. Cureus. .

Abstract

Lichen planus (LP) is a chronic inflammatory disorder that affects the skin, mucous membranes, nails, and hair. Cutaneous LP (CLP) is characterized by violaceous, polygonal, flat-topped papules and plaques that are intensely pruritic. Although it can develop on any part of the body, it most commonly affects the flexor surfaces of the wrists, lower back, and ankles. This report presents an atypical case of LP in a 33-year-old woman who initially exhibited poikilodermatous changes with bluish-gray patches, persisting for a decade. Due to the overlapping clinical and histopathological features, an extensive diagnostic workup including pan-computed tomography, lymph node biopsy, and immunohistochemistry was performed to exclude poikilodermatous mycosis fungoides. One year later, skin examination and histopathological evaluation revealed the classical features of LP, leading to a definitive diagnosis. This case highlights an unusual presentation in which poikiloderma preceded the classic clinical picture of LP. Our findings contribute to the existing knowledge of LP by emphasizing the importance of recognizing atypical presentations for accurate diagnosis and management.

Keywords: lichen planus; mycosis fungoides; poikiloderma; telangiectasia; violaceous papule.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Non-blanchable bluish to grayish and erythematous patches and poikiloderma over (A) the upper and lower extremities, (B) the upper chest, and (C) the anterior thighs
Figure 2
Figure 2. Few scattered atypical lymphoid cells in the upper dermis that infiltrated the lower epidermal layer in addition to finding melanin incontinence
Figure 3
Figure 3. Pan-CT revealing multiple bilateral inguinal enhancing lymph nodes (scale bar: 2.5 cm)
CT: computed tomography
Figure 4
Figure 4. Violaceous scaly papules and plaques with excoriations along her (A) upper extremities, (B) abdomen, (C) lower extremities, and (D) back
Figure 5
Figure 5. Hyperkeratosis, hypergranulosis, basal layer vacuolization, dense, band-like lymphocytic infiltrate, and melanin incontinence
See this image and copyright information in PMC

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