Surgery and cyclosporine A in the treatment of erosive lichen planus of the feet

Abstract

Erosive lichen planus is known to be relatively unresponsive to medical treatment. Surgery could be an alternative treatment for this disease. We report the case of a 68-year-old man with a 10-year history of painful, disabling, ulcerative lesions on the soles of both feet. All previous topical and oral treatments had failed and his condition was gradually worsening. Cyclosporine A was administered twice. The first time, systemic cyclosporine A gave a marked but only temporary improvement. The second time, treatment with cyclosporine A was begun 10 days before the ulcer on his left sole was covered with a Thiersch split-skin graft. The grafting was successful, so cyclosporine A was gradually reduced to smaller maintenance doses and 10 months later it was completely withdrawn. The patient refused to undergo surgery on his right foot thus providing the opportunity to compare the results. At the present time, eighteen months following grafting and ten months after total withdrawal of cyclosporine A, the condition of the left sole is stable and free from pain while the ungrafted ulcer on his right sole is still painful and has increased in size.