Alex Johnson

50 male African-American Married with three children

Hypertension (well-controlled), no known drug allergies, no history of chronic skin conditions.

• Itchy, purple-colored bumps or lesions on the wrists, ankles, and lower back • Symmetrical distribution of lesions • Burning sensation in the mouth, especially when eating spicy foods • No history of trauma to the affected areas • No known new medications or significant environmental changes • Increased pruritus at night

Multiple, well-defined, flat-topped papules with a shiny, violaceous (purple) appearance. wrists, ankles, lower back, and inner aspects of the forearms and shins.

Mild nail pitting and longitudinal ridging, which can be seen in up to 10-30% of patients with lichen planus.

1. Laboratory Results: o CBC (Complete Blood Count): Within normal limits. o Liver Function Tests (LFTs): Normal, ruling out hepatitis (which is sometimes associated with lichen planus). o Serology for Hepatitis B and C: Negative, as viral hepatitis is known to have a relationship with lichen planus in some cases. 2. Histology Results: A skin biopsy of an affected lesion shows: o Hyperkeratosis: Thickened stratum corneum. o Interface dermatitis: Damage to the basal layer of the epidermis with vacuolar degeneration. o Lymphocytic Infiltrate: A dense band-like lymphocytic infiltrate at the dermoepidermal junction. o Sawtooth Appearance: The rete ridges are elongated and irregular, giving the characteristic sawtooth appearance seen in lichen planus. o Absence of granulomas or infection: This helps differentiate lichen planus from other inflammatory or infectious skin conditions.

Psoriasis atopic dermatitis lupus oral candidiasis

Lichen Planus

Phototherapy laser therapy

Corticosteroids both topical and oral , oral retinoids calcineurin inhibitors, tacrolimus