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July 2003

Verrucous Plaques on the Leg—Diagnosis

Author Affiliations
 

MICHAEL E.MINGMD

Arch Dermatol. 2003;139(7):933-938. doi:10.1001/archderm.139.7.933-a

The skin biopsy specimen demonstrated hyperkeratosis and marked irregular epithelial hyperplasia extending into the midreticular dermis. There was a moderately dense lichenoid lymphocytic infiltrate with colloid body formation. The lichenoid infiltrate was most often concentrated near the tips of the rete ridges, with relative sparing of the papillary tips. The histologic features were diagnostic of hypertrophic LP.

The patient was treated with clobetasol propionate ointment under occlusion every evening at bedtime and with lactic acid cream every morning. After 1 month of this treatment regimen, she had significant improvement of her lesions, including flattening of the lesions, decreased hyperkeratosis, and decreased pruritus. After 4 months, there was resolution of all but 2 small persistent hyperkeratotic lesions, which subsequently resolved with intralesional triamcinolone therapy. The patient's condition remained in remission, with mild atrophy and postinflammatory hyperpigmentation at 8 months (Figure 4). Occasional use of topical glucocorticoid cream for flares of pruritus and continued use of topical emollients are required to keep her LP in remission.

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