Three cases of an unusual syndrome of lichen planus, characterized by bullae and ulcerations confined to the feet and toes, permanent loss of toenails, and a cicatricial alopecia of the scalp, are presented. Two similar cases and seven nearly identical cases from the literature are reviewed. How this syndrome might relate to other forms of bullous lichen planus, to the Graham-Little syndrome, and to some of the other unique changes associated with lichen planus is discussed. The distinctive feature is the chronic, painful, and often disabling ulceration of the feet. Such ulceration is a major problem of diagnosis unless the relationship of ulcers to lichen planus elsewhere on the body is apparent. Skin grafting to the affected surfaces has been a successful form of therapy.
CRAM DL, KIERLAND RR, WINKELMANN RK. Ulcerative Lichen Planus of the Feet: Bullous Variant With Hair and Nail Lesions. Arch Dermatol. 1966;93(6):692–701. doi:10.1001/archderm.1966.01600240058010
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