Bullous Lichen Planus: Clinical Case Report

Abstract

Abstract 

Introduction: Lichen planus is an immuno-mediated inflammatory disease with a direct affection to basal keratinocytes and an estimated worldwide prevalence of around 1% has been reported, fourteen varieties of this disease have been described. The bullous lichen planus is a rare variant characterized by the appearance of vesicles or blisters on the typical lesions. These patients are diagnosed by the clinical presentation and histopathology; once the diagnosis is confirmed, they are treated mainly with topical or systemic corticosteroids depending on the clinical response. In cases with an inadequate clinical response, other drugs can be used. 

Objective: Describe the clinical approach, diagnosis and treatment of a patient with bullous lichen planus. 

Material and methods: Retrospective descriptive study, presentation of a clinical case of bullous lichen planus, in the Skin Center, Quito –Ecuador. 

Results: The case of a 37-year-old man who presented purple, itchy plaques on the back for 10 months was reported. That he presented tense blisters that spread to the extremities, head and oral mucosa. In the oral mucosa lesions, Wickham streaks were observed, which led to the suspicion of bullous lichen planus or pemphigoid, the diagnosis was confirmed by histopathological examination where subepidermal blister was evidenced on the lichenoid inflammation and the immunohistochemistry was negative. The patient was treated with oral systemic corticosteroids and topical therapy for the lesions, as well as methotrexate with favorable results. 

Conclusions: Bullous lichen planus is a rare immuno-mediated cutaneous disease; in patients with this pathology, a differential diagnosis with pemphigoid should be made by histopathology. This condition is very rare, which is why it should be taken into account when making a differential diagnosis with other skin conditions that are accompanied by blisters or vesicles.