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44-Year-Old Woman with Purplish Papules Near Elbows & Shins

Can you diagnose this case?

David L. Kaplan 2014 Series Editor @ University of Missouri – Kansas City School of Medicine

Signs and Symptoms

A 44-year-old woman presents with slightly pruritic, purplish papules near the elbows and shins of several weeks’ duration. She has no history of trauma and takes no medication.

What does this look like to you?

Choose one to reveal diagnosis and discussion

Lichen spinulosus
Lichen amyloidosis
Lichen simplex chronicus
Lichen planus
Lichen nitidus

Answer: Lichen planus

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The flat-topped, purplish, polygonal papules are typical of lichen planus, D. Lichen spinulosus lesions are well-circumscribed plaques that contain follicular keratoses. Lichen amyloidosis presents with highly pruritic, hyperpigmented papules and plaques. The pruritic, hyperpigmented papules and plaques of lichen simplex chronicus are often scaly. Lichen nitidus features pinpoint lichenoid papules.

Agents that have been used to treat lichen planus include systemic corticosteroids, class II topical corticosteroids, topical tretinoin, griseofulvin, and dapsone.