Summary

Introduction: Acral lichen planus (ALP) is an uncommon variant of LP, that can sometimes be difficult to diagnose, due to atypical clinical and dermoscopy features and resistance to different therapeutical means. We report the case of a female patient diagnosed with punctate keratotic lichen planus.

Case report: A 49-year-old female patient presented to the Dermatology Clinic of Mures Clinical County Hospital for multiple, severely pruritic, flat and yellowih-coloured papules confined in hyperkeratotic plaques located bilaterally on the palms and soles, in evolution for three months. Clinical, dermoscopical, and histopathological exa-minations further established the diagnosis of punctate keratotic lichen planus. Combined treatment with systemic corticotherapy and anti-H1 antihistamines, topical heparine gel 500 UI/g, twice a day and narrow-band UVB phototherapy was started with significant improvement at two months follow-up.

Conclusions: Keratotic punctate ALP is a very rare and uncommon variant of LP. Patients with punctate keratotic LP might benefit from treatment with topical heparine.