Abstract

ORNELAS, Catarina  and  RODRIGUES, Ana. Lichen planus: a primary care perspective case report. Rev Port Med Geral Fam [online]. 2020, vol.36, n.2, pp.181-185. ISSN 2182-5173.  https://doi.org/10.32385/rpmgf.v36i2.12430.

Introduction: Lichen planus (LP) is an inflammatory chronic disorder that can involve the skin, esophageal, laryngeal, genital and the conjunctival mucous membranes. The estimated prevalence is in the range of 0.22 to 5% worldwide. Case description: Thirty-two years-old man with no relevant personal background, showed up to a primary care medical appointment complaining about pruritic cutaneous lesions with 3-weeks duration. They began in the ankles and spread to the wrists, forearms, and trunk, bilaterally. He denied contact with drugs, risky sexual exposure and other symptoms. The patient started by himself a 3-day course of benzyl benzoate. Since symptoms remained, he pursued the emergency department for help. He was diagnosed with contact eczema and medicated with mometasone cream without response. The physical exam revealed a symmetrical erythematous papule exanthem with the Koebner phenomenon, being the wrists the most problematic areas. It didn’t affect the scalp, plants nor the palms. The ankle showed erythematous scaly plaques and xerotic skin. He also presented a glans penis lesion measuring about 1 cm, with well-defined limits, slightly desquamative, with a cicatricial aspect of the centre. The following diagnostic hypotheses were assumed: secondary syphilis, pityriasis rosea, and LP. Due to clinical characteristics, pityriasis rosea was promptly excluded. Sexually transmitted diseases exams were performed and the patient medicated with hydroxyzine and moisturizing cream. Exams came negative, becoming clear an LP diagnosis. The patient was referenced to Dermatology to start systemic therapy. Commentary: The present clinical report reminds the relevance of a complete physical exam and anamnesis with a high suspicion index in the diagnosis of rare conditions in primary care. Also, it enhances the family physician’s importance in managing patient health care.

Keywords : Lichen planus; Diagnostic; Therapeutics.

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