Purplish, pruritic papules on the limbs

Jennifer Clay Cather, MD, and M. Alan Menter, MD

From the Division of Dermatology, Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas.

Corresponding author: Jennifer Clay Cather, MD, 5310 Harvest Hill Road, Suite 260, Dallas, Texas 75230.

A 46-year-old white man presented with an acute 3- to 4-week history of an intensely pruritic eruption that mainly involved the limbs. Individual lesions appeared to predominate around the wrist flexures. Examination revealed multiple, flat, purplish lesions, 5 to 15 mm in diameter, with coalescence in areas of scratching (Figure 1). Whitish plaques were seen on the oral mucous membrane (Figure 2). The patient was otherwise well, although on further questioning he stated that he felt less energetic than usual. He reported no recent illness or medication ingestion.

What is the diagnosis, and what further laboratory tests are indicated?

DIAGNOSIS: Lichen planus.

(BUMC Proceedings 2001;14:449-451)