A 43-year-old man was referred to dermatology for evaluation of lesions on his volar wrists that had been diagnosed as lichen planus. The lesions had been present for several months and were unresponsive to fluocinolone cream and oral cephalexin 500 mg 3 times a day for a week. At times, the lesions itched terribly. The patient was otherwise healthy and had no odier rashes. He had not traveled internationally, been exposed to new animals, or started any medications. No one around him was similarly afflicted. Examination revealed numerous discrete, whitish planar papules and nodules on the patient's volar wrists (Figure 1). The lesions were somewhat atrophic and smooth to the touch. No erythema could be detected, and no other lesions were seen. Punch biopsy showed a lichenoid infiltrate at the dermoepidermal junction and compact hyperkeratosis in die stratum corneum, which was diicker dian the greatly effaced epidermis. Marked edema was also evident in die upper dermis.
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