How do we treat an extensive case of lichen planus?

This 40-year-old man presented with a generalized eruption of multiple flat topped purple papules and plaques. How will you treat this patient? View more images of lichen planus

Lichen planus 

Erythema annulare centrifugum

Erythema annulare centrifugum is the commonest of the annular erythemas.It may have a trailing scale just behind the expanding edge of a lesion.This patient had multiple lesions some of which joined up to form larger polycyclic shapes.The lesions generally resolve over a three week period.Cases can be associated with infections,drugs,underlying collagen diseases such as lupus erythematosus and rarely internal malignancy.
I do not see this condition very often.If they do not have fungus in the groin or on their feet I am usually stumped in finding the cause.Have others been more successful? View Images

Psoriasis nails

Psoriasis of the nails can have a variety of presentations depending on which part of the nail apparatus the psoriatic process involves.If the nail matrix at the base of the nail is involved then you get pitting, occassionally furrows and often a crumbling nail plate.If the nail bed is involved then you get onycholysis or separation of the nail from the nail bed.People often misinterpret this as a fungal infection.Treatment of this condition is very limited.Topical steroid lotions rarely penetrate the posterior nail fold adequately to alter the process.Intralesional steroid injection is very painful.Methotrexate orally can be used for serious nail disease.
Do others have any other effective treatments? View Images

Tinea Facei

This young lady had a month's history of an expanding scaly area on her cheek.She had used a topical steroid cream and a topical antifungal preparation without effect.Scrapings grew Trichophyton mentagrophytes.It was likely she had acquired it from her friend's guinea pig View Images

PLEVA

I think this little girl had the inflammatory variant of Pityriasis lichenoides (PLEVA).The necrotic papules were suggestive.She was not ill.Chickenpox and an inflammatory reaction to molluscum contagiosum were also considered in the differential diagnosis.Lymphomatoid papulosis would not be so extensive.Her bloods were all normal.She responded to erythromycin after about a week's therapy.A viral exanthem would also be in the differential.She had a past history of Atopic eczema
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Papular Mucinosis

Papular mucinosis is a confusing subject. This lady has had these papular lesions on the nape of her neck for 5 years.She has no paraproteinaemia.Histopathology showed localised mucin deposition.She had no lesions elsewhere.This is presumably a localised form of lichen myxedematosus but it does not really fit the usual classification.Any comments? View Images

Urticarial Vasculitis

I usually think of urticarial vasculitis as an urticarial rash that lasts longer than 24 hours and is associated with hemorrhage into the skin.The hemorrhage will often appear at the edge of the urticarial wheals particularly on the legs.The histopathology is usually a lymphocytic vasculitis.I cannot say I have seen this picture on the hands before.Was a biopsy done?
I usually think of urticarial vasculitis as an early presentation of lupus erythematosus and do blood studies for any evidence. View Images

Topical retinoids to treat syringomas

Syringomas are benign tumors derived from the ductal portion of the eccrine unit. They appear as skin-colored or hyperpigmented papules, typically on the eyelids and cheeks of middle-aged women. Clinical variants of syringomas include solitary, eruptive, milia-like, lichen planus-like, and plaque-type. What is your experience with topical retinoids to treat syringomas? View images



PubMed search on Retinoids and Syringomas

Multiple lesions on the face and scalp

How to treat Molluscum contagiosum?

Molluscum contagiosum involving the face and scalp could be bothersome both for the parents and the affected children. How do you effectively treat this condition in your practice? View images

Hailey-Hailey Disease Inframammary

Involvement of inframammary areas

Hailey -Hailey disease is often complicated by secondary infection.Many times I feel that the infection is the factor that causes the condition to flare.When it is controlled the condition responds again to topical steroids.

This is a Google Scholar search on the topic.

Close up of the axillae

Role of topical antifungals in the treatment of onychomycosis

Onychomycosis may involve any component of the nail unit, including the nail matrix, the nail bed, or the nail plate. It is caused by three main classes of fungi: dermatophytes, yeasts, and nondermatophyte molds, but the clinical appearance is indistinguishable based on the species of fungus causing the infection. Based on the morphology, major subtypes include distal lateral subungual, white superficial, proximal subungual, and candidal.
Do the topical antifungals have a role in the treatment of onychomycosis? View images



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