Dermatology: Practical and Conceptual


Dermatology Practical & Conceptual

Letter | Dermatol Pract Concept. 2021;11(4):e2021123 1

Annular Atrophic Lichen Planus: A Case Report
Ruzica Jurakic Toncic1, Davorin Lončarić1, Stefano Caccavale2, Joan Garces Reñe1,  

Jaka Radoš1

1 University Hospital Centre Zagreb, Department of Dermatology and Venereology, School of Medicine University of Zagreb,  

Kispaticeva 12, Zagreb, Croatia

2 Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli,  

Naples, Italy 

Key words: annular atrophic lichen planus, dermoscopy, lichen planus, morphea

Citation: Toncic RJ, Lončarić D, Caccavale S, Reñe JG, Radoš J. Annular atrophic lichen planus: a case report.  
Dermatol Pract Concept. 2021;11(4):e2021123. DOI: https://doi.org/10.5826/dpc.1104a123

Accepted: March 21, 2021; Published: October, 2021

Copyright: ©2021 Toncic et al. This is an open-access article distributed under the terms of the Creative Commons Attribution  
License BY-NC-4.0, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original 
authors and source are credited.

Funding: None.

Competing interests: None.

Authorship: All authors have contributed significantly to this publication.

Corresponding author:  Ruzica Jurakic Toncic, MD, University Department of Dermatology and Venereology, University Hospital Center, 
Zagreb and University of Zagreb School of Medicine, Zagreb, Croatia. Email: rjtoncic@gmail.com

Introduction
Annular lichen planus (ALP) is considered one of the rarest 

clinical variants of lichen planus (LP). It is characterised by a 

few annular lesions commonly seen on penis and scrotum or 

in intertriginous areas, and it is usually very resistant to ther-

apy. Annular atrophic lichen planus (AALP) is considered as 

a distinctive subtype of ALP with histologically extensive elas-

tolysis caused by lymphatic cells [1-2]. Classical dermoscopic 

criteria for LP diagnosis are missing, diagnosis is therefore 

challenging, and histological evaluation is needed [1]. 

Case Presentation
A 20-year-old female, denying use of any medication or any 

medical history, sought dermatological examination because 

of the appearance of 2 asymptomatic lesions under her breast 

and in her groin fold. Both lesions were annular macules, 

sharply demarcated, violaceous, or brownish in colour with a 

shiny surface, measured 20 to 25 mm in long axis (Figure 1).  

Upon dermoscopic analysis, a pigmented pattern was seen 

with diffuse fine peppering or perifollicular pigmentation 

(Figure 2). A more reddish sub-mammillary lesion was biop-

sied and the histology revealed hyperkeratosis, atrophy of 

epidermis, hydropic degeneration of basal keratinocytes, and 

lichenoid dermal infiltrate with melanophages. Elastic fibers 

were diminished in upper dermis and the final diagnosis 

of AALP was reached (Figure 3). Laboratory examination 

showed negative results for both Hepatitis B and C infection. 

After 1 month of application of high-potency topical steroids, 

brownish pigmentation and scarring persisted.

Conclusions
In this variant of LP, characteristic dermoscopic criteria such 

as Wickham striae and vascular pattern were absent. Of 

substantial help was the discovery of a pigmented pattern 

due to pigment incontinence through which differential 

diagnoses such as morphea or granuloma annulare could 

be excluded. 



2 Letter | Dermatol Pract Concept. 2021;11(4):e2021123

Figure 1. (A) Clinical presentation of both lesions on the trunk, presenting as annular red to livid lesions.  

(B) Clinical presentation of the first lesion, close up view. (C) Close up view of the second lesion on the trunk.

Figure 2. (A) Dermoscopy of the first lesion, presenting with diffuse fine peppering or perifollicular pigmentation. Lesion seems pigmented, 

with reddish and brownish background. Pigmented pattern corresponds with pigment incontinence. (B) Dermoscopy of the second lesion, 

which clinically presented as more livid, brownish lesion. Peppering is more pronounced and background appears more gray, yellowish, and 

pink. Lesion is not sharply delineated at the periphery.



Letter | Dermatol Pract Concept. 2021;11(4):e2021123 3

References

1. Güngör Ş, Topal IO, Göncü EK. Dermoscopic patterns in active 

and regressive lichen planus and lichen planus variants: a mor-

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PMC4462898

Figure 3. (A) Histology of the lesion (H&E, x20). (B) Histology of the lesion, details revealing hyperkeratosis, atrophy of epidermis, hydropic 

degeneration of basal keratinocytes and lichenoid dermal infiltrate with melanophages (H&E, x40). (C) Histology, orcein stain, showing 

reduced elastic fibers, finding consistent with AALP.

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tol20203747