Case Report
A 20-year-old female was referred to our clinic with generalized
reticular pruritic erythematous-violaceous eruption. The lesions had
appeared during the first year of life on her chest and gradually
progressed to the other parts. Repeated courses of topical
corticosteroids had been administered without any significant
improvement. Her past medical and family history was unremarkable.
Examination revealed keratotic violaceous papules arranged in a
reticular pattern with symmetrical distribution over the extremities and
trunk (Figure 1). The lesions were more confluent on the lateral trunk,
breasts, buttocks, and extremities. The individual lesions were
erythematous verrucous papules covered by a hyperkeratotic plug that
could be removed with difficulty.
There was an erythematous rosacea-like eruption on her face. The neck
was involved circumferentially and the scalp was scaly but scalp hair,
eyebrows, and eyelashes had a normal thickness and density. The nails
were dystrophic and greatly thickened and there were many keratotic
papules on the palmoplantar surfaces. She had tender erosions on her
tongue along with soreness sensation in her oral mucosa. Examination of
the other mucosal sites including genital mucosa and conjunctiva was
insignificant. There were no signs of internal organ involvement or
lymphadenopathy.
Routine laboratory data including complete blood count, ESR, CRP, liver,
and renal function tests were normal.
We performed skin biopsy with differential diagnoses of KLC, psoriasis,
hypertrophic lichen planus, and pityriasis rubra pilaris. Histologic
examination of the skin specimen revealed variable epidermal thickening
and areas of acanthosis and atrophy, hyperkeratosis, focal parakeratosis
with remnants of neutrophils, lichenoid interface reaction with
band-like sub-epidermal infiltration of lymphocytes and a few plasma
cells which were compatible with keratosis lichenoides chronica (Figure
2).
The diagnosis of KLC was considered based on typical clinical and
histopathologic findings and the patient was started in acitretin 25
mg/daily. This led to gradual improvement of the skin lesions with
prominent papular flattening and erythema reduction 3 months after
treatment commenced but her oral lesions did not demonstrate any
significant improvement.