Abstract

A 14-year-old female presented with multiple dark coloured itchy lesions on legssince5 months On examination multiple violaceous papules to plaques of varying sizes 1cm - 5cm were present on the extensor aspects of legs forearm and dorsum of feet bilaterally Figs 1-3 Skin biopsy from the lesion showed hyperkeratosis hypergranulosis vacuolar degeneration of basal layer band of dense lymphocytic inflammatory infiltrate in the papillary dermis with perivascular histiocytic infiltrate confirming the diagnosis of lichen planus LP Fig 4 5 She was started on topical corticosteroids antihistamines and emollients After 3 months patient had aggravation of LP with patchy hair loss over the scalp On examination multiple smooth alopecic patches of varying sizes the largest being 4 x 3 cm were noticed on the scalp She was diagnosed clinically as alopecia areata AA Fig 6 Investigations like complete blood count liver function test thyroid profile anti-nuclear antibody rheumatoid arthritis factor C-reactive protein ESR VDRL HBV HCV urine microscopy were normal In view of progressing lesions of LP and AA she was started on oral mini pulse therapy-betamethasone 5 mg twice weekly and was advised for follow up Good response was noticed by four weeks with resolution of LP and regrowth of hair over few patches