Case Presentation:
A 52-year-old woman with a known case of lichen planus was referred to our clinic with a large ulcerative lesion in the plantar area. Her lichen planus disease started 9 years ago with skin involvement and erosion of the oral mucosa. The patient was treated with cyclosporine tablets 100 mg three times a day and triamcinolone acetonide injection with a concentration of 5 mg/ml in the mucosal erosion site, which resulted in improvement of her mucosa and skin condition during the 3-year treatment period. No other diseases were mentioned in the medical history taken from her, and no drug treatments were mentioned except for the one prescribed for the treatment of lichen planus. Three years ago, the patient developed erythema in the sole area, which gradually progressed over 2 years and eventually led to erosion and ulceration (Figure 1).
A biopsy sample was taken from the lesion, and the pathologist reported findings consistent with lichen planus, including hyperkeratosis, irregular acanthosis, hypergranulosis, basal layer degeneration, band-like lymphocytic infiltration, civatte body, and melanin incontinence. Despite the treatment with cyclosporine tablets (100 mg, three times a day), no satisfactory clinical improvement was observed in the lesion. Additionally, the patient experienced an increase in blood pressure following the use of the drug. As a result, the medication was discontinued, and the patient was referred to our clinic for further evaluation and treatment.
After obtaining a detailed medical history, a clinical examination was performed on the patient. The examination revealed an ulcer in the sole of the foot with an irregular and crusted border. There were no signs of infection, and the lesion was exuding. No skin lesions were observed in other areas, and the mucous membranes of the mouth and genitals appeared to be free of erosions. Upon reviewing the pathology report and considering the patient’s refusal to undergo further sampling, a diagnosis of ulcerative lichen planus was proposed.
Routine blood tests were ordered for the patient, but no pathological findings were observed. She was prescribed methotrexate tablets at a dose of 15 mg per week and triamcinolone acetonide injection with a concentration of 5 mg/ml at monthly intervals as part of her treatment plan. After 8 months from the start of the treatment, there was partial recovery in the lesions, but the patient’s ulcer had not completely healed. Therefore, while re-examining the blood tests, tofacitinib 5 mg tablets were prescribed twice a day. After completing a one-month course of the drug, the patient’s ulcer completely healed, and no side effects were reported by the patient (Figure 1).