Bilateral Burning Palmoplantar Lesions

A 59-year-old woman with a history of type 2 diabetes, liver dysfunction, thyroid nodules, vitamin deficiencies, and diffuse androgenic alopecia presented with hypopigmented, ivory papules and plaques on her palms and soles, which were initially misdiagnosed as plaque psoriasis. Despite treatment with high-potency topical steroids and biologics, her condition did not improve. A punch biopsy revealed lichen sclerosus (LS), a rare chronic inflammatory skin condition often underdiagnosed and characterized by porcelain-white atrophic plaques. LS is associated with autoimmune diseases and can present with debilitating symptoms, though it is rare for it to affect the palms and soles without genital involvement.