A Generalized Reticulate Eruption with Scarring Alopecia, Vulvovaginitis, Keratoderma, and 20-Nail Dystrophy in a 70-Year-Old Woman

A 70-year-old woman with a history of oral lichen planus (LP) experienced a 2-year progression of symptoms including hairline recession, vulvovaginitis, keratoderma, nail dystrophy, and generalized reticulated hyperpigmentation. Examination showed desquamative gingivitis, white lacy plaques, 20-nail dystrophy, perifollicular erythema, and hairline recession. Histology confirmed LP with a band-like inflammatory infiltrate. Treatment with oral prednisone and methotrexate led to resolution of mucosal lesions and stabilization of hair loss after 2 months, although pruritus and hyperpigmentation persisted.