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

April 2016 in “ Journal of the American Academy of Dermatology ”

scarring alopecia lichen planus hairline recession perifollicular erythema oral prednisone methotrexate hair loss prednisone

TLDR Treatment improved some symptoms but not all.

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.

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