Lésions verruqueuses périnéales

Verrucous lichen planus (VLP), is a chronic inflammatory dermatosis mainly involving the lower limbs. It rarely affects the perineal area, where it occurs in association with other mucocutaneous lichen lesions. We here report the case of a 51-year old patient with isolated perineal verrucous lichen planus. The patient, who had no significant medical history, presented with painless, verrucous, slightly itchy lesions in the perineal area that had gradually increased in volume over the past 8 years. Clinical examination revealed the presence of multiple firm grayish budding lesions with a rough surface, measuring 1-4 cm in diameter, in the perianal and scrotal area (A). The remainder of the somatic examination was normal. Histology showed verrucous acanthotic epidermis associated with mainly lymphocytic inflammatory infiltrate penetrating the basement membrane and pigmentary incontinence with the formation of apoptotic bodies in the basal layer of epidermis, without signs of viral infection or malignant transformation (B). The diagnosis of verrucous lichen planus was retained. Hepatitis C serology, lipid assessment as well as abdominal ultrasound were normal. A very strong local corticosteroid therapy was prescribed. The patient had a favorable outcome without recidivism at 18-months’ follow-up.