A 50-year-old farmer presents with intensely itchy, thick, verrucous, violaceous plaques over both shins present for 2 years. Biopsy shows irregular acanthosis with marked pseudoepitheliomatous hyperplasia and a band-like lymphocytic infiltrate at the dermoepidermal junction. What is the diagnosis?
- A Prurigo nodularis
- B Hypertrophic lichen planus ✓
- C Chronic plaque psoriasis
- D Squamous cell carcinoma
Correct answer: B. Hypertrophic lichen planus
Explanation
Hypertrophic (hyperkeratotic) lichen planus classically occurs as thick, warty, pruritic plaques on the pretibial skin, and histology combines the band-like interface infiltrate of lichen planus with prominent pseudoepitheliomatous hyperplasia. Prurigo nodularis lacks the band-like interface dermatitis, psoriasis shows regular rete ridge elongation with parakeratosis rather than a lichenoid band, and squamous cell carcinoma would show atypical keratinocytes invading the dermis, not a purely band-like lymphocytic infiltrate.
Reference: Rook's Textbook of Dermatology, 9th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.