This 40 year old woman had a history of an erythemato-papular rash on the trunk and the extensor surfaces of the arms: initially diagnosed as Lichen Ruber Planus, she underwent UV-B treatment with a severe flare-up of the cutaneous involvement. Further investigation revealed the presence of antinuclear autoantibodies and was therefore referred to our Department.
On admission she had arthralgia, weakness, malar rash, and an erythemato- papular eruption with scaling on the anterior surface of the neck, the upper trunk, the extensor surface of the arms and the dorsa of both hands. Furthermore, microhematuria, antinuclear, anti SS-A and anti SS-B antibodies were found.
She was therefore treated with deflazacort (30mg/d) and isotretinoin (40mg/d, i.e. 0.8mg/Kg/d) with the lesions improving slightly but not completely: the erythemato-papular plaques on the trunk slowly extended peripherally to assume an annular-polycyclic pattern.
After 6 months, isotretinoin was withdrawn.
The treatment was continued with steroids and antimalarials with very slow resolution of the inflammatory lesions and residual areas of hypopigmentation (click for detail).
Clinical and histological differentiation of Lichen Planus and Cutaneous Lupus Erythematosus may sometimes be difficult. LP-LE overlap syndrome has been proposed for the diagnosis of rare cases.
Unfortunately we have no records of this patient's initial manifestations: nonetheless we may learn from this experience that adequate follow-up, repeated biopsies and laboratory investigations may help whenever a clear diagnosis of LP or LE can not be made.