Rapid resolution of generalized lichen planus by tofacitinib: Assessment by polarized and ultraviolet-induced fluorescence dermoscopy

Lichen planus (LP) is a chronic, T-cell-mediated inflammatory disorder affecting the skin, mucosa, hair, and nails.LP commonly presents as violaceous, polygonal, flat-topped papules and plaques on the flexor surface of extremities, associated with intense pruritus.Although involvement of intertriginous areas and genitalia is uncommon, it may lead to diagnostic uncertainty and therapeutic resistance.erapeutic ladder for generalized LP includes systemic corticosteroids, retinoids, and immunosuppressants such as methotrexate and azathioprine. [1] Janus kinase-signal transducer and activator of transcription (JAK-STAT) pathway has emerged as a key factor in LP development, which supports the use of JAK inhibitors, including tofacitinib, for treatment. [2,3]rmoscopy serves as a useful, non-invasive tool for diagnosing LP and treatment response as well.Classically, it shows Wickham's striae, dotted and short linear vessels which disappear after successful treatment. [4]However, ultraviolet-induced fluorescent (UVF) dermoscopic assessment is not described in the literature.We report a case of generalized LP involving the genitalia extensively.It was successfully treated with short-term oral tofacitinib and a short course of systemic corticosteroids and assessed by both polarized and UVF dermoscopy.A 29-year-old male presented with severe pruritic, hyperpigmented papules and plaques involving extremities, thighs, and genitalia for 5 months [Figures 1 and2].e lesions were associated with intense itching.ere was no evidence of mucosal damage or nail abnormalities.No history of long-term medications for any systemic illness.Examination revealed violaceous to grayish papules and plaques on the scrotum, inner thighs, and extremities.Dermoscopic analysis was done using both polarized and UVF modes.Lesions on the scrotum revealed annular and linear Wickham striae, dotted vessels, brown dots, and scales in polarized mode [Figure 1], and annular and linear bluish-green fluorescence in UVF mode [Figure 1].While lesions on the thighs showed Wickham striae, focal yellow areas, white rosettes, scales, and dotted and short linear vessels in polarized mode [Figure 2], and linear and diffuse bluish-green fluorescence in UVF mode [Figure 2].Based on clinical and dermoscopic features, a diagnosis of LP was made.Blood investigations such as complete blood count, random blood sugar, liver function tests, renal function tests, lipid profile, echocardiography, and Mantoux test were within normal limits.