Surgical treatment of painful lichen planus of the hand and foot.

Lichen planus of the hands and feet, although uncommon, can be very disabling with painful hypertrophic areas or ulcers, mainly of palmar and plantar surfaces. These lesions may not respond to conventional medical treatment. A case of surgical treatment with excision and split skin grafting of ulcerative lichen planus of the soles, with a fourteen year follow up, is reported. Only three other reported cases with a longer review period could be found. A second patient is described in which excision and grafting of painful, hypertrophic, ulcerative lichen planus of the hands achieved a satisfactory long term outcome. No other examples could be found in the English literature. It is suggested that surgical treatment should be considered more often and sooner in painful lichen planus of the hands and feet.