A 50-year-old man comes to the physician for evaluation of an itchy rash on his extremities for the last several weeks. He was diagnosed with hepatitis C infection 6 months ago but refused further workup and treatment. His vital signs are normal. Skin findings are shown in the image below. The remainder of the examination is within normal limits.

Which of the following is the most appropriate treatment for this patient's current condition?

Question

A 50-year-old man comes to the physician for evaluation of an itchy rash on his extremities for the last several weeks. He was diagnosed with hepatitis C infection 6 months ago but refused further workup and treatment. His vital signs are normal. Skin findings are shown in the image below. The remainder of the examination is within normal limits.

Which of the following is the most appropriate treatment for this patient's current condition?

Quizplus · Accepted Answer

This patient's skin findings are consistent with cutaneous lichen planus (LP), an immunologically mediated skin disorder affecting mainly middle-aged adults. Although the etiology is unknown, cutaneous LP has been associated in some cases with hepatitis C. A clinically similar lichenoid eruption can also occur with exposure to certain medications (eg, angiotensin-converting enzyme inhibitors, beta blockers). Patients typically develop a papulosquamous rash that can involve the skin, nails, mucous membranes of the mouth, and external genitalia. The classic skin lesions are characterized by the 4 Ps (pruritic, purple, polygonal shape, and papules/plaques) and most commonly occur on the flexural surfaces of the ankles and wrists. Lesions may also show lacy white markings known as Wickham's stria. Wickham's stria The diagnosis of LP is mainly clinical, based on the appearance and distribution of lesions. Uncertain cases may require punch biopsy for confirmation. Topical high-potency corticosteroids are preferred as first-line treatment for cutaneous LP. Patients who do not respond to topical therapy may require oral corticosteroids or phototherapy. (Choices A and E) Emollients and topical vitamin D are adjunctive therapies for psoriasis, which causes symmetrically distributed plaques involving the scalp, elbows, knees, and back. The plaques are usually erythematous with sharply defined borders and silvery scale. psoriasis (Choice B) Oral lamivudine is an antiviral medication indicated for treatment of HIV and hepatitis B. It is not used for hepatitis C and is not useful for LP. (Choice C) Topical antifungals can treat tinea corporis, which usually presents as an erythematous, pruritic, oval-shaped patch or plaque. The rash usually spreads centrifugally, which is not consistent with this patient's skin findings. tinea corporis Educational objective: Lichen planus causes pruritic, purple, polygonal papules or plaques involving the ankles and wrists, nails, oral mucous membranes, or external genitalia. It has been associated with hepatitis C. Topical corticosteroids are first-line treatment. __________ References: Lichen planus: an update and review. (http://www.ncbi.nlm.nih.gov/pubmed/22908728) Diagnosis and treatment of lichen planus. (http://www.ncbi.nlm.nih.gov/pubmed/21766756)

A 50-Year-Old Man Comes to the Physician for Evaluation of an Itchy