Slide 16
Lesions resulting from Lichen planus

This slide shows a patient who presented to his primary care physician with penile irritation and ulceration. He was diagnosed as suffering from recurrent genital herpes and topical aciclovir was prescribed. This made no difference to the lesions, which persisted. Three months later, he came for a specialist opinion. All screening tests for STIs, including HSV swabs, were negative, and subsequent consultation with a dermatologist confirmed the symptoms to be due to Lichen planus. The patient was treated with a topical steroid and advised to use emollients for washing, and the lesions improved. It is essential that correct diagnostic tests be taken to confirm a new diagnosis of genital herpes, which can either detect the virus locally or use type-specific serological methods. In patients who have skin lesions without a confirmed diagnosis, it is important that follow-up is arranged to resolve differential diagnoses, which must always include ulcerating and erosive skin conditions such as Lichen planus. In this patient’s case, there were no typical perioral or wider cutaneous lesions to give the diagnostic clue.