A 29-year-old caucasian female patient was referred to the Dermatology Outpatient Clinic of Hospital Universitario San Cecilio, Granada, Spain in 2018 with a pruriginous palmoplantar eruption over the previous five months that had not improved with the application of high-potency topical corticosteroids. She had no personal or family history of skin diseases. Recently, she denied the use of any medications. Dermatological examination revealed the presence of a well-defined diffuse erythema on

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... e palm of the hands that spared the fingertips and bilateral violaceous polygonal papules on the dorsum aspect of the hands [ Figures 1A & B ]. On the soles of her feet, well-defined erythematous patches sparing the plantar arch were observed [ Figure 1C ]. No involvement of other skin areas or mucosa was noted. Laboratory tests including complete blood count, general biochemistry, venereal research laboratory tests, hepatitis B and C and HIV serology showed normal results. In addition, an allergic contact dermatitis patch test was negative. Histolopathologic examination of a lesion on the dorsum of the right hand revealed orthokeratotic hyperkeratosis, irregular acanthosis, vacuolar degeneration of the basal layer and band-like lymphocytic infiltration on the papillary dermis [ Figure 2 ]. Therefore, the patient was diagnosed with palmoplantar lichen planus (PPLP). Treatment with isotretinoin was proposed at a dose of 0.5 mg/kg/day with a substantial improvement three months later. At present, the patient remains asymptomatic with periodic consultations. Psoralen and ultraviolet A (PUVA) therapy for localised disease was refused by the patient for her inability to attend due to work-related reasons. Comment PPLP is an uncommon entity of low prevalence on the clinical spectrum of lichen planus with an incidence rate of 12.9-26%. 1 This disease has a male predilection and the average age of onset of 38 years with a range of 9-72 years. 2 The absence of the typical polygonal violaceous papules, which were found on the dorsal aspect of both hands of the current patient, is not unusual; on the palms, the fingertips are usually spared. 3, 4 In general, of localised lichen planus cases become generalised with Figure 1: Photographs of the hands and feet of a 29-year-old female patient showing well-defined diffuse erythema (arrows) on both (A) palms and (B) dorsum sparing the fingertips and (C) well-defined erythematous patches sparing the plantar arch on both soles.