Description
A young man in his late 20s presented with a whitish eruption on his glans penis for the past 5 months. He occasionally reported mild itching and discomfort over the lesions. There were no symptoms during sexual activity or micturition. He was in a monogamous sexual relationship with his wife and denied having sexual activity outside his marriage. Genital examination showed whitish lacy reticular eruption on the glans penis extending onto the shaft of the penis (figure 1). There was the presence of a single white papule on the glans portion of the penis. There were no skin lesions on his body or other mucosal surfaces. Laboratory work-up for sexually transmitted infections (syphilis, HIV and hepatitis C virus) was negative. The patient did not give consent for a biopsy from the lesion. A diagnosis of the reticular pattern of genital lichen planus (LP) was made on clinical grounds. The patient was prescribed a superpotent topical steroid cream (clobetasol propionate 0.05%) to be applied once a day.
Figure 1.
Clinical image showing whitish lacy reticular lesion on the shaft of the glans penis extending proximally on the shaft of the penis.
LP is an autoinflammatory disease that demonstrates genital and extragenital manifestations. LP is a complex immunologic disease driven by cytotoxic T-cells directed against basal cells of the epidermis. Genital LP can result in pruritus, sexual dysfunction, pain and irritation.1 2 Oral Janus Kinase inhibitors have shown efficacy in treating genital LP without significant side effects.3 LP affects 0.5–1% of the general population in the third to sixth decade of life. A multicentre retrospective study done in France showed 15.7% of genital LP to have a lacy pattern.4
Learning points.
Non-infectious causes of genital lesions are a cause of concern for patients.
Isolated involvement of external genitalia can be seen in lichen planus (LP).
Genital LP commonly affects uncircumcised men.
Footnotes
Twitter: @rashlessdoctor
Contributors: The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content; gave final approval of the manuscript: BM and NS.
Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.
Competing interests: None declared.
Provenance and peer review: Not commissioned; externally peer reviewed.
Ethics statements
Patient consent for publication
Consent obtained directly from patient(s).
References
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