Bullous lichen planus in childhood – A case report / Bulozni lichen planus u dečijem uzrastu

In Europe, only 1% of all patients with lichen planus are children. We report a case of lichen planus in a 5-year-old boy with blisters developing on papules. There was no history of Hepatitis B virus vaccination in the past 12 months. Routine laboratory analyses showed no abnormalities. Hepatitis B surface antigen and anti-Hepatitis C virus antibodies were negative. Our patient had disseminated and coalesced papules on the trunk and extremities with vesicles and bullae on the hands and feet. Histopathology confirmed the diagnosis of lichen planus and bullous lichen planus. Negative direct immunofluorscence test excluded lichen planus pemphigoides. The boy was treated with prednisone 1 mg/kg/ day (the dose was gradually tapered and discontinued over the next 1.5 month), ultraviolet B phototherapy, fluocinolon acetonide, and topical pimecrolimus 1% cream till complete remission after 2.5 months. Bullous form of lichen planus is seen in 1-16% of all children with lichen planus. Two months upon the completion of therapy, there were no signs of relapse. In our case, short course of systemic corticosteroids and ultraviolet B phototherapy have been safe and effective. This was the only pediatric case of bullous lichen planus treated in our Clinic in the last 20 years. Long-term prognosis of childhood lichen planus is not predictable, and there is no consensus regarding the treatment of childhood lichen planus.