Understanding the Zebras of Wound Care: An Overview of Atypical Wounds

Elizabeth Ansert, DPM, MBA, MA; Anthony Tickner, DPM, FACCWS, FAPWCA, FAPWH; Donald Cohen, DPM; Weldon Murry, DPM; Samuel Gorelik, DPM


Wounds. 2022;34(5):124-134. 

In This Article

Lichen Planus

Lichen planus has a presentation that helps differentiate it from other wounds. It presents in the form of pruritic, polygonal, erythematous, and/or flat lesions, and it frequently occurs in patients with diabetes (Figure 3). There are many variants of lichen planus in the general population. Histopathologic examination reveals similar features between lichen planus and lichen planus variant lesions. Papules often present with a dry, shiny surface in streaks known as Wickham striae.[30] The lesions tend to favor flexor surfaces of the forearms, wrists, and ankles, as well as the hands, shins, and trunk. Oral lichen planus is also common and appears as white stripes with a reticular pattern. Lichen planus affects both men and women equally. Histopathologic features include wedge-shaped areas of hypergranular tissue in the epidermis that have a defined border. On microscopic examination, lichen planus also demonstrates saw-tooth acanthosis (overgrowth) of the rete ridges. These lesions usually self-resolve within a few years after onset. The treatment goals are to shorten the time to resolution and to provide symptomatic relief of the lesions and ulcerations. In addition to wound care management, management typically consists of topical corticosteroids or cyclosporine.[30,31]

Figure 3.

Lichen planus: (A) cutaneous lichen planus, (B) acral lichen planus, (C) acral lichen planus with hyperkeratotic papules and plaques, and (D) bizarre manifestation with diffuse keratoderma. Used with permission; Dockery G, Bakotic B. What you should know about lichen planus. Podiatry Today. 2007;20(6):52–60.