Lichenoid keratosis successfully treated with topical Imiqui
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A 76-year-old man presented with an asymptomatic single skin lesion over the right temple. The patient reported that the lesion had been present for 2 weeks. No previous skin lesions had been noted by the patient at the same site. The lesion was stable in size, color and shape. Physical examination revealed a solitary violaceous thin plaque measuring 1.5x2 cm. Scalp, mucosal and nail examinations were normal. The patient was being treated with 5 mg Amlodipine/160mg Valsartan for hypertension and used Salbutamol and Budesonide/Formoterol inhalers for bronchial asthma.

A 3-mm punch biopsy was taken from the center of the lesion, which showed interface lympho-histocytic infiltrate with focal saw-tooth rete ridges and scattered necrotic keratinocytes. Solar elastosis was also noted in the upper dermis.

The lesion’s dermoscopic features in the first visit showed light brown pseudo network with fading regularly scalloped border, subtle grey circles, structureless pink white area and shine white blotches. White circles, scales and short thin serpentine vessels are also seen. The overall organized dermoscopic features and scales supports the diagnosis of lichenoid keratosis.

The patient was treated initially with mometasone cream and tacrolimus ointment once daily. After 12 days of treatments, there was no change observed in the lesion, so imiquimod 5% cream to be applied 5 days per week was prescribed. After 6 weeks of treatment, patient showed significant clinical improvement. No recurrence was observed after 7 months of follow-up. The lesion’s dermoscopic features after 7 months follow up suggested regression of lichenoid keratosis with great improvement.