# Plantar Ulcerative Lichen Planus as a Therapeutic Challenge: A Review of Literature

## TL;DR

Plantar ulcerative lichen planus is a rare, painful skin condition on the soles with no standard treatment, requiring more research for effective management.

## Contribution

This paper reviews 18 PULP cases to summarize clinical features, comorbidities, and treatment responses, highlighting the lack of standardized care.

## Key findings

- PULP predominantly affects older women with a mean age of 63.7 years.
- Treatments like corticosteroids and JAK inhibitors showed variable effectiveness.
- Histopathology is essential for diagnosis, but therapeutic outcomes remain inconsistent.

## Abstract

Plantar ulcerative lichen planus (PULP) is a rare variant of lichen planus (LP), with fewer than 20 cases reported in the literature. It presents as chronic, painful ulcers on the soles, often without other classic LP manifestations. The condition remains poorly understood, with unclear pathogenesis and no standardized treatment. Diagnosis relies on histopathological confirmation. This review aims to summarize the clinical features, comorbidities, diagnostic approaches, and therapeutic outcomes of PULP based on available literature.

A literature search was conducted on PubMed and Google Scholar up to December 2024. Relevant articles reporting cases of PULP with available clinical and treatment data were included.

A total of 18 cases were identified. The condition showed a strong female predominance, with a mean age of 63.7 years. Some patients had mucocutaneous involvement, while others presented with isolated plantar disease. Painful ulcerations affecting ambulation were the main clinical feature. Common comorbidities included autoimmune and metabolic disorders. Diagnosis was confirmed by histopathological features consistent with LP. Reported treatments included topical and systemic corticosteroids, calcineurin inhibitors, retinoids, cyclosporine, dapsone, phototherapy, biologics, surgical interventions, and Janus kinase (JAK) inhibitors such as tofacitinib, with variable outcomes.

PULP is a rare, chronic, and treatment-resistant condition that leads to significant morbidity. Histopathology remains essential for diagnosis, but therapeutic response is inconsistent and lacks standardization. Further studies are needed to better characterize the condition and establish evidence-based treatment guidelines.