Lichen Planus Associated With an Orthopedic Implant: A Report of a Rare Case

TL;DR

A man developed a rare skin condition near an orthopedic implant, suggesting the implant might have triggered an immune response.

Contribution

This case report highlights a rare instance of lichen planus possibly caused by an orthopedic implant.

Findings

Lichen planus occurred at the site of an orthopedic implant with no other known triggers.

The condition showed partial improvement with treatment but recurred quickly.

Orthopedic implants may act as antigenic stimuli for localized immune reactions.

Abstract

We report the case of a 56-year-old man who developed cutaneous lichen planus (LP) localized to the site of orthopedic hardware implantation one month following open reduction and internal fixation of an ankle fracture. The eruption was confined to the surgical scar and adjacent skin and demonstrated classic clinical features of LP, with no evidence of mucosal involvement. The patient denied exposure to known lichenoid triggers, including culprit medications, and hepatitis serologies were negative. Despite treatment with high-potency topical corticosteroids, systemic prednisone, and oral isotretinoin, the lesions exhibited only partial and transient improvement, with rapid recurrence upon discontinuation of therapy. Given the strict localization of disease to the implant site, absence of alternative triggers, and refractory clinical course, an implant-related immune-mediated reaction was suspected. Although lichenoid reactions to dental metals are well documented, reports of LP associated with orthopedic implants remain exceedingly rare. This case highlights the importance of considering implanted orthopedic hardware as a potential persistent antigenic stimulus in patients presenting with localized, treatment-resistant LP following surgical implantation.

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