DOI: 10.36347/sjmcr.2021.v09i12.029

Pages: 1223-1229

Background: Actinic lichen planus (ALP) is a rare variety of lichen planus localized in sun-exposed areas, usually present in patients with dark skin phototype residing in tropical and subtropical countries. It predominantly involves the sun-exposed areas on the face, neck, and forearms, and is frequently misdiagnosed owing to its clinical similarity to the other pigmented or photosensitivity dermatoses. Involvement of the scalp is very uncommon and may present a diagnostic challenge, especially if it resembles more common entities such as seborrheic dermatitis or discoid lupus erythematosus (dLE). Case Presentation: Here, we describe a case of a 45-year-old Indian man with a 6-month history of chronic and itchy hyperpigmented patch over the frontal scalp. The lesion had insidiously developed and was photoaggravated. The patient used to work in forest throughout the day and was not on any drugs at the time of arrival. On examination, she had a violaceous, scaly plaque restricted to the frontal scalp. Dermoscopy revealed Wickham striae which were corroborated on histopathological examination which revealed features characteristic of actinic lichen planus including basal cell degeneration, hyperkeratosis, and dense lichenoid lymphocytic infiltrate. Management and Outcome: The patient was managed with topical corticosteroids, oral antihistamines, and strictly photoprotective measures. Progression was noted within 4 weeks, but the lesion resolved with no subsequent recurrence at 8 weeks follow-up. Conclusion: This case highlights the need of including ALP in the differential diagnosis of chronic scalp dermatoses in sun‐exposed individuals. Early diagnosis and correct treatment with conservative therapy may achieve favorable clinical presentations. ALP of the scalp as predominant location is still a diagnostic challenge and it should be kept in mind, especially in tropical settings.