DOI: https://doi.org/10.36347/sasjm.2026.v12i06.004

Pages: 595-598

Bullous lichen planus is an exceptionally rare vesiculobullous variant of lichen planus in children and represents a significant diagnostic challenge because of its clinical overlap with infectious and autoimmune blistering disorders. We report the case of an 8-year-old girl presenting with a chronic generalized pruritic vesiculobullous eruption evolving for one year and not responding to multiple courses of antibiotics. Dermatological examination revealed widespread flaccid vesicles and bullae associated with post-bullous erosions arising on hyperpigmented macules involving the trunk, limbs, flexural regions, and external genitalia. Simultaneously, slate-gray pigmentation of the face and neck was also noted. Histopathological examination revealed acanthosis, orthokeratotic hyperkeratosis, subepidermal blister formation, and a dense lichenoid inflammatory infiltrate at the dermo-epidermal junction, consistent with bullous lichen planus. Direct immunofluorescence was negative. Systemic corticosteroid therapy with prednisone at 1 mg/kg/day resulted in marked clinical improvement. Bullous lichen planus is considered a hyper-reactive form of lichen planus secondary to severe basal keratinocyte degeneration leading to dermo-epidermal cleavage. Because of its rarity and polymorphic presentation, diagnosis is frequently delayed, particularly in pediatric patients. Histopathology remains essential for distinguishing this condition from bullous impetigo, dermatitis herpetiformis, pemphigus, and other vesiculobullous dermatoses. This case emphasizes the importance of early recognition of bullous lichen planus in children presenting with chronic blistering eruptions in order to avoid misdiagnosis, unnecessary treatments, and prolonged disease evolution.