Papulosquamous disorders: lichen planus hypertrophic variant: practice question

A Dermatology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Dermatology · Papulosquamous disorders: lichen planus hypertrophic variant

Sample item

A 48-year-old has intensely itchy, thick, warty violaceous plaques on both shins for two years. Biopsy shows irregular acanthosis, hypergranulosis and a band-like lymphocytic infiltrate. Which treatment is the best first step?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Superpotent topical corticosteroid under occlusion

Hypertrophic lichen planus is thick and treatment-resistant, so a superpotent steroid under occlusion or intralesional triamcinolone is used first. Systemic retinoids or phototherapy are reserved for widespread or resistant disease.

Option by option

  • A. Superpotent topical corticosteroid under occlusion (correct)

    Correct. A superpotent steroid under occlusion penetrates thick plaques.

  • B. Oral penicillin

    Oral penicillin has no role in lichen planus.

  • C. Topical mupirocin

    Mupirocin is an antibacterial and the process here is not infective.

  • D. Oral ketoconazole

    Oral ketoconazole is an antifungal and does not treat an immune-mediated lichenoid disease.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Dermatology question

What is the answer to this Dermatology question?

The best answer is A, Superpotent topical corticosteroid under occlusion. Hypertrophic lichen planus is thick and treatment-resistant, so a superpotent steroid under occlusion or intralesional triamcinolone is used first.

Why is "Oral penicillin" not the answer?

Oral penicillin has no role in lichen planus.

Why is "Topical mupirocin" not the answer?

Mupirocin is an antibacterial and the process here is not infective.

Why is "Oral ketoconazole" not the answer?

Oral ketoconazole is an antifungal and does not treat an immune-mediated lichenoid disease.

What concept does this question test?

It tests Papulosquamous disorders: lichen planus hypertrophic variant in Dermatology. Systemic retinoids or phototherapy are reserved for widespread or resistant disease.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Papulosquamous disorders: lichen planus hypertrophic variant?

Learn each condition by its primary lesion, site and signature sign. Then use the flashcards and the other Dermatology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.