History:

 A very pruritic, firm, skin-colored to brownish papules and palques with verrucous scaly surface involved the lower limbs of many months duration was diagnosed as lichen planus hypertrophicus. The main differentials were lichen amyloidosis (which is the most important DDx in this case), prurigo nodularis and widespread lichen simplex chronicus. Skin biopsy has confirmed LPH. The large number of lesions and wide areas involved made intralesional CS unsuitable mode of therapy! First trial was with topical ultra-potent CS ointment under occlusion plus oral antihistamines resulted in slight improvement that didn't stop the patient's suffering! Addition of systemic steroids (prednisolone 30 mg per day) gave significant improvement but the side effects and rebound on decreasing dose were problematic!!! Cyclosporine (Sandimmun) 5 mg per kg body weight divided in two equal daily doses greatly improved the condition (abolished itching and tremendously improved the rash). Two months later the dose was reduced to maintenance dose of 2.5 mg/kg/day and maintained on that.