Keratosis lichenoides chronica: a diagnosis to remember

Keratosis lichenoides chronica (KLC) or Nekam’s disease, is an uncommon dermatosis, assumed for years as a variant of another inflammatory dermatosis (such as cutaneous lupus erythematosus or lichen planus) but currently accepted as a distinctive condition. Although pathophysiologic mechanisms need further research, clinical aspects of KLC are well-characterised, particularly lichenoid hyperkeratotic papules arranged linearly or in a reticulate pattern over the extremities, seborrheic-like dermatitis on the face and oral or genital erosions. Histopathology usually shows lichenoid interface dermatitis with numerous necrotic keratinocytes and parakeratosis. Keratosis lichenoides chronica (KLC) typically has a chronic progressive course with poor response to treatment. In the following case, we present a 56-year-old man with chronic dermatosis whose clinicopathological findings allowed the diagnosis of KLC. The patient was treated with acitretin, topical steroids and topical calcineurin inhibitors with partial improvement of the lesions.