Extragenital lichen sclerosus et atrophicus co-exististing with pemphigus vulgaris

Indian Dermatology Online Journal | January-February 2017 | Vol 8 | Issue 1 57 In view of the pressure‐induced lesional changes, pain on weight bearing, and clinical morphology, we favored a diagnosis of PPP but our patient had several unusual features. Most importantly, majority of the lesions were relatively large in size (2.5–3.5 cm) in contrast to the existing literature (0.2– 2 cm, average 0.8 cm)[1,3‐5] and could therefore be labeled as nodules/tumors rather than papules. Obesity resulting in increased pressure on the heels may possibly explain the development of large PPP in our patient. Although increase in diameter of PPP with increasing age and body weight has been reported in children,[5] obesity as a factor in the development of PPP has not been suggested in adults. Furthermore, the lesions were only partially reducible on release of pressure in our case (and completely reducible only on manual reduction). In contrast, typical PPP lesions characteristically disappear on taking the foot off the ground. Hence, we propose the name piezogenic pedal tumors of obesity.