Lichen Planus Pigmentosus Refractory to Topical Corticosteroids and Calcineurin Inhibitor, Successfully Treated With Roflumilast Cream 0.3%: A Case Report.

Lichen planus pigmentosus (LPP) is an uncommon variant of lichen planus, characterized by dark-brown to gray-toned macules and papules and often accompanied by mild-to-moderate pruritus, that is often difficult to manage with conventional therapies. Topical corticosteroids and calcineurin inhibitors are commonly used but are often ineffective or associated with adverse effects, particularly in intertriginous areas. We report the case of a 36-year-old man with pruritic LPP of the proximal medial thighs refractory to topical corticosteroids and a calcineurin inhibitor. Monotherapy with roflumilast cream 0.3% was initiated. After 3 months of treatment, the pruritus resolved, with some initial lightening of the hyperpigmented macules. After another 4 months, there was near-complete resolution of the lesions, with the patient reporting significant improvement and satisfaction. This case highlights roflumilast as a promising nonsteroidal therapeutic option for refractory LPP, offering potential advantages in efficacy, safety, and patient adherence. Further studies are warranted to confirm its long-term outcomes and establish its role in the management of this condition.