{'fraction_non_alphanumeric': 0.03354978354978355, 'fraction_numerical': 0.007575757575757576, 'mean_word_length': 5.082236842105263, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
New‐onset cutaneous lichen planus following therapy for hepatitis C with ledipasvir‐sofosbuvir

To the Editor, Ledipasvir-sofosbuvir (Harvoni, Gilead Sciences, Foster City, CA, USA) is a recently approved single-tablet oral hepatitis C virus (HCV) treatment that produces profound sustained virologic responses and is generally well tolerated. The impact of ledipasvir-sofosbuvir treatment on lichen planus (LP), an inflammatory mucocutaneous disease associated with HCV, has not been previously described. Here, we report a patient with HCV and a 30-year history of LP limited to the oral mucosa who presented with a 1-month history of widespread cutaneous LP following effective treatment and eradication of HCV with ledipasvir-sofosbuvir. A 55-year-old man presented with a 1-month history of a highly pruritic rash on the chest, axillae, groin and penis. His history was notable for a longstanding history of chronic HCV with recent liver biopsy showing Grade 2 activity and Stage 0 fibrosis. His disease was previously treatment-naïve and 6 months prior, he had begun a 3-month course of ledipasvir-sofosbuvir. His three most recent serum tests showed undetectable HCV RNA, indicating a sustained virologic response. Notably, the patient reported a 30-year history of oral LP that had been mild and well-controlled with occasional use of mild topical steroids. There were no new medications. Physical examination revealed numerous pale purple, flat-topped papules and plaques covered by fine, lacy scale on the trunk and extremities, with accentuation in the flexural areas (Fig. 1). There were subtle lacy, annular plaques on the glans penis, and focally eroded reticular white striae on the bilateral buccal mucosa. Fig. 1. Clinical images. A) Erythematous scaly papules with flexural accentuation. B) Closer examination of axillary lesions.