The case report of a 83-year-old woman with lichen ruber ulcerosus is reviewed. Clinically the patient showed extensive ulcerations of the sole of one foot, with synechiae of the toes. In addition, there was subtotal atrophic alopecia of the scalp, vulvar atrophy, and circumscribed cutaneous lesions of lichen planus. The disease started with chronic recurrent paronychiae. The ulcerative defect was successfully treated with mesh grafting, which is the therapy of choice.