Within the limitations of a single-centre approach, PU development appears to be associated with an increase in mortality among patients requiring MV for 24 hours or longer.
interesting medical image A 57-year-old woman presented at a dermatology unit in Granada, Spain, in 2015 with a two-month history of slightly pruritic brown-coloured macular lesions on the trunk and right arm. She was not taking any medications or using cosmetics and had not been exposed to the sun before the onset of the rash. On examination, clearly defined hyperpigmented brown macules were seen on the right submammary region, right hemithorax, right abdomen and right buttock [ Figure 1] with an S-shaped appearance, compatible with the pattern of Blaschko lines. Tests for hepatitis B and hepatitis C were negative. A histological examination showed rich lymphocytic infiltrate and melanin incontinence with slight epidermal atrophy and lichenoid reaction with hypergranulosis [ Figure 2]. Considering these features, a diagnosis of lichen planus pigmentosus (LPP) with Blaschkoid distribution was proposed. The patient was prescribed topical clobetasol propionate for four weeks. The lesions responded well to the treatment, with significant pigment reduction and improvement of the associated pruritus.
CommentVarious triggering factors, ranging from viral infections and vaccinations to trauma, have been implicated in the aetiology of lichen planus.1 A rare variant of lichen planus, LPP is distinguished by hyperpigmented macules or papules. The histological characteristics of LPP include epidermal atrophy, vacuolar degeneration of the basal cell layer and rich dermal lichenoid infiltrate.2 Kanwar et al. suggested that LPP may represent a lichenoid reaction to an unknown agent or stimuli, with regards to the histological concordance between LPP and lichen planus.3 The differential diagnosis of LPP includes conditions such as lichen striatus, erythema dyschromicum perstans, incontinentia pigmenti, linear and whorled nevoid hypermelanosis, occupational Sultan Qaboos University Med J, August 2016, Vol. 16, Iss. 3, pp. e383-384,
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