Erythema dyschromicum perstans and lichen planus

Abstract

Erythema dyschromicum perstans (EDP) is a cutaneous pigmentary disturbance originally considered to be a variant of erythema perstans. The nosologic identity of EDP has been challenged repeatedly as the number of patients with concurrent EDP-like eruptions and lichenoid disorders has increased. In this report, we describe a woman who had EDP for two years before the onset of classic lichen planus (LP). The active lesions of LP gradually evolved into typical ashy-gray macules of EDP. This case provides further support for the concept that EDP and EDP-like conditions should be classified, in certain instances, as erythema dyschromicum variants of LP.

Reticulate postinflammatory hyperpigmentation with band‐like mucin deposition

“…The inflammatory infiltrate was poor and very limited foci of slight basal cell vacuolation were observed. These findings may draw attention to pigmentary disorders such as lichen planus pigmentosus, 5 erythema dyschromicum perstans, 6 , 7 pigmentatio maculosa eruptiva idiopathica, 8 , 9 dermatopathia pigmentosa reticularis, 10 prurigo pigmentosa, 11 and frictional melanosis. 12 None of these entities, however, includes mucin deposition among the microscopic features.…”

Lichen planus pigmetosus-like ashy dermatosis

“…Opinions vary about whether ashy dermatosis is an abortive form of lichen planus or a distinct entity. 6 – 8 …”

Erythema Dyschromicum Perstans in Prepubertal Children

“…In contrast with the preponderance of adult Hispanic patients in the literature, five of our patients were Caucasian, and 52% of reported prepubertal patients have been Caucasian, suggesting an increased prevalence in lighter-skinned patients during childhood. Adult patients with EDP have limited to no improvement in their dyspigmentation (1,(7)(8)(9)(10)12,13,(16)(17)(18)(20)(21)(22)(23)(24)(25)(26)(28)(29)(30)(31)(32)(33)(34). The complete resolution of lesions in all of our pediatric patients (as well as 6 of 11 prepubertal children for whom the clinical course was specified in the literature) (2,5,15,20) suggests that childhood EDP is likely to clear completely; this in contrast with the course of the disorder in adults.…”

“…Most adult patients with EDP have been of Hispanic descent, although Caucasian patients have been described from Europe (4,6–11), Scandinavia (2,12,13) and the United States (14–29). African American (15,19–21,23,26), Asian (3,9,27,28), and Indian (27,29) patients have also been described. Prepubertal children with EDP are more likely to be Caucasian than Hispanic.…”

“…Immunofluorescent deposits are seen inconsistently, and may be absent (32), but may appear as colloid or cytoid bodies with IgM (3,4,18–20), IgG (14,19,28), IgA (22), C3 (4,22), fibrinogen (22), or C4 (18). Alternatively, granular IgM (21) and fibrinogen may be deposited at the dermoepidermal junction (13). Ultrastructural analysis of lesional skin has demonstrated vacuoles and liquefactive degeneration in the basal cell layer, intraepidermal lymphocytes, and increased intercellular spaces without desmosomal alteration (9,25,32).…”