Hyperpigmented Upper Eyelid: A Clue to the Diagnosis of Facial Lichen Planus Pigmentosus in a Patient with Frontal Fibrosing Alopecia

Abstract

Facial lichen planus pigmentosus (LPPig), a rare variant of classic lichen planus, was first described in patients with frontal fibrosing alopecia (FFA) by Dlova [Br J Dermatol 2013; 168: 439–442] in 2013. The diagnosis of facial LPPig is sometimes not easy, since clinical signs and histopathological features may frequently be confused with melasma or postinflammatory hyperpigmentation. We describe a case of a postmenopausal black woman diagnosed with FFA who presented with an identical brown-grayish pigmentation of the face and upper eyelids and typical dermoscopy analysis on both regions. We suggest that the hyperpigmentation of the upper eyelid with typical LLPig dermoscopy (upper eyelid sign) may be a clue for the diagnosis of LPPig and may avoid a scar-causing face biopsy.

Frontal Fibrosing Alopecia Associated with Lichen Planus Pigmentosus: Not Only in Dark Phototypes

“…Some of these patients are sometimes misdiagnosed with erythematous rosacea, although they never had inflammatory papules or pustules. As published by Gavazzoni Dias et al [12], 4 women in this series had hyperpigmentation of the upper lid, a clue to the diagnosis of facial LPPig that helps its differentiation from other dermatoses such as melasma.…”

The role of dermoscopy in diagnostics of dermatological conditions of the eyelid, eyelashes, and conjunctiva – a literature review

“…A literature search revealed one case report. Dias et al 17 . reported the presence of facial pigmented lichen planus with prominent upper eyelid involvement as a sign coexisting with frontal fibrosing alopecia.…”

Periorbital acquired dermal macular hyperpigmentation: A distinctive clinical entity in young adults—Observational case-control study

“…[ 3 ] Recently, hyperpigmentation of upper eyelid with characteristic dermoscopic features of LPP has been described. [ 9 ]…”