Lichen planus pigmentosus

Abstract

Lichen planus pigmentosus (LPP) is an uncommon variant of lichen planus that tends to occur in middle-aged individuals with darker pigmented skin. Clinical findings include hyperpigmented, brown to gray-brown macules and patches in sun-exposed areas, typically on the head and neck. Histopathologic features include epidermal atrophy, vacuolar degeneration of the basal layer of the epidermis, perivascular lymphohistiocystic infiltrate in the upper dermis, and dermal melanophages. We present a unique case of LPP that was characterized by an atypical initial inflammatory phase and subsequent circinate lesions with central clearing. Case synopsisA 31-year-old man presented to the Dermatology Clinic in Bellevue Hospital Center in August 2011 with a two-year history of dark areas on the skin of the face, neck, trunk, and extremities. He had no local or systemic symptoms. At the time of examination, he was assured that there were no active lesions and he was subsequently lost to follow-up. In March 2012, he presented with new macules on his face and neck, which had evolved over the course of one week and were asymptomatic without pruritus, burning, or pain. He had used oral fluconazole and topical selenium sulfide without benefit. He denied fevers, chills, diaphoresis, sun sensitivity, exposure to pesticides, contrast dye and ionizing radiation. He denied taking any medications. He specifically denied taking diuretics or nonsteroidal anti-inflammatory drugs. Past medical history included a resolved gastric ulcer.Physical Examination: Gray-brown, annular, circular and oval, hyperpigmented patches were present on the face, some with a thin, raised, erythematous border. There were reticulated blue-grey patches without erythema on the arms, trunk, and legs. On the buccal mucosa, there was a faint, lacy hypopigmented patch. Laboratory Data: A complete blood count and basic metabolic panels were normal. Alanine aminotransferase was 37 U/L. Hepatitis B and C serologies were non-reactive. Cholesterol was 207 mg/dL.

Positive Antinuclear Antibody and Blaschkoid Lichen Planus Pigmentosus

“…Commonly ashy dermatosis presents with former lacking erythematous border. Lichen planus pigmentosus and ashy dermatosis are considered two different diseases based on the clinical presentation [ 13 , 14 ]. The findings of hyperkeratosis, hyper granulosis, lichenoid infiltrate, perifollicular infiltrate and fibrosis, and superficial dermal pigment incontinence favor the diagnosis of lichen planus pigmentosus.…”

“…Usually, lichen planus pigmentosus runs a longer course than the other variants of lichen planus. Successful treatment has been achieved using topical steroids and tacrolimus ointment but with poor response to chloroquine [ 14 ]. Small dose isotretinoin and sunscreens showed promising results in controlling the disease progression and extent of pigmentation [ 15 ].…”

Orofacial pigmentation in hemodialysis patients: A Case Control Study

“…Lichen planus pigmentosus (LPP) is a disease with an unknown etiology that has an insidious onset and a long course. It is characterized by dark brown macules that appear on the body's exposed parts, although it can also appear on the oral mucosa [39] .…”

Acquired Dermal Macular Hyperpigmentation Mimicking Dowling Degos Disease: A Case Report

“…It appears as reticulated hyper-pigmented macules and/or papules that initially appear in the axillae and groin followed by the intergluteal and inframammary folds, neck, and trunk. Comedone-like lesions on the back or neck, pitted perioral scars, epidermoid cysts, and hidradenitis suppurativa are additional features in some patients [ 2 , 4 , 5 ]. However, our patient had none of these.…”

“…Topical treatment includes steroids, calcineurin inhibitors, and retinoids. Systemic treatment includes steroids, retinoids including acitretin and isotretinoin, hydroxychloroquine, methotrexate, azathioprine, and phototherapy [ 4 , 5 ].…”