ABSTRACT
Background: Although well known in clinical practice, research in lichen planus pigmentosus and related dermal pigmentary diseases is restricted due to lack of consensus on nomenclature and disease definition. Aims and Objectives: Delphi exercise to define and categorise acquired dermal pigmentary diseases. Methods: Core areas were identified including disease definition, etiopathogenesis, risk factors, clinical features, diagnostic methods, treatment modalities and outcome measures. The Delphi exercise was conducted in three rounds. Results: Sixteen researchers representing 12 different universities across India and Australia agreed to be part of this Delphi exercise. At the end of three rounds, a consensus of >80% was reached on usage of the umbrella term ‘acquired dermal macular hyperpigmentation’. It was agreed that there were minimal differences, if any, among the disorders previously defined as ashy dermatosis, erythema dyschromicum perstans, Riehl’s melanosis and pigmented contact dermatitis. It was also agreed that lichen planus pigmentosus, erythema dyschromicum perstans and ashy dermatosis did not differ significantly apart from the sites of involvement, as historically described in the literature. Exposure to hair colours, sunlight and cosmetics was associated with these disorders in a significant proportion of patients. Participants agreed that both histopathology and dermatoscopy could diagnose dermal pigmentation characteristic of acquired dermal macular hyperpigmentation but could not differentiate the individual entities of ashy dermatosis, erythema dyschromicum perstans, Riehl’s melanosis, lichen planus pigmentosus and pigmented contact dermatitis. Limitations: A wider consensus involving representatives from East Asian, European and Latin American countries is required. Conclusion: Acquired dermal macular hyperpigmentation could be an appropriate conglomerate terminology for acquired dermatoses characterised by idiopathic or multifactorial non-inflammatory macular dermal hyperpigmentation
ABSTRACT
The Q-switched Nd:YAG laser is an established modality of treatment for epidermal and dermal pigmented lesions. The dual wavelengths of 1064nm and 532nm are suited for the darker skin tones encountered in India. Though this laser has become the one of choice for conditions such as nevus of Ota, Hori's nevus and tattoos, its role in the management of melasma and other acquired dermal melanoses is not clear. Despite several studies having been done on the Q-switched Nd:YAG laser in melasma, there is no consensus on the protocol or number of sessions required. Acquired dermal melanoses are heterogenous entities with the common features of pigment incontinence and dermal melanophages resulting in greyish macular hyperpigmentation. This article reviews the current literature on laser toning in melasma and the role of the Q-switched Nd:YAG laser in stubborn pigmentary disorders such as lichen planus pigmentosus. As the pathology is primarily dermal or mixed epidermal-dermal in these conditions, the longer wavelength of 1064nm is preferred due to its deeper penetration. Generally multiple sessions are needed for successful outcomes. Low fluence Q-switched Nd:YAG laser at 1064nm utilizing the multi-pass technique with a large spot size has been suggested as a modality to treat melasma. Varying degrees of success have been reported but recurrences are common on discontinuing laser therapy. Adverse effects such as mottled hypopigmentation have been reported following laser toning; these can be minimized by using larger spot sizes of 8 to 10mm with longer intervals (2 weeks) between sessions.
ABSTRACT
La dermatosis cenicienta es un trastorno pigmentario infrecuente que se presenta en individuos de piel morena, especialmente en centroamericanos. Las lesiones consisten en manchas hiperpigmentadas de coloración gris-azulada, principalmente localizadas en la cara, tronco y brazos. Su principal diagnóstico diferencial debe ser planteado con tres dermatosis pigmentarias de origen idiopático: eritema discrómico perstans, pigmentación macular eruptiva idiopática y liquen plano pigmentoso. Hay consenso en considerar al eritema discrómico perstans como la misma enfermedad, pero con un borde eritematoso transitorio. La pigmentación macular eruptiva idiopática es clínicamente similar, pero sin una dermatitis de interfase al estudio histopatológico, y sólo muestra una pigmentación de la capa basal, incontinencia pigmentaria y melanófagos en la dermis. Finalmente, el liquen plano pigmentoso debe ser considerado como una variedad pigmentada de liquen plano.
Ashy dermatosis is an infrequent disorder of pigmentation, which predominantly occurs in darkly pigmented individuals, specially in central americans. The lesions consist of bluish-gray hyperpigmented patches mainly located on the face, trunk and arms. Its main differential diagnosis must be raised with three idiopathic pigmentary disorders: erythema dyschromicum perstans, idiopathic eruptive macular pigmentation and lichen planus pigmentosus. It has been widely accepted that erythema dischromicum perstans is the same disease, but with a transient erythematous border. Idiopathic eruptive macular pigmentation is clinically similar but without an interfase dermatitis at histopathologic studies, only showing increased pigmentation of the basal layer and pigmentary incontinence and many melanophages in the dermis. Finally, lichen planus pigmentosus must be considered as a pigmented variant of lichen planus.
Subject(s)
Humans , Pigmentation Disorders/diagnosis , Erythema/diagnosis , Pigmentation Disorders/pathology , Diagnosis, Differential , Erythema/pathology , Lichen Planus/diagnosisABSTRACT
El liquen plano pigmentoso invertido es una variante rara de liquen plano caracterizada por lesiones marrones o violáceas,de borde sobreelevado y centro atrófico, que afecta casi exclusivamente grandes pliegues. Es más frecuente en individuos caucásicos. Presentamos el caso de un paciente masculino de 57 años, con antecedente de politraumatismo y hemotransfusión en el año 1983, que consultó a nuestro servicio por presentar lesiones ligeramente pruriginosas en pliegues de tres años de evolución. La biopsia cutánea confirmó el diagnóstico de liquen plano y entre los estudios de laboratorio se detectó serología positiva para el virus de la hepatitis C (VHC). Con la clínica, el estudio histopatológico y los métodos complementarios arribamos al diagnóstico de liquen plano pigmentoso invertido asociado a VHC.
Lichen planus pigmentosus-inversus is a rare variant of lichen planus characterized by brown or violet lesions, raised edge andatrophic centre, which affects almost exclusively large folds. It is more common in Caucasians. A 57-year-old male with a historyof multiple trauma and blood transfusion in 1983 is presented. He consulted our service for slightly pruritic lesions in folds ofthree years of evolution. Skin biopsy confirmed the diagnosis of lichen planus and positive serology for hepatitis C virus (HCV)was detected on laboratory studies. With the clinical, histopathological and complementary methods we arrive to the diagnosisof lichen planus pigmentosus-inversus associated with HCV.
Subject(s)
Humans , Hepatitis , Hepatitis C , Lichen Planus , Autoimmunity , HIV Infections , Skin DiseasesABSTRACT
Lichen Planus Pigmentosus (LPP), an uncommon variant of lichen planus, is clinically characterized by insidious onset of diffuse or reticulated hyperpigmented patches on the sun-exposed areas and flexural folds. Histopathologic findings of LPP show atrophic epidermis with vacuolar degeneration of the basal cell layer and sparse lichenoid lymphohistiocytic infiltration with melanophages in the dermis. Although there have been few reports of LPP, clinical and histological pathogenesis and prognosis are not well known. Herein, we describe a case of linear LPP along the Blaschko's lines in 34-year old Korean man who presented with linear hyperpigmented, dark brown patches on his left thigh, repeatedly developing new lesions of erythematous reticular patches since puberty. This report shows the early events of LPP and the protracted course.
Subject(s)
Dermis , Epidermis , Lichen Planus , Lichens , Prognosis , Puberty , ThighABSTRACT
Lichen planus pigmentosus (LPP) is an uncommon variant of lichen planus, which manifests as hyperpigmented dark brown macular hyperpigmentations chiefly involving the face and upper extremities. The histopathologic changes consist of vacuolar degeneration of the basal layer, presence of dermal melanophages, and lichenoid lymphocytic infiltrations. LPP with exclusive localization in intertriginous areas is named as LPP-inversus, and is infrequently reported in previous dermatologic literature. A 16-year-old girl presented with several brownish to dark grayish patches on both axilla for 7 months. The lesions were asymptomatic and did not have preceding erythema. The patient had not come into contact with any chemicals and denied existence of previous allergy episodes, and her medical history was non-contributory. A skin biopsy from a brownish patch revealed vacuolar alteration of the basal layer, and band-like lymphocytic infiltration with pigment incontinence. We report a typical case of LPP-inversus with relevant literature.
Subject(s)
Adolescent , Humans , Axilla , Biopsy , Erythema , Hypersensitivity , Lichen Planus , Lichens , Skin , Upper ExtremityABSTRACT
Facial melanoses (FM) are a common presentation in Indian patients, causing cosmetic disfigurement with considerable psychological impact. Some of the well defined causes of FM include melasma, Riehl's melanosis, Lichen planus pigmentosus, erythema dyschromicum perstans (EDP), erythrosis, and poikiloderma of Civatte. But there is considerable overlap in features amongst the clinical entities. Etiology in most of the causes is unknown, but some factors such as UV radiation in melasma, exposure to chemicals in EDP, exposure to allergens in Riehl's melanosis are implicated. Diagnosis is generally based on clinical features. The treatment of FM includes removal of aggravating factors, vigorous photoprotection, and some form of active pigment reduction either with topical agents or physical modes of treatment. Topical agents include hydroquinone (HQ), which is the most commonly used agent, often in combination with retinoic acid, corticosteroids, azelaic acid, kojic acid, and glycolic acid. Chemical peels are important modalities of physical therapy, other forms include lasers and dermabrasion.
ABSTRACT
Lichen planus pigmentosus-inversus is a rare variant of lichen planus pigmentosus. The eruption of lichen planus pigmentosus-inversus occurs mainly in the flexural regions and presents with brownish macules and patches. Here we describe the case of a 31-year-old Korean woman who presented with hyperpigmented lesions over her antecubital and popliteal area and groin. Physical examination revealed multiple brownish macules and patches on the intertriginous area without pruritis, and histologic findings showed a regressive pattern of lichen planus. These clinical and histological findings were consistent with a diagnosis of lichen planus pigmentosus-inversus.
Subject(s)
Adult , Female , Humans , Groin , Lichen Planus , Lichens , Physical Examination , PruritusABSTRACT
Lichen planus pigmentosus (LPP) is a rare variant of lichen planus, and it is characterized by hyperpigmented, dark brown to violaceous colored macules or patches on the sun exposed areas of the skin. The term of LPP-inversus was proposed to describe some cases with LPP arising on the intertriginous areas. Clinically, LPP-inversus is characterized by well defined dark brown to violaceous macules or patches with minimal symptoms and it is predominantly confined on the flexural areas. The histological characteristics are a lichenoid inflammatory infiltrate on the upper dermis, melanophages and pigmentary incontinence. The clinical course can vary. We present here an additional case of LPP-inversus that developed on the both inguinal folds and we review the relevant literature.
Subject(s)
Dermis , Lichen Planus , Lichens , Skin , Solar SystemABSTRACT
El liquen plano pilaris lineal de la cara (LPPL) es una rara variante de liquen plano pilaris, caracterizado por presentar pápulas foliculares asintomáticas en una configuración lineal. Hay pocos casos reportados en hombres adultos y menos aún en mujeres. El liquen plano pigmentoso (LPP) es también una forma diferente del liquen plano clásico, con un curso clínico prolongado, se manifiesta con máculas marrones oscuras. Describimos un caso muy raro de liquen plano pilaris pigmentado con una distribución lineal en áreas del mentón y cuello en una paciente mujer.
Linear lichen planopilaris (LPPL) of the face is a rare variant of lichen planus pilaris, characterized by asymptomatic follicular papules in a linear configuration. There are few reported cases in adult men and even less in woman. Lichen planus pigmentosum is also a different presentation of classic lichen planus with a prolonged clinical course and dark brown macules. We describe a very rare case of LPPL pigmentosus with a linear distribution on the neck and chin in a female patient.
Subject(s)
Humans , Female , Adult , Facial Dermatoses , Lichen PlanusABSTRACT
Lichen planus pigmentosus (LPP) is chronic pigmentary disorder that shows diffuse or reticulated hyperpigmented, dark brown macules on the sun-exposed areas such as the face, neck and other flexural folds. Clinically, it is different from classical lichen planus because LPP has a longer clinical course and it manifests with dark brown macules. In case of LPP, involvement of the scalp, nail or mucosal area is rare. The histopathological findings of the lesions show an atrophic epidermis, the presence of melanophages and a vacuolar alteration of the basal cell layer with a sparse lymphohistiocytic lichenoid infiltration. Although there have been a few reports of LPP, there have only 3 cases of linear LPP along the lines of Blaschko in the Korean dermatologic literature. Our patient had lesions on the neck and chin with a linear pattern. In this report, we describe a very rare case of LPP with a linear distribution related to Blaschko's lines on the neck and chin areas.
Subject(s)
Humans , Chin , Epidermis , Lichen Planus , Lichens , Nails , Neck , ScalpABSTRACT
Lichen planus pigmentosus (LPP) is an uncommon variant of lichen planus that presents clinically as hyperpigmented, dark brown macules or patches in sun-exposed areas and flexural folds. LPP has been described previously as a pigmented form of actinic lichen planus or as erythema dyschromicum perstans. Recently, however, these diseases have been recognized as different clinical entities. Histopathologically, in atrophic epidermis, vacuolar alteration of the basal cell layer and scarce lymphohistiocytic lichenoid infiltration and pigment incontinence are seen. Herein, we report a case of LPP that developed in a unilateral linear pattern, probably in relation to Blaschko's lines.
Subject(s)
Actins , Epidermis , Erythema , Lichen Planus , LichensABSTRACT
Lichen planus pigmentosus-inversus (LPP-inversus) is an extremely rare variant of lichen planus (LP), and only a few cases have been reported. Its course is characterized by exacerbations and remissions, and it is known to be more chronic than classical LP is. We report two cases of LPP-inversus and offer the suggestion that LPP-inversus may originate from LP of flexural areas.
Subject(s)
Lichen Planus , LichensABSTRACT
We report two cases of lichen planus pigmentosus (LPP) that developed in a unilateral linear pattern. The patients presented with unilateral linear brown macules on the extremities. Skin biopsy showed orthokeratosis, basal hydropic degeneration with scarce lymphohistiocytic infiltrates, and numerous melanophages in both patients. These patients, to the best of our knowledge, are the first cases of LPP presenting with a linear pattern. LPP should be considered in the differential diagnosis of linear hyperpigmented skin lesions.