Acute Onset Linear Lichen Planus Pigmentosus of the Forehead: A Case Series.

Linear lichen planus pigmentosus (LPP) of the face is a rare variant of lichen planus, with only a few cases published in the literature.1 It is an inflammatory condition with unknown etiology, characterized by blue-gray hyperpigmented macules, and tends to affect sun-exposed areas of the head and neck.1-4 The pathophysiology of linear lichen pigmentosus is poorly understood, though it is postulated to be caused by T-lymphocyte autoimmunity against keratinocytes.5-7 LPP more frequently affects middle age woman and skin phototypes III-VI.1,3 Treatment for linear LPP is difficult and there is no established first-line therapy; however, tacrolimus ointment, topical corticosteroids, and various systemic agents have shown to be effective in improving the appearance.3,8,9 Prior reports have characterized linear LPP that follows the lines of Blashko as more commonly affecting the trunk.1 We present three cases of linear lichen planus pigmentosus (LPP) of the forehead, a unique novel presentation of linear LPP of the face. One of our cases also provides supporting evidence for tacrolimus to be used as a preferred therapy to treat linear LPP of the face; however, more research is needed to support this claim. To our knowledge, this case series is the largest case series of linear lichen planus pigmentosus (LPP) of the forehead to be reported. J Drugs Dermatol. 2023;22(1):94-97. doi:10.36849/JDD.7200.

Revisiting Solitary Pedunculated Lipofibromas.

OBJECTIVES: Pedunculated lipofibromas are soft, compressible, skin-colored nodules that typically present as an acquired solitary lesion, predominantly located on the buttocks and thighs. We aimed to differentiate between pedunculated lipofibromas and nevus lipomatosus superficialis. Although benign, this may be important as treatment options vary. METHODS: We describe 3 cases of solitary pedunculated lipofibromas occurring in older, obese adults that required clinicopathologic correlation for the correct diagnosis. RESULTS: The histopathologic features of pedunculated lipofibromas include a broad-based lesion with aggregates of mature adipocytes extending upwards into the dermis without an associated inflammatory infiltrate. The primary histopathologic differential diagnoses include fibroepithelial polyps with adipocytes and nevus lipomatosus superficialis, which is more frequently found in children or young adults and is typically characterized clinically by multiple lesions with a cerebriform to verrucoid surface. CONCLUSIONS: While the precise relationship between pedunculated lipofibromas and nevus lipomatosus is still unknown, we propose using pedunculated lipofibroma as a more specific clinical term to refer to solitary pedunculated or broad-based fatty lesions with a smooth surface that occur in older patients and in a wide anatomic distribution.