Combination therapy with prednisone and isotretinoin in early erythema dyschromicum perstans: A retrospective series

Abstract

Erythema dyschromicum perstans (EDP) is an acquired hyperpigmentation disorder characterized by asymptomatic, polycyclic, irregularly shaped light lilac-grey patches surrounded by erythematous borders in the early inflammatory stage and subsequently greyish-blue patches in the later ashy stage. Affected areas include the trunk, neck, face, and upper extremities. Mucous membranes are spared.1 EDP occurs in both children and adults, has a higher frequency noted in women, and is common among Latin American, Asian, and Indian populations.2, 3, 4 The cause remains largely unknown; however, proton pump inhibitors,5 radioactive contrast,6 hypothyroidism, vitiligo,7 and parasitic and hepatitis C infections,1 are among the associations with EDP. Histopathologic findings of EDP include vacuolar interface dermatitis and pigment incontinence.4 EDP is histopathologically indistinguishable from lichen planus pigmentosus8; however, distinct clinical characteristics separate the 2 disorders with lichen planus pigmentosus characterized by pruritic, brown-black macules and patches on the face, upper extremities, and flexures with occasional involvement of mucous membranes.1 EDP is cosmetically disfiguring and poses as a therapeutic challenge. Multiple treatments have been proposed that show inconsistent efficacy. Among these are topical steroids, tretinoin, hydroquinone, clofazimine, dapsone, lasers, and narrow-band ultraviolet light B phototherapy.4 A single case is reported each for the use of isotretinoin9 and prednisone.10 In this case series of 4 adult patients with EDP, we report that a combined treatment regimen of prednisone and isotretinoin initiated in the early inflammatory stage leads to rapid resolution of the erythematous border, arrest of progression, and clearance of the hyperpigmentation.