Abstract
Background: Facial melanosis is a major pigmentery problem seen in the daily clinical practice. Melasma and lichen planus actinicus are among these common causes. Still some facial melanosis that had features of melasma and butterfly lichen planus actinicus but could not be classified to either of them. Objective: To evaluate melasma, lichen planus actinicus and cases that could not be classified into one or either of them using clinical picture, Wood’s lump examination, and histopathological assessment. Patients and Methods: This is a case descriptive, comparative, clinical and histopathologicasl study carried out in Department of Dermatology, Baghdad Teaching Hospital, Baghdad, Iraq during the period from December 2012-May 2014. Forty patients with facial hyperpigmentation were included in this study. Twelve (30%) were males and 28 (70%) were females with female to male ratio: 2.3:1. Mean age ± SD of studied patients was 37.07 ± 9.63 years. History, physical examination, Wood’s lump examination and photographic pictures were done for all patients. Punch biopsy was taken from each patient, and processed and stained with Hematoxylin-Eosin (HE) and Fontana-Masson (FM) for histological evaluations. Results: These diseases were classified into: melasma with 11 patients, female to male ratio: 4.5:1 with mean age ± SD was 33.64 ± 6.516 years, melasma-like lichen planus actinicus with 21 patients, female to male ratio: 2.5:1,mean age ± SD: 39 ± 8.349 years, butterfly lichen planus actinicus with 8 patients, female to male ratio: 1:1, mean age ± SD: 36.75 ± 15.088 years. This classification depends on the following findings: some of these results could be more frequent and intense in one than others; they were the diseases of young age group, that had more tendency to affect females than males, sun light exposure and outdoor activities were the main etiological factors, but these factors were more triggering in lichen planus actinicus followed by melasma-like lichen planus actinicus and to lesser extent in melasma. The skin types were mostly III, the location and distribution of pigmentation were almost similar, Wood’s lamp findings were similar although was not conclusive. The histopathological findings especially the level of melanin deposition and inflammatory infiltrate were comparable but the melanin deposition was more intense in butterfly lichen planus and melasma-like lichen planus actinicus and to lesser extent in melasma. Conclusion: From the epidemiological, clinical and histopathological findings of the present work, we can suggest a conclusion that melasma, butterfly lichen planus actinicus, and melasma-like lichen planus actinicus were inflammatory skin diseases that build up one spectrum where melasma at one pole and lichen planus actinicus at the other pole and melasma-like lichen planus actinicus at the middle. The young age group, during their active reproductive life, will have these diseases in relation to sun light exposure with seasonal variations.
Highlights
IntroductionFacial melanosis is a major cosmetic problem among people especially in people with dark complexion and we can categorise the commonest causes of facial melanosis as follows [1]-[3].Melasma is representing 61%, frictional melanosis 12%, postinflamatory hyperpigmentation 9.5%, butterfly lichen planus actinicus (LPA) 8%, acanthosis nigricans 7.5%, nevus of Ota 1%, phytophotodermatitis 0.5%, gazelle eye like facial melanosis 0.5% [4].Facial melanosis could be defined as increase in the melanin stores either in the epidermis or dermis or both as a result of increase in the number or function of melanocytes as seen in inflammatory conditions like melasma and lichen planus [5]. melasma and butterfly lichen planus actinicus are considered distinctive clinical entities but they share many epidemiological, clinical and histopathological features as both diseases are common in the dark skin colored peoples and especially seen in countries of Middle East [6]-[8]
Patients were categorized into following groups depending on history and clinical pictures: 1—Typical melasma 11 patients, with brown and dark brown pigemented butterfly patches associated with histopathological features of melasma. 2—Typical lichen planus actinicus (LPA) butterfly type 8 patients, with gray brown pigmented butterfly like configuration patches associated with histopathological features of LPA
Forty patients with facial hyperpigmentation were included in this study, twelve (30%) were males and 28 (70%) were females with female to male ratio (2.3:1).The mean age ± SD of studied patients was 37.07 ± 9.63 years
Summary
Facial melanosis is a major cosmetic problem among people especially in people with dark complexion and we can categorise the commonest causes of facial melanosis as follows [1]-[3].Melasma is representing 61%, frictional melanosis 12%, postinflamatory hyperpigmentation 9.5%, butterfly lichen planus actinicus (LPA) 8%, acanthosis nigricans 7.5%, nevus of Ota 1%, phytophotodermatitis 0.5%, gazelle eye like facial melanosis 0.5% [4].Facial melanosis could be defined as increase in the melanin stores either in the epidermis or dermis or both as a result of increase in the number or function of melanocytes as seen in inflammatory conditions like melasma and lichen planus [5]. melasma and butterfly lichen planus actinicus are considered distinctive clinical entities but they share many epidemiological, clinical and histopathological features as both diseases are common in the dark skin colored peoples and especially seen in countries of Middle East [6]-[8]. Sun exposure is the main etiological triggering factors in both conditions plus other additional factors and both diseases are seen in outdoor activities with seasonal variations [6]-[9] They are diseases of young age people with more tendency to affect females with positive family history [10] [11]. Objective: To evaluate melasma, lichen planus actinicus and cases that could not be classified into one or either of them using clinical picture, Wood’s lump examination, and histopathological assessment. This classification depends on the following findings: some of these results could be more frequent and intense in one than others; they were the diseases of young age group, that had more tendency to affect females than males, sun light exposure and outdoor activities were the main etiological factors, but these factors were more triggering in lichen planus actinicus followed by melasma-like lichen planus actinicus and to less-
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