Lichen Planus Pigmentosus Research Articles

Dermoscopy of Lichen Planus Pigmentosus and Histopathological Correlation: A Case Series

Introduction: Lichen planus pigmentosus (LPP) is an acquired pigmentary disorder affecting the dark-skinned population. There is a wide range of differentials with substantial clinicopathological overlap. Dermoscopy may contribute to the better characterization of this dermatosis. Objective: This study aimed to describe dermoscopic features of LPP with a histopathological correlation. Methods: LPP lesions of 23 patients were studied using a polarized dermoscopy, followed by histological evaluation. Results: The most common dermoscopic finding was dots and/or globules (n=23) in different patterns: speckled (n=4), dotted (n=2), reticular (n=4), diffuse (n=9), hem-like (n=1), and circular (n=2). Other patterns were exaggerated pseudo-reticular pattern (n=12), sparing of follicular openings (n=23), targetoid appearance (n=3), blue-white veil (n=5), rosettes (n=5), erythema (n=4), and telangiectasia (n=7). Histological findings included pigment incontinence (n=23), the severity being mild (n=8) and severe (n=15). We found a statistically significant association between the intensity of pigmentary incontinence on the histological examination and the presence of blotches in dermoscopy (p=0.046); and between blue-white veil and rosettes in flexural areas (p=0.01). Also, a statistical relationship was found between severe pigment density (reticulated and diffused patterns) and a short disease duration (p=0.016). Conclusion: We described LPP dermoscopic changes according to disease progression. We found that blotches are indicative of long-duration disease and could be specific dermoscopic features of LPP. We demonstrated that a blue-white veil associated with rosettes could be pathognomonic features of LPP inversus.

Facial dyschromias: A review of clinical and dermoscopic features

Facial dyschromias are a common complaint among individuals with skin of color. Until the advent of dermoscopy, clinical examination and histopathology were used to arrive at a definitive diagnosis. Dermoscopy is an emerging tool used to diagnose various pigmentary conditions. It may be used to diagnose various facial dyschromias, including melasma, lichen planus pigmentosus, facial acanthosis nigricans, post-inflammatory pigmentation, maturational dyschromia, vitiligo, and salt and pepper pigmentation, to name a few. Some of these conditions show characteristic dermoscopic features, thereby obviating the need for a skin biopsy for confirmation of diagnosis. Dermoscopy is, therefore, a reliable, non-invasive tool which can be used to diagnose various facial dyschromias.

Lichen Planus Pigmentosus Inversus: case report and systematic review

Lichen Planus Pigmentosus Inversus (LPPI) is a rare variant of lichen planus characterized by well-demarcated, often slight pruritic, dark-gray plaques in intertriginous zones, hence the attribute of “inversus”, originally described by Pock et al. in 2001. Less than 100 cases have been reported to date, and here we present a case in a 52-year-old male who presented with two months duration of grey-brownish plaques in bilateral axillary, submammary, antecubital, and inguinal folds. No triggering agent was present, and the biopsy showed an interface/lichenoid dermatitis with plenty of pigment incontinence. Topical tacrolimus 0.1% ointment was administered with moderate improvement at five weeks. A review of the literature showed no significant differences in involved sites and age distribution among genders, with a slightly longer duration of manifestations in females. The most administered therapeutic agents were topical corticosteroids, alone or in combination with other agents, and tacrolimus.

52986 Highlighting the Link between Lichen Planus Pigmentosus and Frontal Fibrosing Alopecia: A Case Series of 3 Patients

52986 Highlighting the Link between Lichen Planus Pigmentosus and Frontal Fibrosing Alopecia: A Case Series of 3 Patients

Patch testing with Indian standard series of 20 allergens in 125 patients of chronic dermatitis and dermatoses

Objectives: Patch testing is generally done in cases of allergic contact dermatitis to find the offending allergen/s. It has been less reported in patients clinically presenting as non-eczematous contact reactions such as lichen planus, lichenoid eruption, lichen planus pigmentosus and facial melanosis overlap. In addition, it may give clues to the sensitizers leading to chronic, recurring dermatitis and overlap of dermatoses in the form of systemic contact dermatitis. The aim of the present study was to identify the sensitizer/s with patch testing in patients presenting with non-eczematous contact reactions as well as chronic, relapsing dermatitis and overlap of dermatoses. Material and Methods: In the present study, patch testing was done using the Indian standard series in 125 cases presenting clinically as lichen planus, lichen planus pigmentosus, facial melanosis, cheilitis, mucosal lichen planus and vulvar dermatitis, in addition to cases of chronic and recurrent dermatitis such as nummular eczema, lichenoid eruption, pompholyx, photo aggravated dermatitis, air borne contact and hand and feet dermatitis. Results: The tests were positive in 102 (81.6%) patients, negative in 16, doubtful in 3 and invalid in 4 patients. Positive results were found in 100% cases of photo aggravated dermatitis and chronic dermatitis of hands/feet dermatitis and 76% cases of facial melanosis and lichen planus pigmentosus overlap, 88.9% cases of nummular eczema, 81.8% cases of lichenoid eruption, 75% cases of lichen planus, 57% cases of atopic eczema, 66.6% cases of pompholyx, and 100% of mucosal lichen planus. Test for nickel was positive in 40 (32%) cases, parthenium in 37 (29.6%), cobalt in 23 (18.4%), fragrance in 19 (15.2%), paraphenylenediamine in 17 (13.6%), paraben in 9 (7.2%) and neomycin in 5 (4%) cases, either alone or in combination. In the present study, in addition to eczematous dermatoses, non-eczematous conditions such as lichen planus, lichenoid eruption, lichen planus pigmentosus and facial melanosis also showed positive results on patch testing. Conclusion: Patch testing should be considered in patients presenting with chronic and recurrent dermatitis and overlap of more than one type of dermatoses. Identification and elimination of culprit allergens can help in achieving long term remission in these chronic conditions.

Cloaked Identity: Unmasking Pigmented Macular Chronic Cutaneous Lupus Masquerading as Lichen Planus Pigmentosus.

Cloaked Identity: Unmasking Pigmented Macular Chronic Cutaneous Lupus Masquerading as Lichen Planus Pigmentosus.

Quality of Life in Patients with Acquired Dermal Macular Hyperpigmentation: A Systematic Review.

Acquired dermal macular hypergpigmentation (ADMH) encompasses conditions including lichen planus pigmentosus, erythema dyschromicum perstans, ashy dermatosis, Riehl's melanosis and pigmented contact dermatitis. This group of cosmetically distressing pigmentary disorders pose a therapeutic challenge, yet there have been no systematic reviews published that describe their quality of life (QOL) impact. An electronic database search of PubMed, EMBASE, PsycINFO and Cochrane library was performed in December 2022, to search for articles published from inception until 15/12/2022. Articles were included if they fulfilled the following criteria: (1) primary clinical publication; (2) reports QOL in patients with ADMH; and (3) available in full-text. Overall, the review highlighted a considerable gap in the literature concerning the impact of ADMH on QOL. Seven studies fulfilling the inclusion criteria were included, with a total of 259 patients. All seven studies reported an impaired QOL in patients with ADMH. The currently available literature on this topic indicate that ADMH has a significant adverse impact on QOL, likely to a greater degree than melasma, and to a similar or lesser degree than vitiligo. Five of seven studies reported the QOL impairment for patients with ADMH based on the Dermatology Life Quality Index (DLQI); these studies consistently found a mean DLQI score reflective of a moderate effect on patient's QOL. Clinicians must be aware of, and should seek to address the significant, yet often overlooked, psychosocial burden associated with ADMH when taking a holistic approach to management.

Therapeutic response to combination of oral isotretinoin and topical 0.1% tacrolimus ointment in lichen planus pigmentosus: A case series

Lichen Planus Pigmentosus (LPP) is a pigmentary disorder of unknown etiology, presenting with diffuse hyperpigmentation in sun-exposed areas. It is a cosmetically distressing pigmentary disorder often posing a therapeutic challenge. There are few reports showing efficacy of oral isotretinoin and topical tacrolimus in LPP. However combination of both these therapeutic modalities has not been described earlier. Herein we report a series of 10 patients who showed good response to combination of oral isotretinoin (20 mg/day) and topical 0.1% tacrolimus ointment.

Poster presentationsBC04 Clinical efficacy of oral tranexamic acid in lichen planus pigmentosus: case series

Poster presentationsBC04 Clinical efficacy of oral tranexamic acid in lichen planus pigmentosus: case series

Combination of topical silymarin 0.7%, dual toning and chemical peels (SeQuenCe protocol) for lichen planus pigmentosus in Indian skin

Combination of topical silymarin 0.7%, dual toning and chemical peels (SeQuenCe protocol) for lichen planus pigmentosus in Indian skin

A clinico-epidemiological study of different dermoscopic patterns in hyperpigmented facial lesions in a tertiary care centre.

Facial pigmentation is a common presentation of patients attending dermatology out patient department (OPD) and is of great concern to patients. Facial pigmentation may be multifactorial and is only rarely diagnosed accurately by a detailed history and clinical examination. Pigmentary disorders cause psychological distress and negatively impact the quality of life of an individual. (1) To study different dermoscopic patterns in facial melanosis. (2) To estimate the frequency of different dermoscopic patterns. Patients with facial hyperpigmentation attending the dermatology OPD were recruited after taking their written consent. A detailed history was taken to collect demographic data. Clinical examination and dermoscopy were done in all patients. Biopsy was done as and when required. Descriptive statistics has been used to describe the quantitative data. Qualitative data were presented as frequency and percentage for clinical and dermoscopic patterns. The study included 100 patients with 15 different facial melanoses. The most common age group affected was 21-40 years in 53 (53%) cases. The female-to-male ratio was 1.63:1. Melasma was reported as the most common cause of facial melanosis constituting 49 (49%) of the total cases. Out of the total melasma cases, epidermal melasma constituted 22 (45%) cases, dermal melasma constituted four (4%) cases and mixed melasma constituted 23 (47%) cases. Other cases included were lichen planus pigmentosus (14; 14%), facial acanthosis nigricans (14; 14%), periorbital hyperpigmentation (7; 7%), post-inflammatory hyperpigmentation (4; 4%), exogenous ochronosis (2; 2%), lentigines (2; 2%), frictional melanosis (2;2%), and one case each of Becker's nevus, nevus of Ota, olanzapine-induced hyperpigmentation, Riehl's melanosis, macular amyloidosis, and tanning. Melasma was reported as the most common cause of facial melanosis. The most common dermoscopic feature was accentuated pseudopigment network. The study is beneficial in understanding the different clinical and dermoscopic patterns of facial melanosis, thus helping the physician to effectively manage the conditions and reduce the need of biopsy. (1) A small sample size. (2) Histopathological correlation was not done in all cases.

Blepharochalasis and Lichen Planus Pigmentosus: A Very Rare Association

Abstract Blepharochalasis syndrome is a condition of the eyelids consisting of episodic inflammation and chronic skin changes. It is usually bilateral and tends to manifest in the upper eyelids. But, there are cases of unilateral presentation also which exclusively affects the lower eyelids. There are multiple theories regarding the etiology of blepharochalasis. Blepharochalasis is believed to be a manifestation of angioneurotic edema. Hormonal changes may play an important role in the disease process. Immunohistochemical analysis of excised eyelid skin has demonstrated the presence of IgA in several studies. These findings suggest that there may be a concomitant inflammatory process accompanying the extravasations’ of fluid and localized edema occurring at the capillary level. Blepharochalasis might also present as part of systemic disease. The disease, lichen planus pigmentosus, is a variant of lichen planus and has also been noted the presence of IgA and IgG along with complement C3 in the epidermal cells in several studies.

Trichoscopic findings in patients with patchy alopecia and its comparison with histopathological diagnosis

ABSTRACT Introduction: Loss of hair is one of the most common complaints that baffle dermatologists. Diagnosis of patchy alopecia is challenging because of overlapping clinical and histopathological features. Trichoscopy is an easy diagnostic modality which also helps demonstrate the problem to the patient. Objective: To study the trichoscopy and histopathology in patchy alopecia scalp and to look for any correlation. Materials and Methods: This was a cross-sectional study for 18 months from January 2017 after obtaining permission from the institutional ethics committee. Results: Trichoscopic and histopathological concordance in patchy alopecia was 73.77% in our study. The most common trichoscopic findings observed were black dots, perifollicular pigmentation, and white patches in alopecia areata, lichen planus pigmentosus, and discoid lupus erythematosus, respectively. Conclusion: Trichoscopy is a useful tool in the diagnosis of patchy alopecia.

Reflectance confocal microscopy as a complementary diagnostic tool for greyish-brown dermatoses in children.

Mastocytosis, lichen planus pigmentosus (LPP), fixed drug eruption (FDE) and café-au-lait macules (CALM) have a similar appearance, often lead to misdiagnosis and missed diagnoses. At the outpatient clinic at Tianjin Children's Hospital in 21 patients with mastocytosis, 18 with LPP, 11 with FDE and 12 with CALM we evaluated the characteristics and distinguishing features of their dermatoses using reflectance confocal microscopy (RCM). In mastocytosis, the dermal papillary rings generally had a significantly increased bright refractive index and the superficial dermis was filled with moderate refractive flocculent material. In LPP, the dermal papillary rings were absent and numerous different-sized cellular structures were densely distributed in the superficial dermis. In FDE, the dermal papillary rings were intact with a significantly increased bright refractive index. In CALM, normal dermal papillary rings were detected with a uniformly slightly increased refractive index and no obvious abnormality in the superficial dermis. RCM allows for real-time visualization of the major key diagnostic and distinguishing features of four greyish-brown dermatoses in children.

Clinical and histopathological study of cutaneous lichen planus in a tertiary care center of central India

Abstract Background: Lichen planus (LP) is an idiopathic, chronic inflammatory disease of the skin, mucous membrane, and nails. Worldwide distribution is seen, with 0.38% of the lesions prevalent in India. Objective: The present study was conducted to study the demographic profiles (such as age and gender) and histopathology of LP and their clinical presentation. Materials and Methods: The present study was conducted in the Department of Pathology at Sri Aurobindo Medical College and Post Graduate Institute, Indore. All cases presenting with LP and undergoing skin biopsy from December 2018 to May 2021 were included in the study. Detailed clinical history was taken, and histomorphological evaluation was performed for all the included cases. Results: A total of 155 cases of LP were analyzed. The mean age of presentation was 34.89 ± 16.02 years, with slight male predominance. The mean duration of the disease was 7.82 ± 5.34 months. Clinically, most cases presented with mild to moderate pruritis (64.51%), followed by intense pruritis (25.16%). Violaceous papules and plaques were the predominant findings in 80.64% of patients, followed by hyperpigmented papules and macules (13.54%). Histomorphologically, hyperkeratosis was observed in almost all cases (99.35%), followed by wedge-shaped hypergranulosis (65.80%). The most common variant found was classic LP (30.96%), followed by hypertrophic LP (29.6%) and LP pigmentosus (26.4%). Clinicopathological discordance was seen in ~14 (10%) cases. Conclusion: Detailed history, clinical examination, and careful histological assessment help diagnose LP and differentiate its variants.

Atypical distribution of lichen planus pigmentosus: Pigmentation of the nose and ears

Atypical distribution of lichen planus pigmentosus: Pigmentation of the nose and ears

Lichen planus pigmentosus inversus limited to the umbilicus — a case report with dermoscopic findings

Lichen planus pigmentosus inversus limited to the umbilicus — a case report with dermoscopic findings

Acquired dermal macular hyperpigmentation: an overview of the recent updates.

Acquired dermal macular hyperpigmentation (ADMH), previously known as macular pigmentation of uncertain etiology (MPUE), is an umbrella concept that unifies the distinct but overlapping acquired dermal pigmentary disorders like lichen planus pigmentosus, ashy dermatosis, erythema dyschromicum perstans, Riehl's melanosis and pigmented contact dermatitis. All of these disorders usually lack a clinically apparent inflammatory phase, are characterised by dermal pigmentation clinically and histologically, and have a variable protracted disease course. Recently, a proposal has been made to classify these disorders into those with and without contact sensitisation. Dermoscopy is essentially similar across the spectrum of these disorders, and is useful for diagnosis and therapeutic response monitoring. Scoring system has been validated for the same. The treatment of ADMH remains challenging, with multiple topicals, oral therapies including mycophenolate mofetil, and lasers tried. Need of the hour is randomised controlled trials to enhance the therapeutic armamentarium.

Ashy Dermatosis: A Narrative Literature Review

Ashy dermatosis (AD) or erythema dyschromicum perstans (EDP) is a type of hyperpigmented macules characterized by asymptomatic, gray macular lesions with a symmetrical distribution. Some of the predisposing factors for ashy dermatosis are intestinal parasitic infections, a bad environment such as consumption of ammonium nitrate, X-ray contrast media and genetic factors such as the HLA-DR4 allele. The clinical manifestations of ashy dermatosis are hyperpigmented or gray macules with slow progression and pigmentation abnormalities in the inner epidermal layer. The differential diagnosis of ashy dermatosis is with lichen planus pigmentosus, idiopathic eruptive macular pigmentation, and Riehl's melanosis. Diagnosis of ashy dermatosis needs to be linked between clinical findings and histopathological examination, other supporting examinations and differentiating it from other differential diagnoses. Management for patients with ashy dermatosis is with topical or systemic agents. For now, a combination of laser and tacrolimus ointment is recommended.

Hyperpigmented Macules in an Indian boy: is it EDP or LPP ? - A Case Report

Erythema dyschromicum perstans (EDP) and Lichen planus pigmentosus (LPP) are both inflammatory disorders of pigmentation with unknown etiology and are difficult to differentiate clinically and histologicaly. There is no consensus on whether both entities are separate or belong to the same spectrum of cutaneous disorders. We present a 13 year old boy with mostly asymptomatic hyperpigmented lesions over body. The lesions were subsequently diagnosed as EDP after detailed examination and histopatholgical examination.