Lichen Planus Pigmentosus Research Articles

Clinicohistopathologic study of lichenoid interface dermatitis

Background: Interface dermatitis (IFD)/lichenoid tissue reactions are among the most frequently presenting disorders in dermatology, which in common have a constellation of histopathological features but varied clinical presentation. Aim: Clinicopathologic correlation and determination of histomorphologic changes associated with various lichenoid IFD of the skin. Materials and Methods: This was a prospective study with purposive sampling of patients reporting to the outpatient department of dermatology, venerology, and leprosy of our hospital from January 2017 to July 2018. Skin biopsies of 150 patients of either sex diagnosed provisionally as one of the lichenoid IFD on clinical grounds were studied. Clinicohistopathologic correlation was done. Results: We encountered 58 cases of classic lichen planus, seven variants of lichen planus (hypertrophic lichen planus, ashy dermatosis, lichen planus pigmentosus, actinic lichen planus, lichen planopilaris, lichen nitidus, and lichen striatus), and 16 cases of lichenoid eruptions. About 82.6% of the cases were concordant histopathologically. The peak incidence was in 20–40 years of age with an equal predilection for males and females. A majority of the lesions were multiple, pruritic, papules, and plaques involving the limbs. Histopathologically, the most consistent findings were basal cell vacuolar degeneration followed by melanin incontinence. Conclusion: Lichenoid IFDs are exclusive clinicopathological entities with several variants. Subtle features noted on histopathology help in differentiating these lesions. Understanding and interpreting these subtle changes aids in better clinical management of the patient.

Lichen planus pigmentosus in systemic sclerosis: a rare association

Lichen planus pigmentosus in systemic sclerosis: a rare association

The diagnostic conundrum of Riehl melanosis and other facial pigmentary disorders: a case report with overlapping clinical, dermoscopic, and histopathological features

Riehl melanosis (RM) is a form of pigmented contact dermatitis that often poses a diagnostic challenge due to overlaps in its clinical, dermoscopic, and histopathological features with other pigmentary disorders. This report highlights significant findings and the proper approach for diagnosis. We present the case of a 47-year-old female with progressive facial hyperpigmentation (irregular, blotchy, grayish patches on the forehead, cheeks, and around the mouth) that acknowledged applying a lightening product before her complaint. Dermoscopy revealed brownish-gray dots and pseudonetwork pigmentation. The histopathological findings were comprised of hypergranulosis, interface dermatitis, and pigment incontinence. The patient's history and clinical, dermoscopic, and histopathological examination results showed features consistent with-but not exclusive to-RM, such that it was not possible to rule out lichen planus pigmentosus (LPP) and ashy dermatosis (AD). We finally diagnosed the patient with RM and treated her with medications consisting of alpha hydroxy acid, tretinoin, hydroquinone, and sunscreen. Patch testing might help because higher positivity rates were found in RM patients compared to LPP and AD. However, positive patch testing favors RM, and, regardless of diagnosis, provides a basis for substance avoidance in the treatment plan.

Lichen planus pigmentosus, linear nevoid pattern along the lines of blaschko with mucosal involvement

Pigmented lichen planus is a rare variant of lichen planus that is characterized by oval and round shape dark brown macules with indistinct border. Linear pigmented lichen planus is a clinical pattern of planus disease that presents unilaterally along one or more lines of blaschko. We report a 30–year-old female patient with Linear pigmented lichen planus along the lines of blaschko with mucosal involvement. Keywords: Pigmented lichen planus; Blaschko line; Mucosal involvement.

Ashy Dermatosis and Lichen Planus Pigmentosus: The Histopathological Differences.

Background Ashy dermatosis (AD) and lichen planus pigmentosus (LPP) are both acquired macular pigmentation of uncertain aetiology. Despite the controversy surrounding their entities, recent global consensus has concluded that they are 2 different diseases with distinct clinical presentations. Nevertheless, there are limited data on their histopathological comparisons. Objective To evaluate the differences in histopathological findings between AD and LPP. Methods Electronic records and photographs of patients with the diagnosis of AD or LPP from January 2008 to December 2018 were retrospectively reviewed by a dermatologist. Patients were then classified into groups with AD and LPP, based on the clinical descriptions from the recent consensus. Those with history/clinical presentations suggestive of other causes of macular pigmentation were excluded. The histopathological diagnosis of AD and LPP was then reevaluated by a blinded dermatopathologist. Results One hundred and twenty-four patients with acquired macular pigmentation were identified; 24 were excluded due to clinical history or photographs being inconsistent with AD or LPP. Of the remaining 100 patients, 71 had clinical findings consistent with LPP while 29 had AD. The prevalence of epidermal hyperkeratosis was significantly higher in LPP when compared to AD (33.8% vs. 0%, p < 0.001), as well as epidermal hypergranulosis (35.2% vs. 0%, p < 0.001), lichenoid dermatitis (49.3% vs. 7.1%, p < 0.001), perifollicular infiltration (47.9% vs.10.3%, p < 0.001), and perifollicular fibrosis (35.2% vs. 10.3%, p=0.01). In addition, the degree of pigmentary incontinence was more severe in LPP (21.1% vs. 3.5%, p=0.015). For AD, vacuolization of the epidermal basal cell layer was more common (96.4% vs. 77.5%, p=0.02). Conclusions Although most cases of AD and LPP can be diagnosed clinically, in doubtful cases, histopathological findings of lichenoid dermatitis, epidermal hyperkeratosis/hypergranulosis, and moderate to severe pigmentary incontinence can help distinguish LPP from AD.

Increased Preauricular Wrinkles in Frontal Fibrosing Alopecia Compared to Age-Matched Controls: A Prospective Study of 64 Patients

Introduction: Frontal fibrosing alopecia (FFA) is a scarring alopecia affecting mainly postmenopausal females. Associated clinical signs include facial papules, glabellar red dots, depression of frontal veins, and lichen planus pigmentosus. Our objective was to establish the validity of increased preauricular lines as another clinical marker of FFA. Materials and Methods: Thirty-two females with FFA were compared to 32 age-matched females with either androgenetic alopecia or chronic telogen effluvium. Bilateral images of the preauricular area were taken, and disease severity was calculated in all FFA patients using the FFA severity scale (FFASS). The average number of preauricular lines were determined and compared based on group, age, and severity. Results: Patients with FFA had a significantly higher mean number of preauricular lines than controls (p = 0.002). Intergroup analysis among the FFA patients revealed no significant difference between FFASS and the number of wrinkles or the number of wrinkles in patients ≥60 years old. Discussion and Conclusion: Females with FFA have increased preauricular lines compared to age-matched controls regardless of age, and disease severity was not correlated to increased lines. Although the cause is unknown, atrophy and loss of elastic fibers in biopsies of the preauricular area in diseased patients may contribute. These findings reveal another potential clinical marker of FFA.

Lichen planus pigmentosus in a patient with coexistence of discoid lupus and lichen planus

Lichen planus pigmentosus in a patient with coexistence of discoid lupus and lichen planus

The color of skin: gray diseases of the skin, nails, and mucosa

Gray diseases are a group of skin disorders characterized mainly by gray discoloration with or without involving the mucous membranes and nails. These diseases may be hereditary or acquired. Some of the better-known hereditary entities are dermal melanocytosis, incontinentia pigmenti, hypomelanosis of Ito, hemochromatosis, ochronosis, and silvery hair syndrome. Acquired diseases with gray coloring include late-stage organ failure, lichen planus pigmentosus, erythema dyschromicum perstans, and drug reactions. The discoloration is due to either increased epidermal and or dermal melanin or dermal deposition of a chromogen or a combination of both. Investigations are directed to determining the underlying medical condition and a skin biopsy is usually unnecessary. Likewise, treatment is directed mainly toward the underlying medical disease. Although bleaching (lightening) agents may diminish the discoloration, better results may be obtained from using a Q-switched laser and intense pulsed light, either alone or in combination with topical agents.

A clinico-demographic study of 344 patients with lichen planus pigmentosus seen in a tertiary care center in India over an 8-year period.

Lichen planus pigmentosus (LPP) is an acquired disorder of hyperpigmentation affecting certain racial and ethnic groups. To retrospectively analyze the demographic and clinical characteristics of LPP. Clinical and demographic records of all LPP patients attending our pigmentary clinic from January 2011 to June 2018 were reviewed. Data of 344 LPP patients (229 females) were analyzed. Affected females had significantly higher age at onset (P<0.002) but lesser disease duration at presentation (P<0.001) as compared to males. Significant positive correlation between body surface area involvement and disease duration was observed (r=0.72). Personal history of atopy and accompanying autoimmune diseases were observed in 49 (14.24%) and 45 (13.08%) patients, respectively. Observed morphological patterns of LPP included diffuse (n=193, 56.1%); reticular (n=45, 13.1%); blotchy (n=41, 11.9%); and follicular (n=28, 8.1%). All the patients had a chronic and indolent course of disease with approximately half (49.2%) reporting satisfactory improvement with treatment. This is the largest clinico-demographic study till date on LPP. A longer disease duration was associated with more widespread disease. Although the disease improved over time as per patient and physician global assessment, a complete clearance was rarely attained.

Significant reduction in the expression of interleukins-17A, 22 and 23A, forkhead box p3 and interferon gamma delineates lichen planus pigmentosus from lichen planus.

Recent studies have noticed significant role of interleukin (IL)-17, 22, 23, Foxp3, interferon-gamma (IFN-γ) and Wnt5a in oral and cutaneous lichen planus (LP). This study was undertaken to assess whether similar expression exists in lichen planus pigmentosus (LPP). We recruited 30 patients of treatment-naïve 'LPP' (in absence of cutaneous/mucosal LP elsewhere, group 1), 10 patients having active treatment-naïve cutaneous 'LP' (group 2), 10 patients having 'post-LP' hyperpigmentation (in absence of active LP and off treatment for at least past 3months, group 3), and 10 controls. Quantitative real-time polymerase chain reaction (qRT-PCR, peripheral blood mononuclear cells [PBMCs] and skin) and immunohistochemistry (IHC, skin) was performed. mRNA expression (in PBMCs) of IL-17A, IL-22, IL-23A, IFN-γ and Foxp3 was significantly decreased in group 1 and 3 as compared to group 2 (p < 0.05). Wnt5a expression was maximal in controls; and while there was no difference between group 1 and 2; whereas expression in group 3 was significantly lesser than group 1 and 2 (p < 0.05). qRT-PCR (skin) and IHC (skin) revealed similar results; and mRNA expression and mean fluorescence intensity of IL-17A, IL-22, IL-23A/R was significantly increased in group 2 and 3 compared to group 1 (p < 0.05). Mean fluorescence intensity and mRNA expression of IFN-γ, Foxp3 and Wnt5a were significantly increased in group 2 compared to group 1 (p < 0.05); whereas the difference between group 1 and 3 was not significant. Mean fluorescence intensity and mRNA expression of IL-17A, 1L-22 and IFN-γ showed no difference between group 2 and 3; whereas that of IL-23A/R, foxp3 and wnt5a were significantly higher in group 2 than group 3 (p < 0.05). Overall, maximal expression of IL-17A, IL-22, IL-23A, IFN-γ and Foxp3 (mRNA PBMCs) was observed in LP. Minimal expression of IL-17A, IL-22, IL-23A/R, IFN-γ and Foxp3 (mRNA skin and IHC skin) was seen in LPP patients. In contrast to LP, LPP lacks the expression of IFN-γ, Foxp3 and the cytokines representing Th17 pathway, and thus seems to have a distinct pathogenesis.

Lichen planus pigmentosus and association with autoimmune diseases: A case–control study

Lichen planus pigmentosus and association with autoimmune diseases: A case–control study

Contact sensitization to hair colours in acquired dermal macular hyperpigmentation: results from a patch and photo-patch test study of 108 patients.

Acquired dermal macular hyperpigmentation (ADMH) is an umbrella term including lichen planus pigmentosus, erythema dyschromicum perstans and pigmented contact/cosmetic dermatitis. To establish contact sensitization to hair colours as an aetiological factor for ADMH. Detailed clinical examination, skin biopsies, and patch and photo-patch testing with Indian standard series and patient's own cosmetic products were performed. Thirty-nine (36.1%) patients were found to demonstrate a positive patch/photo-patch test with 35/39 reacting to their own products (all were hair colours) and 16/39 reacting to antigens from commercial series (commonly paraphenylenediamine). Fourteen patients developed delayed hyperpigmentation on positive patch-test sites at 1 month. Higher mean age, symptomatic pigmentation (pruritus, burning and photosensitivity), hair margins involvement (outer surface, helix and lobule of ear; temples and preauricular area), ill-defined lesions, epidermal atrophy and epidermal melanization extending >3 layers were significantly common in patch-test-positive patients. Well-defined lesions, perioral involvement and associated lichen planus were clinical pointers towards patch-test negativity. Index study exemplifies that patch-test results have distinct clinical and histopathological correlates in ADMH. Hair dye contact sensitization appears to be an important aetiological factor in about one-third patients presenting with ADMH.

Lichen planus pigmentosus: a case series with different ethnical, clinical and dermoscopic features

Lichen planus pigmentosus: a case series with different ethnical, clinical and dermoscopic features

Could colchicine represent a new therapeutic approach for lichen planus pigmentosus?

Dermatologic TherapyVolume 32, Issue 2 e12809 Therapeutic Hotline: Letter Could colchicine represent a new therapeutic approach for lichen planus pigmentosus? Emanuele Cozzani, Corresponding Author Emanuele Cozzani emanuele.cozzani@unige.it Dissal Section of Dermatology, Policlinico San Martino Hospital, University of Genova, Genova, Italy Correspondence Emanuele Cozzani, Dissal Section of Dermatology, Policlinico San Martino Hospital, University of Genova, Largo Rosanna Benzi 10, 16132 Genova, Italy. Email: emanuele.cozzani@unige.itSearch for more papers by this authorLodovica Gariazzo, Lodovica Gariazzo Dissal Section of Dermatology, Policlinico San Martino Hospital, University of Genova, Genova, ItalySearch for more papers by this authorMargherita Cioni, Margherita Cioni orcid.org/0000-0002-3056-2026 Dissal Section of Dermatology, Policlinico San Martino Hospital, University of Genova, Genova, ItalySearch for more papers by this authorAurora Parodi, Aurora Parodi Dissal Section of Dermatology, Policlinico San Martino Hospital, University of Genova, Genova, ItalySearch for more papers by this author Emanuele Cozzani, Corresponding Author Emanuele Cozzani emanuele.cozzani@unige.it Dissal Section of Dermatology, Policlinico San Martino Hospital, University of Genova, Genova, Italy Correspondence Emanuele Cozzani, Dissal Section of Dermatology, Policlinico San Martino Hospital, University of Genova, Largo Rosanna Benzi 10, 16132 Genova, Italy. Email: emanuele.cozzani@unige.itSearch for more papers by this authorLodovica Gariazzo, Lodovica Gariazzo Dissal Section of Dermatology, Policlinico San Martino Hospital, University of Genova, Genova, ItalySearch for more papers by this authorMargherita Cioni, Margherita Cioni orcid.org/0000-0002-3056-2026 Dissal Section of Dermatology, Policlinico San Martino Hospital, University of Genova, Genova, ItalySearch for more papers by this authorAurora Parodi, Aurora Parodi Dissal Section of Dermatology, Policlinico San Martino Hospital, University of Genova, Genova, ItalySearch for more papers by this author First published: 07 January 2019 https://doi.org/10.1111/dth.12809Citations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume32, Issue2March/April 2019e12809 RelatedInformation

Modified phenol peels for treatment-refractory hyperpigmentation of lichen planus pigmentosus: A retrospective clinico-dermoscopic analysis.

Lichen Planus Pigmentosus (LPP), a disorder with stubborn treatment-refractory hyperpigmentation predominantly affects the darker skin. Deep dermal pigmentary incontinence of LPP renders the condition treatment-refractory. Lack of a consistently effective depigmenting treatment protocol of inactive LPP mandates exploration of novel approaches. We analyzed the effect of six sessions of modified phenol peel on reduction of pigmentation of LPP in Indian patients. The results of a retrospective analysis of the efficacy and safety of six sessions of Croton oil free phenol combination (CFPC) peel done every 3weeks, for inactive LPP-associated hyperpigmentation in 17 patients are presented. Efficacy evaluation was done with patient-reported improvement, physician-evaluated improvement (photographic comparison of baseline and post-treatment clinical images), and pre- and posttreatment comparison of dermoscopic images using a simple scale. Out of 17, 5 (29%) patients sustained excellent improvement with >75% reduction of pigmentation. Overall 13 (76%) patients had moderate to excellent improvement, that is, at least 25% or more reduction in pigmentation. The patient-reported improvement, physician-graded improvement, and dermoscopic changes-all three measures showed harmonious overlap. Lightening of the background color and reduction in density and color intensity of pigmented structures was observed on dermoscopy in majority of patients. The treatment was well tolerated with no serious local/systemic adverse effects. Modified phenol peels seem effective in reduction of hyperpigmentation of LPP. They are safe and well tolerated. Thorough priming, stringent sun protection and use of post-peel adjuvant topicals boost the peel effect and aid in maintaining the effect for up to a year.

Lichen Planus Pigmentosus: A Clinico-etiological Study.

Introduction:Lichen planus pigmentosus (LPP) is a distinct clinical entity commonly encountered in the Indian population.Aim:To study the clinicoetiological profile of LPP at a tertiary care hospital.Methods:A total of 100 patients with clinically and histopathologically confirmed diagnosis of LPP were included. Demographic details including the age of onset, duration of disease, symptoms, and family history were obtained. History regarding any precipitating factors, cosmetics, drug intake, and associated cutaneous or systemic diseases was taken. Clinical examination of the skin, oral cavity, hair, and nails was carried out.Results:Of the total 100 patients, 56 (56%) were females and 44 (44%) males with age ranging from 18 to 54 years (mean age - 31.23 years). The duration of disease ranged from 2 to 60 months with a mean of 19.31 months. Cosmetic disfigurement (68%) was the commonest complaint, followed by itching (41%) while, 30% of the patients were asymptomatic. History of topical mustard oil and hair dye application was present in 62% and 48% of the cases each. Other topicals included perfumes (24%), aftershave lotion (36%), and cosmetics (20%). Face (54%) and neck (48%) were the commonest sites affected, followed by upper back (36%), upper limbs, and chest (each 32%). A total of 11 patients showed only flexural involvement. The commonest pattern of pigmentation was diffuse (56%) followed by reticular in 16%. The color of the pigmentation varied from slate grey to brownish-black in varying proportions. A positive association was found between hypothyroidism with diffuse LPP where the P value was <0.001.Conclusion:LPP is a distinct clinical entity caused by diverse etiological factors and shows varied clinical patterns. All the patients should be advised to stop using mustard oil/henna/hair dye/after shave lotions and cosmetics. Hypothyroidism can be considered to be a disease associated with LPP and all the patients should be investigated for the same.

Five year descriptive study of the histomorphological features of lichen planus

Background: Lichen planus is a chronic or sub-acute disorder characterized by small, flat-topped, shiny, erythematous or violaceous, pruritic polygonal papules most commonly involving the wrists and/or ankles in symmetric fashion. The spectrum of clinical diseases related to the lichenoid tissue reaction is getting wider with a recent increase in new subgroups of the lichenoid clinical picture. Lichen Planus contributes to the major bulk of cases of lichenoid tissue reactions. This study is designed to study the histopathology of clinical variants of lichen planus and its distribution in relation to age, sex and site of lesion. Objectives of the study: To study the histopathological features of lichen planus and its variants and clinicopathological correlation with respect to age and sex. Methods: This study was carried out over 5 years (retro and prospective) at Mahadevappa Rampure Medical College, Kalaburagi on clinically diagnosed cases of lichen planus. The tissue was fixed in 10% formalin and paraffin embedded sections were obtained for microscopic examination. Results: We studied 107 skin biopsy specimens. The variants of lichen planus received were classical lichen planus (55), hypertrophic lichen planus (27), follicular lichen planus (12), actinic lichen planus (6), isolated oral lichen planus (3), lichen planus pigmentosus (3), lichen planus pemphigoides (1). Maximum number of cases occurred in 2nd decade (29.9%). A slight female preponderance was noted (53.2%). Extremities were the most common site affected in 59 cases (55.1%). Conclusion: Lichen planus presents with varied morphology and microscopy, hence detailed clinical examination with data collection and proper histopathological examination is necessary for categorization and understanding of lichen planus and differentiation from various, diverse and perplexing lichenoid tissue reactions.

Optimizing Q-switched lasers for melasma and acquired dermal melanoses

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.

Histological Evaluation of Acquired Dermal Macular Hyperpigmentation.

Context:An umbrella term, acquired dermal macular hyperpigmentation (ADMH), has been proposed to denote conditions including ashy dermatosis, erythema dyschromicum perstans, lichen planus pigmentosus, and idiopathic macular eruptive pigmentation.Aims:To classify the patients manifesting ADMH on the basis of histology.Settings and Design:In this retrospective, cross-sectional study, histology specimens of patients of ADMH, who underwent skin biopsy in our institution from 1.1 2015 to 31.12.2017, were included after obtaining ethical clearance.Materials and Methods:The histology specimens of patients of ADMH were reviewed by the pathologist and classified. Clinical features of individual patient were collected from previous records and the data analyzed.Statistical Analysis Used:Pearson's Chi-square test was used to determine significance of association between age of onset and duration of pigmentation with histology type.Results:Three patterns of histology were identified in the study group (17 males and 13 females). Type 1: Basal cell degeneration and moderate to dense inflammation (12 patients, 40%), type 2: Significant pigment incontinence and sparse inflammation without basal cell degeneration, (12 patients, 40%), and type 3: sparse inflammation without basal cell degeneration or significant pigment incontinence (six patients, 20%). Statistically significant association was noted between age of onset of pigmentation and histology type (P value, 0.02).Limitations:Main limitation was the small sample size.Conclusions:Prospective studies evaluating the clinical progression and dermoscopy features and analyzing serial biopsies of ADMH patients may confirm whether the histology patterns observed represent different stages of same disease process or are different entities.

Lichen planus pigmentosus: A report of two cases

Lichen planus pigmentosus is a condition characterized by persistent and asymptomatic slaty-gray pigmentation, predominantly in the face. Two patients, aged 11-year-old female and 35-year-old male, reported to the Department of Oral Medicine and Radiology with burning sensation on taking spicy foods. On examination, only extensive symmetric brownish-black pigmentation of the buccal mucosa was observed bilaterally. The workup and management of these cases are presented along with the relevant review of literature.