Introduction: Lichen planus pigmentosus (LPP) is a rare variant of lichen planus that presents with pruritic, slate gray to black macules and patches on both sun and non-sun exposed areas. Lesions may be clinically similar to ashy dermatosis. The etiology of LPP is not fully elucidated and the condition may spontaneously regress or remain active for years. Several literatures have mentioned improvement with topical calcineurin inhibitors however, no standard treatment exist.
Case Summary:Case 1 is a 71-year-old male who presented with a five-month history of pruritic, gradually enlarging, gray to black macules and patches on the nose, right upper arm, interdigital webbing of the hands, hypogastric area, and lower back. Immunofluorescence showed shaggy, linear deposits of fibrinogen on the basement membrane zone. Case 2 is a 19-year-old male who presented with a one year history of multiple erythematous, macules and patches on the thighs that gradually increased in number and size affecting the face, neck and post-surgical site on the trunk. Skin punch biopsies for the two cases revealed a lichenoid inflammatory infiltrate and numerous pigment-laden macrophages in the dermis. Clinicopathologic presentation for both were consistent with a diagnosis of lichen planus pigmentosus. Patients were managed with 0.03% tacrolimus cream.
Conclusion :Lichen planus pigmentosus is a rare condition that presents with distinctive clinical and histopathologic features. The presence of hyperpigmented lesions on both sun and non-sun exposed areas along with a characteristic lichenoid pattern on biopsy differentiates LPP from other hyperpigmented skin conditions.
Paredes, R., Dela Cruz, CM., Pipo, E. & Dayrit, J. (2017). Lichen planus pigmentosus in two Filipino males: a case report. Journal of the Philippine Dermatological
Society, 26(2), 61-63.
lichen planus pigmentosus, lichenoid pattern, skin hyperpigmentation
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