Authors: Roy Lawrence S. Paredes, MD, Ciara Mae H. Dela Cruz, MD, Eugenio Pipo, MD, Johannes F. Dayrit, MD, FPDS

Abstract

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.

Citation

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.

Keywords

lichen planus pigmentosus, lichenoid pattern, skin hyperpigmentation

1. Weston G, Payette M. Update on Lichen Planus and its clinical variants. Int J Womens Dermatol. 2015 Sep; 16;1(3):140-149.
2. Güngör S, Topal I, Erdogan Ş, Özcan, D. Classical lichen planus and lichen planus pigmentosus inversus overlap with dermoscopic features. Our Dermatol Online.2014; 5(1):42-44.
3. Ghosh A, Coondoo A. Lichen Planus Pigmentosus: The Controversial Consensus. Indian J Dermatol. 2016 Sep-Oct;61(5):482-6.
4. Mckee PH, Calonje E, Granter SR. Pathology of the skin with clinical correlations 3^rd ed. China: Elsevier Mosby. 2005.
5. Sehgal VN, Verma P, Bhatttacharya SN, Sharma S, Rasool F. Lichen planus pigmentosus. Skinmed. 2013 Mar-Apr;11(2):96-103.
6. Fernandez-Flores A, Montero MG. Ashy dermatosis, or ‘Tyndall-effect’ Dermatosis. Dermatol Online J. 2006 May 30;12(4):14.
7. Rieder E, Kaplan J, Kamino H, Sanchez M, Pomeranz MK. (2013). Lichen planus pigmentosus. Dermatol Online J. 2013 Dec 19(12):9.
8. Al-Mutairi N, El-Khalawany M. Clinicopathological Characteristics of lichen planus pigmentosus and its response to tacrolimus ointment: an open label non-randomized, prospective study. J Eur Acad Dermatol Venereol. 2010 May;24(5):535-40.
9. Kim JE, Won CH, Chang S, Lee MW, Choi JH, Moon KC. Linear lichen planus pigmentosus of the forehead treated by neodymium:yttrium-aluminum-garnet laser and topical tacrolimus. J Dermatol. 2012 Feb;39(2):189-91.
10. Vachiramon V, Suchonwanit P, Thadanipon K. Bilateral linear lichen planus pigmentosus associated with hepatitis C virus infection. Case Rep Dermatol. 2010 Sep 11;2(3):169-172.
11. Muthu S, Narang T, Uma S, Jit Kanwar A, Parsad, D, Dogra S. Low-dose oral isotretinoin therapy in lichen planus pigmentosus: an open-label non-randomized prospective pilot study Int J Dermatol. 2016 Sep;55(9):1048-54.

More Articles