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A 24 Year Old Male with Hyperpigmented Macules in Face, Neck and Upper Extremities

  • Dipak Kumar Agarwalla
Chapter
Part of the Clinical Cases in Dermatology book series (CLIDADE)

Abstract

Lichen planus pigmentosus (LPP) is considered to be a macular variant of lichen planus with an unknown etiology. A 24 year old male presented with asymptomatic progressive slate grey to brown-black macules in face, neck and upper extremities. LPP, erythema dyschromicum perstans, reihl’s melanosis, macular amyloidosis and post-inflammatory pigmentation were the common differentials considered. Dermoscopy reveals grey to blue pigment dots forming a net like pattern. Histopathology showed marked pigmentary incontinence, focal basal cell degeneration with minimal perivascular lymphocytic infiltrate in superficial dermis. Based on these findings diagnosis of LPP was made. This rare variant of lichen planus usually affects people with darker skin. It is characterized by slate gray to brown black coloured macules presenting predominantly on the sun-exposed areas, although it can be more widespread. Dermoscopy and histopathology help in confirming the diagnosis. Treatment with vitamin A, oral and topical steroids, topical tacrolimus and photoprotection show variable response.

Keywords

Lichen planus pigmentosus Lichen planus Erythema dyschromicum perstans Reihl’s melanosis Macular amyloidosis Post-inflammatory pigmentation 

References

  1. 1.
    Kanwar AJ, Dogra S, Handa S, Parsad D, Radotra BD. A study of 124 Indian patients with lichen planus pigmentosus. Clin Exp Dermatol. 2003;28(5):481–5.CrossRefGoogle Scholar
  2. 2.
    Robles-Méndez JC, Rizo-Frías P, Herz-Ruelas ME, Pandya AG, OcampoCandiani J. Lichen planus pigmentosus and its variants: review and update. Int J Dermatol. 2018;57(5):505–14.CrossRefGoogle Scholar
  3. 3.
    Güngör S, Topal IO, Göncü EK. Dermoscopic patterns in active and regressive lichen planus and lichen planus variants: a morphological study. Dermatol Pract Concept. 2015;5(2):45–53.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Ghosh A, Coondoo A. Lichen planus pigmentosus: the controversial consensus. Indian J Dermatol. 2016;61:482–6.CrossRefGoogle Scholar
  5. 5.
    Mathews I, Thappa DM, Singh N, Gochhait D. Lichen planus pigmentosus: a short review. Pigment Int. 2016;3:5–10.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Dipak Kumar Agarwalla
    • 1
  1. 1.Gauhati Medical College and HospitalGuwahatiIndia

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