Lichen Planus Pigmentosus: The Controversial Consensus

Aparajita Ghosh, Arijit Coondoo, Aparajita Ghosh, Arijit Coondoo

Abstract

A pigmented variant of lichen planus (LP) was first reported from India in 1974 by Bhutani et al. who coined the term LP pigmentosus (LPP) to give a descriptive nomenclature to it. LP has a number of variants, one of which is LPP. This disease has also later been reported from the Middle East, Latin America, Korea, and Japan, especially in people with darker skin. It has an insidious onset. Initially, small, black or brown macules appear on sun-exposed areas. They later merge to form large hyperpigmented patches. The disease principally affects the sun-exposed areas of the body such as the face, trunk, and upper extremities. The oral mucosa may rarely be involved. However, the palms, soles, and nails are not affected. Histologically, the epidermis is atrophic along with vacuolar degeneration of basal cell layer. The dermis exhibits incontinence of pigment with scattered melanophages and a sparse follicular or perivascular infiltrate. There is a considerable similarity in histopathological findings between LPP and erythema dyschromicum perstans. However, there are immunologic and clinical differences between the two. These observations have led to a controversy regarding the identity of the two entities. While some dermatologists consider them to be the same, others have opined that the two should be considered as distinctly different diseases. A number of associations such as hepatitis C virus infection, frontal fibrosing alopecia, acrokeratosis of Bazex and nephrotic syndrome have been reported with LPP. A rare variant, LPP inversus, with similar clinical and histopathological findings was reported in 2001. As opposed to LPP, this variant occurs in covered intertriginous locations such as groins and axillae and mostly affects white-skinned persons.

Keywords: Erythema dyschromicum perstans; lichen planus; lichen planus pigmentosus.

Figures

Figure 1
Figure 1
Lichen planus pigmentosus starts with lesions on face
Figure 2
Figure 2
Lichen planus pigmentosus lesions on neck
Figure 3
Figure 3
Lichen planus pigmentosus lesions spreading to trunk and extremities
Figure 4
Figure 4
Lichen planus pigmentosus histopathology showing basket-weave horny layer, vacuolar degeneration of the basal layer; lichenoid infiltrate and melanin incontinence (H and E, ×400)

References

    1. Bhutani LK, Bedi TR, Pandhi RK, Nayak NC. Lichen planus pigmentosus. Dermatologica. 1974;149:43–50.
    1. Rieder E, Kaplan J, Kamino H, Sanchez M, Pomeranz MK. Lichen planus pigmentosus. Dermatol Online J. 2013;19:20713.
    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;28:481–5.
    1. Vachiramon V, Suchonwanit P, Thadanipon K. Bilateral linear lichen planus pigmentosus associated with hepatitis C virus infection. Case Rep Dermatol. 2010;2:169–172.
    1. Gupta D, Thappa DM. Dermatoses due to Indian cultural practices. Indian J Dermatol. 2015;60:3–12.
    1. Ingber A, Weissmann-Katzenelson V, David M, Bialowons M, Feuerman EJ. Lichen planus and lichen planus pigmentosus following gold therapy – Case reports and review of the literature. Z Hautkr. 1986;61:315–9.
    1. Hong S, Shin JH, Kang HY. Two cases of lichen planus pigmentosus presenting with a linear pattern. J Korean Med Sci. 2004;19:152–4.
    1. Kumar YH, Babu AR. Segmental lichen planus pigmentosus: An unusual presentation. Indian Dermatol Online J. 2014;5:157–9.
    1. Cho S, Whang KK. Lichen planus pigmentosus presenting in zosteriform pattern. J Dermatol. 1997;24:193–7.
    1. Vineet R, Sumit S, Garg VK, Nita K. Lichen planus pigmentosusin linear and zosteriform pattern along the lines of Blaschko. Dermatol Online J. 2015;21 pii: 13030/qt4rk2w3rm.
    1. Akarsu S, Ilknur T, Özer E, Fetil E. Lichen planus pigmentosus distributed along the lines of Blaschko. Int J Dermatol. 2013;52:253–4.
    1. Pock L, Jelínková L, Drlík L, Abrhámová S, Vojtechovská S, Sezemská D, et al. Lichen planus pigmentosus-inversus. J Eur Acad Dermatol Venereol. 2001;15:452–4.
    1. Gaertner E, Elstein W. Lichen planus pigmentosus-inversus: Case report and review of an unusual entity. Dermatol Online J. 2012;18:11.
    1. Murzaku EC, Bronsnick T, Rao BK. Axillary lichen planus pigmentosus-inversus: Dermoscopic clues of a rare entity. Diagnosis: Lichen planus pigmentosus (LPP) J Am Acad Dermatol. 2014;71:e119–20.
    1. Ghorbel HH, Badri T, Ben Brahim E, Fenniche S, Benmously R, Mokhtar I. Lichen planus pigmentosus inversus. Indian J Dermatol Venereol Leprol. 2014;80:580.
    1. Kashima A, Tajiri A, Yamashita A, Asada Y, Setoyama M. Two Japanese cases of lichen planus pigmentosus-inversus. Int J Dermatol. 2007;46:740–2.
    1. Kim KJ, Bae GY, Choi JH, Sung KJ, Moon KC, Koh JK. A case of localized lichen planus pigmentosus on the thigh. J Dermatol. 2002;29:242–3.
    1. Laskaris GC, Papavasiliou SS, Bovopoulou OD, Nicolis GD. Lichen planus pigmentosus of the oral mucosa: A rare clinical variety. Dermatologica. 1981;162:61–3.
    1. 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;24:535–40.
    1. Parodi G, Parodi A, Guarrera M, Cannata G, Piccardo G. Lichen pigmentosus with scarring alopecia and circulating antinuclear antibodies. Int J Dermatol. 1990;29:227–8.
    1. Sehgal VN, Verma P, Bhattacharya SN, Sharma S, Rasool F. Lichen planus pigmentosus. Skinmed. 2013;11:96–103.
    1. Dlova NC. Frontal fibrosing alopecia and lichen planus pigmentosus: Is there a link? Br J Dermatol. 2013;168:439–42.
    1. Sassolas B, Zagnoli A, Leroy JP, Guillet G. Lichen planus pigmentosus associated with acrokeratosis of Bazex. Clin Exp Dermatol. 1994;19:70–3.
    1. Mancuso G, Berdondini RM. Coexistence of lichen planus pigmentosus and minimal change nephrotic syndrome. Eur J Dermatol. 2009;19:389–90.
    1. Sehgal VN, Srivastava G, Sharma S, Sehgal S, Verma P. Lichenoid tissue reaction/interface dermatitis: Recognition, classification, etiology, and clinicopathological overtones. Indian J Dermatol Venereol Leprol. 2011;77:418–29.
    1. Gougerot MH. Lichens atypiques ou invisibles pigmentogenes revelie par des pigmentations. Bull Soc Fr Dermatol Syphiligr. 1935;42:792–4. Article in French.
    1. Desai SC, Marquis L. Lichen planus: Clinical study of 67 cases with results of penicillin therapy. Indian J Dermatol Venreol. 1956;22:31–48.
    1. Shima T. Supplementative study of lichen pigmentosus. Jpn J Dermatol. 1956;66:353.
    1. Ramirez CO. Los Cenicrentas-Problem Clinico, Report 1st Central American Congress of Dermatology, San Salvador; 1957
    1. Convit J, Kerdel-Vegas F, Rodriguez G. Erythema dyschromicumperstans. A hitherto undescribed skin disease. J Invest Dermatol. 1961;36:457–62.
    1. Knox JM, Dodge BG, Freeman RG. Erythema dyschromicum perstans. Arch Dermatol. 1968;97:262–72.
    1. Pinkus H. Lichenoid tissue reactions. A speculative review of the clinical spectrum of epidermal basal cell damage with special reference to erythema dyschromicum perstans. Arch Dermatol. 1973;107:840–6.
    1. Degos R, Civatte J, Belaïch S. Idiopathic eruptive macular pigmentation (author's transl) Ann Dermatol Venereol. 1978;105:177–82.
    1. Naidorf KF, Cohen SR. Erythema dyschromicum perstans and lichen planus. Arch Dermatol. 1982;118:683–5.
    1. Bhutani LK. Ashy dermatosis or lichen planus pigmentosus: What is in a name? Arch Dermatol. 1986;122:133.
    1. Vega ME, Waxtein L, Arenas R, Hojyo T, Dominguez-Soto L. Ashy dermatosis versus lichen planus pigmentosus: A controversial matter. Int J Dermatol. 1992;31:87–8.
    1. Vega ME, Waxtein L, Arenas R, Hojyo T, Dominguez-Soto L. Ashy dermatosis and lichen planus pigmentosus: A clinicopathologic study of 31 cases. Int J Dermatol. 1992;31:90–4.
    1. Kanwar AJ, Dawn G, Dhar S. Lichen dyschromicum perstans. Indian J Dermatol Venereol Leprol. 1996;62:213–9.
    1. Pittelkow MR, Daoud MS. In: Lichen Planus. Fitzpatrick's Dermatology In General Medicine. 7th ed. Wolff K, Goldsmith AL, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, editors. New York: Mc Graw Hill; 2008. p. 247.
    1. Zaynoun S, Rubeiz N, Kibbi AG. Ashy dermatoses – A critical review of the literature and a proposed simplified clinical classification. Int J Dermatol. 2008;47:542–4.
    1. Bhutani LK, George M, Bhate SM. Vitamin A in the treatment of lichen planus pigmentosus. Br J Dermatol. 1979;100:473–4.
    1. 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;39:189–91.
    1. Han XD, Goh CL. A case of lichen planus pigmentosus that was recalcitrant to topical treatment responding to pigment laser treatment. Dermatol Ther. 2014;27:264–7.
    1. Chandran V, Kumarasinghe SP. Macular pigmentation of uncertain aetiology revisited: Two case reports and a proposed algorithm for clinical classification. Australas J Dermatol. 2016 doi: 10.1111/ajd.12428. Epub ahead of print.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit