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Vinay K, Kamat D, Narayan R V, Minz RW, Singh J, Bishnoi A, Chatterjee D, Parsad D, Kumaran MS. Major histocompatibility complex (MHC) gene frequency in acquired dermal macular hyperpigmentation: a case control study. Int J Dermatol 2024; 63:773-779. [PMID: 38263574 DOI: 10.1111/ijd.17017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/12/2023] [Accepted: 12/28/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Human leukocyte antigen (HLA) allele frequencies have a known association with the pathogenesis of various autoimmune diseases. METHODS We recruited 31 Indian patients of acquired dermal macular hyperpigmentation (ADMH) and 60 unrelated, age-and-gender-matched healthy controls. After history and clinical examination, 5 ml of blood in EDTA vials was collected. These samples were subjected to DNA extraction and the expression of HLA A, B, C, DR, DQ-A, and DQ-B was studied. RESULTS There was a predominance of females with a gender ratio of 23 : 8 and the most common phototype was Fitzpatrick type IV (83.9%). There was a significant association of HLA A*03:01 (OR: 5.8, CI: 1.7-17.0, P = 0.005), HLA B*07:02 (OR: 5.3, CI: 1.9-14.6, P = 0.003), HLA C*07:02 (OR: 4.3, CI: 1.8-9.6, P = 0.001), HLA DRB1*10:01 (OR: 7.6, CI: 1.7-38.00, P = 0.022), and HLA DRB1*15:02 (OR: 31.0, CI: 4.4-341.8, P < 0.001) with patients compared to controls, whereas HLA DQB*03:01 was less associated with patients compared to controls (OR: 0.2, CI: 0.0-0.6, P = 0.009). CONCLUSION Patients with ADMH are more likely to have the HLA A*03:01, HLA B 07*02, HLA C*07:02, HLA DRB1*10:01, HLA DRB1*15:02 and less likely to have the HLA DQB*03:01 allele. Larger cohort studies may thus be conducted studying these specific alleles.
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Affiliation(s)
- Keshavamurthy Vinay
- Department of Dermatology, Venereology & Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Divya Kamat
- Department of Dermatology, Venereology & Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vignesh Narayan R
- Department of Dermatology, Venereology & Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ranjana W Minz
- Department of Immunopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jagdeep Singh
- Department of Immunopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anuradha Bishnoi
- Department of Dermatology, Venereology & Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Debajyoti Chatterjee
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Davinder Parsad
- Department of Dermatology, Venereology & Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Muthu S Kumaran
- Department of Dermatology, Venereology & Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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2
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Bobotsis R, Brathwaite S, Eshtiaghi P, Rodriguez-Bolanos F, Doiron P. HIV: Inflammatory dermatoses. Clin Dermatol 2024; 42:169-179. [PMID: 38142786 DOI: 10.1016/j.clindermatol.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
Patients living with HIV may experience a variety of inflammatory dermatoses, ranging from exacerbations of underlying conditions to those triggered by HIV infection itself. This article presents a current literature review on the etiology, diagnosis and management of atopic dermatitis, psoriasis, pityriasis rubra pilaris, lichen planus, seborrheic dermatitis, eosinophilic folliculitis, pruritic papular eruption and pruritus, in patients living with HIV.
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Affiliation(s)
- Robert Bobotsis
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Shakira Brathwaite
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Panteha Eshtiaghi
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Fabian Rodriguez-Bolanos
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Philip Doiron
- Division of Dermatology, Department of Medicine, Faculty of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada.
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3
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Cohen PR, Erickson CP, Calame A. Lichen Planus Pigmentosus Inversus: A Case Report of a Man Presenting With a Pigmented Lichenoid Axillary Inverse Dermatosis (PLAID). Cureus 2024; 16:e56995. [PMID: 38681353 PMCID: PMC11046377 DOI: 10.7759/cureus.56995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 05/01/2024] Open
Abstract
Lichen planus pigmentosus is an uncommon subtype of lichen planus and lichen planus pigmentosus inversus is a rare variant of lichen planus pigmentosus. Lichen planus pigmentosus inversus typically presents as hyperpigmented patches or plaques, particularly in the intertriginous areas such as the axillae, the groin and inguinal folds, and in the submammary region. In some patients with lichen planus pigmentosus inversus, the condition can present as a pigmented lichenoid axillary inverse dermatosis (PLAID) when the lesions are in the axillae. A 49-year-old Hispanic man who had hyperlipidemia and diabetes mellitus developed lichen planus pigmentosus inversus and presented with a PLAID. Skin biopsies established the diagnosis of lichen planus pigmentosus inversus. The clinical differential diagnosis of lichen planus pigmentosus inversus includes inherited disorders, primary cutaneous dermatoses, acquired dyschromias, and reactions to topical or systemic medications. Friction in intertriginous areas has been related to the development of lichen planus pigmentosus inversus. Factors that can precipitate lichen planus pigmentosus inversus include not only topical exposure to almond oil, amala oil, cold and cosmetic creams, henna, and paraphenyldiamine but also either topical contact or consumption of mustard oil and nickel. Lichen planus pigmentosus inversus can be associated with autoimmune conditions (hypothyroidism), endocrinopathies (diabetes mellitus), and hyperlipidemia. The dyschromia found in patients with lichen planus pigmentosus inversus is frequently refractory to treatment. Initial management includes removal of potential disease triggers such as eliminating tight clothing to stop friction with the adjacent skin. Topical corticosteroids do not result in improvement; however, topical calcineurin inhibitors such as tacrolimus have been reported to be efficacious. In conclusion, inverse lichen planus and lichen planus pigmentosus inversus can present with a PLAID; whereas topical corticosteroids may be helpful to resolve inverse lichen planus lesions, topical tacrolimus may be useful to improve the dyschromia in lichen planus pigmentosus inversus.
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Affiliation(s)
- Philip R Cohen
- Dermatology, University of California Davis Health, Sacramento, USA
- Dermatology, Touro University California College of Osteopathic Medicine, Vallejo, USA
| | | | - Antoanella Calame
- Dermatology/Dermatopathology, Compass Dermatopathology, San Diego, USA
- Dermatology, Scripps Memorial Hospital, La Jolla, USA
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4
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Krishnoji Rao S, Dixit A, Dhar S, De A. Lichen Planus Pigmentosus Masquerading as Nevus Spilus. Indian J Dermatol 2024; 69:91-93. [PMID: 38572046 PMCID: PMC10986890 DOI: 10.4103/ijd.ijd_629_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Affiliation(s)
- Sneha Krishnoji Rao
- From the Department of Dermatology, Kosmoderma Clinic, Bangalore, Karnataka, India
| | - Ambika Dixit
- Department of Dermatology, Kaya Skin Clinic, Delhi, India
| | - Subhra Dhar
- Department of Pathology, Wizderm Specialty Skin and Hair Clinic, Kolkata, India
| | - Abhishek De
- Department of Dermatology, Calcutta National Medical College, Kolkata, India E-mail:
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5
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Shah S, Baskaran N, Vinay K, Bishnoi A, Parsad D, Kumaran MS. Acquired dermal macular hyperpigmentation: an overview of the recent updates. Int J Dermatol 2023; 62:1447-1457. [PMID: 37767951 DOI: 10.1111/ijd.16859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/11/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023]
Abstract
Acquired dermal macular hyperpigmentation (ADMH), previously known as macular pigmentation of uncertain etiology (MPUE), is an umbrella concept that unifies the distinct but overlapping acquired dermal pigmentary disorders like lichen planus pigmentosus, ashy dermatosis, erythema dyschromicum perstans, Riehl's melanosis and pigmented contact dermatitis. All of these disorders usually lack a clinically apparent inflammatory phase, are characterised by dermal pigmentation clinically and histologically, and have a variable protracted disease course. Recently, a proposal has been made to classify these disorders into those with and without contact sensitisation. Dermoscopy is essentially similar across the spectrum of these disorders, and is useful for diagnosis and therapeutic response monitoring. Scoring system has been validated for the same. The treatment of ADMH remains challenging, with multiple topicals, oral therapies including mycophenolate mofetil, and lasers tried. Need of the hour is randomised controlled trials to enhance the therapeutic armamentarium.
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Affiliation(s)
- Shikha Shah
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Narayanan Baskaran
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Keshavamurthy Vinay
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anuradha Bishnoi
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Davinder Parsad
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Muthu S Kumaran
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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6
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Almarek RA, AlQadri NG, Alotaibi M. Coexistence of Lichen Planus Pigmentosus and Classic Lichen Planopilaris: A Case Report and Literature Review. Cureus 2023; 15:e46952. [PMID: 38021648 PMCID: PMC10640707 DOI: 10.7759/cureus.46952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Lichen planus (LP) is a common inflammatory skin disorder with multiple variants. The coexistence of lichen planus pigmentosus (LPPigm) and frontal fibrosing alopecia is well-established in the literature. However, the coexistence of LPPigm and classic lichen planopilaris (LPP) is rare. We report a case of LPPigm and classic LPP in a postmenopausal woman with a literature review.
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Affiliation(s)
- Rana A Almarek
- Department of Dermatology, King Saud Medical City, Riyadh, SAU
| | - Nada G AlQadri
- Department of Dermatology, King Saud Medical City, Riyadh, SAU
| | - Manar Alotaibi
- Department of Dermatology, Prince Sultan Military Medical City, Riyadh, SAU
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7
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AlNodali N, Aleissa AI. A Case of Unilateral Blaschko-Linear Lichen Planus Pigmentosus in a Seven-Year-Old Female: A Rare Presentation. Cureus 2023; 15:e41354. [PMID: 37546110 PMCID: PMC10399280 DOI: 10.7759/cureus.41354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
Lichen planus pigmentosus (LPP) is a rare form of lichen planus that typically affects middle-aged people with darker-pigmented skin. LPP is associated with a longer clinical course than classical lichen planus, which distinguishes it clinically. Its occurrence in children is uncommon, with few reported cases in this population in the literature. We report a rare presentation of unilateral blaschkoid LPP in a seven-year-old Saudi Arabian female patient.
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8
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McFeely O, Victory L, Pender E, Higgins E, Storan E. A progressive pigmentary dermatosis. Clin Exp Dermatol 2023; 48:284-286. [PMID: 36763705 DOI: 10.1093/ced/llac075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/07/2022] [Accepted: 11/10/2022] [Indexed: 01/22/2023]
Abstract
A 53-year-old Indian man presented with a striking reticulate hyperpigmentation on photoexposed sites with a sharp cutoff in a V distribution on his anterior chest. Histopathology showed prominent basal degenerative changes, focal lymphocyte exocytosis and an upper dermal lymphohistiocytic infiltrate.
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Affiliation(s)
- Orla McFeely
- Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Liana Victory
- Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Emily Pender
- Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Eoin Storan
- Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland.,Charles Institute of Dermatology, University College Dublin, Dublin, Ireland
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9
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Wang RF, Ko D, Friedman BJ, Lim HW, Mohammad TF. Disorders of hyperpigmentation. Part I. Pathogenesis and clinical features of common pigmentary disorders. J Am Acad Dermatol 2023; 88:271-288. [PMID: 35151757 DOI: 10.1016/j.jaad.2022.01.051] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/22/2021] [Accepted: 01/10/2022] [Indexed: 01/17/2023]
Abstract
Disorders of hyperpigmentation are common and, depending on the extent and location of involvement, can affect the quality of life and pose a significant psychologic burden for patients. Given the similarities in presentation of the various causes of hyperpigmentation, it is often difficult to elucidate the etiology of these conditions, which is important to guide management. Furthermore, certain disorders, such as lichen planus pigmentosus and ashy dermatosis, have similar clinical and/or histologic presentations, and their classification as distinct entities has been debated upon, leading to additional confusion. In this review, the authors selected commonly encountered disorders of hyperpigmentation of the skin, subdivided into epidermal, dermal, or mixed epidermal-dermal disorders based on the location of pigment deposition, along with disorders of hyperpigmentation of the mucosa and nails. Melanocytic nevi, genetic disorders, and systemic causes of hyperpigmentation were largely excluded and considered to be outside the scope of this review. We discussed the pathogenesis of hyperpigmentation as well as the clinical and histologic features of these conditions, along with challenges encountered in their diagnosis and classification. The second article in this 2-part continuing medical education series focuses on the medical and procedural treatments of hyperpigmentation.
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Affiliation(s)
- Rebecca F Wang
- From the Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Dayoung Ko
- From the Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Ben J Friedman
- From the Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Henry W Lim
- From the Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Tasneem F Mohammad
- From the Department of Dermatology, Henry Ford Hospital, Detroit, Michigan.
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10
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Herrero-Ruiz SP, Garrido-Ríos AA, Romero-Maté A, Khedaoui R, Fernández De la Fuente L, Borbujo J. Facial hyperpigmentation with singular dermoscopic findings. Int J Dermatol 2023; 62:197-198. [PMID: 36200587 DOI: 10.1111/ijd.16434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/21/2022] [Accepted: 09/20/2022] [Indexed: 01/20/2023]
Affiliation(s)
| | | | - Alberto Romero-Maté
- Department of Dermatology, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Radia Khedaoui
- Department of Pathology, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | | | - Jesús Borbujo
- Department of Dermatology, Hospital Universitario de Fuenlabrada, Madrid, Spain
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11
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Sarkar R, Vinay K, Bishnoi A, Poojary S, Gupta M, Kumaran MS, Jain A, Gurumurthy C, Arora P, Kandhari R, Rathi S, Zawar V, Gupta V, Ravivarma VN, Rodrigues M, Parsad D. A Delphi consensus on the nomenclature and diagnosis of lichen planus pigmentosus and related entities. Indian J Dermatol Venereol Leprol 2023; 89:41-46. [PMID: 35593293 DOI: 10.25259/ijdvl_804_2021] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 11/01/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although well known in clinical practice, research in lichen planus pigmentosus and related dermal pigmentary diseases is restricted due to lack of consensus on nomenclature and disease definition. AIMS AND OBJECTIVES Delphi exercise to define and categorise acquired dermal pigmentary diseases. METHODS Core areas were identified including disease definition, etiopathogenesis, risk factors, clinical features, diagnostic methods, treatment modalities and outcome measures. The Delphi exercise was conducted in three rounds. RESULTS Sixteen researchers representing 12 different universities across India and Australia agreed to be part of this Delphi exercise. At the end of three rounds, a consensus of >80% was reached on usage of the umbrella term 'acquired dermal macular hyperpigmentation'. It was agreed that there were minimal differences, if any, among the disorders previously defined as ashy dermatosis, erythema dyschromicum perstans, Riehl's melanosis and pigmented contact dermatitis. It was also agreed that lichen planus pigmentosus, erythema dyschromicum perstans and ashy dermatosis did not differ significantly apart from the sites of involvement, as historically described in the literature. Exposure to hair colours, sunlight and cosmetics was associated with these disorders in a significant proportion of patients. Participants agreed that both histopathology and dermatoscopy could diagnose dermal pigmentation characteristic of acquired dermal macular hyperpigmentation but could not differentiate the individual entities of ashy dermatosis, erythema dyschromicum perstans, Riehl's melanosis, lichen planus pigmentosus and pigmented contact dermatitis. LIMITATIONS A wider consensus involving representatives from East Asian, European and Latin American countries is required. CONCLUSION Acquired dermal macular hyperpigmentation could be an appropriate conglomerate terminology for acquired dermatoses characterised by idiopathic or multifactorial non-inflammatory macular dermal hyperpigmentation.
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Affiliation(s)
- Rashmi Sarkar
- Department of Dermatology, Lady Hardinge Medical College, New Delhi, India
| | - Keshavamurthy Vinay
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anuradha Bishnoi
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shital Poojary
- Department of Dermatology, K. J. Somaiya Medical College, Mumbai, Maharashtra, India
| | - Monisha Gupta
- Department of Dermatology, Liverpool Hospital, The Skin Hospital, NSW, Conjoint University of NSW, Western Sydney University, Sydney, Australia
| | - Muthu Sendhil Kumaran
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Akshay Jain
- Department of Dermatology, Venereology and Leprology, Government Medical College, Kota, Rajasthan, India
| | - Chethana Gurumurthy
- Department of Dermatology, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Pooja Arora
- Department of Dermatology, Dr RML Hospital and ABVIMS, New Delhi, India
| | | | - Sanjay Rathi
- Dr. Rathi's Skin Clinic, Siliguri, West Bengal, India
| | - Vijay Zawar
- Department of Dermatology Dr. Vasantrao Pawar Medical College, Nashik, Maharashtra, India
| | - Vishal Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Vignesh Narayan Ravivarma
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Michelle Rodrigues
- Chroma Dermatology, Pigment and Skin of Colour Centre, Melbourne, Australia
| | - Davinder Parsad
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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12
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Bodnariuk N, Bastard D, Enz P. Alopecia frontal fibrosante y liquen plano pigmentoso ¿variantes de una misma entidad? ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:617-618. [DOI: 10.1016/j.ad.2020.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/29/2020] [Accepted: 08/08/2020] [Indexed: 10/19/2022] Open
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13
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[Translated article] Frontal Fibrosing Alopecia and Lichen Planus Pigmentosus: Variants of the Same Disease? ACTAS DERMO-SIFILIOGRAFICAS 2022. [DOI: 10.1016/j.ad.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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14
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Nofal A, Alakad R, Selim H, Anis N. Poikilodermatous lichen planus pigmentosus: A unique variant of a common disease. J Cosmet Dermatol 2022; 21:5215-5218. [PMID: 35037370 DOI: 10.1111/jocd.14754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/15/2021] [Accepted: 01/04/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Ahmad Nofal
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.,Member of Interactive Dermatology Research Group, Egypt
| | - Rania Alakad
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.,Member of Interactive Dermatology Research Group, Egypt
| | - Heba Selim
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Nourhan Anis
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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15
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Dhar S, Dhar S, De A, Sarda A. Lichen planus pigmentosus in linear and zosteriform pattern along the lines of Blaschko: a rare presentation. PIGMENT INTERNATIONAL 2022. [DOI: 10.4103/pigmentinternational.pigmentinternational_42_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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16
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Eljazouly M, Agharbi FZ, Alj M, Oqbani K, Chiheb S. Blaschko-Linear Lichen Planus Pigmentosus: An Unusual Presentation. Cureus 2021; 13:e20047. [PMID: 34987928 PMCID: PMC8717938 DOI: 10.7759/cureus.20047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 11/29/2022] Open
Abstract
Lichen planus pigmentosus (LPP), an uncommon variant of lichen planus (LP), is characterized by diffuse hyperpigmented dark brown macules in sun-exposed areas. We report an unusual case of LPP with a blaschkoid distribution in an area of radiotherapy for breast cancer. This description is rarely reported. Its pathogeny is poorly understood and suggests an embryological origin by genetic mosaicism and also discusses the immunomodulatory role of radiotherapy in the disease.
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17
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Vinay K, Bishnoi A, Kamat D, Chatterjee D, Kumaran MS, Parsad D. Acquired Dermal Macular Hyperpigmentation: An Update. Indian Dermatol Online J 2021; 12:663-673. [PMID: 34667751 PMCID: PMC8456249 DOI: 10.4103/idoj.idoj_881_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/10/2021] [Accepted: 04/15/2021] [Indexed: 12/16/2022] Open
Abstract
Acquired dermal macular hyperpigmentation (ADMH) is an umbrella term that includes disorders clinically characterized by small and large pigmented macules/patches and histopathologically showing an evidence of current or resolved interface dermatitis with pigment incontinence, without clinically significant prior inflammatory phase. The term intends to include diseases previously described in the literature as lichen planus pigmentosus, Riehl's melanosis/pigmented cosmetic dermatitis and ashy dermatosis/erythema dyschromicum perstans. The nomenclature and origin of these disorders have always been a matter of discussion. These disorders share many clinicopathological similarities, are difficult to treat and adversely affect the quality of life. Recent consensus points towards the need for a unifying term to facilitate research and therapeutic trials. This article aims to provide a comprehensive review of the recent advances in ADMH.
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Affiliation(s)
- Keshavamurthy Vinay
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anuradha Bishnoi
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Divya Kamat
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Debajyoti Chatterjee
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Muthu Sendhil Kumaran
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Davinder Parsad
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Ruiz-Lozano RE, Hernández-Camarena JC, Valdez-Garcia JE, Roman-Zamudio M, Herrera-Rodriguez MI, Andrade-Carrillo D, Garza-Garza LA, Cardenas-de la Garza JA. Ocular involvement and complications of lichen planus, lichen planus pigmentosus, and lichen planopilaris: A comprehensive review. Dermatol Ther 2021; 34:e15137. [PMID: 34541780 DOI: 10.1111/dth.15137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 09/16/2021] [Indexed: 11/28/2022]
Abstract
Ocular involvement of lichenoid dermatoses, such as lichen planus (LP), lichen planus pigmentosus (LPP), and lichen planopilaris (LPL), although uncommon, is associated with skin manifestations. Isolated ocular involvement is very rare. When lesions are confined to the skin, the dermatologist inquires and evaluates for oral and genital symptoms and lesions, respectively; hence, eye manifestations are commonly neglected by the non-ophthalmologist. Ocular involvement in LP, LPP, and LPL may result in significant morbidity. An ophthalmic interrogatory and a gross ophthalmic evaluation performed by the dermatologist may unravel ocular signs and symptoms that require evaluation by an eye specialist. Ocular surface inflammation and scarring, when untreated, results in serious complications such as corneal perforation and permanent vision loss. This review aims to present an up-to-date overview for the dermatologist of the ocular involvement and complications of LP, LPP, and LPL, and when to refer to the ophthalmologist to prevent blinding complications.
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Affiliation(s)
- Raul E Ruiz-Lozano
- Tecnológico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | - Julio C Hernández-Camarena
- Tecnológico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | - Jorge E Valdez-Garcia
- Tecnológico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | - Mariana Roman-Zamudio
- Tecnológico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | - Monica I Herrera-Rodriguez
- Tecnológico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | - Daniela Andrade-Carrillo
- Tecnológico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | - Lucas A Garza-Garza
- Tecnológico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | - Jesus A Cardenas-de la Garza
- Universidad Autónoma de Nuevo León, Rheumatology Service, University Hospital "Dr. José Eleuterio González, Monterrey, Mexico
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19
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Mohaghegh F, Talebzadeh Z, Bahraminejad M, Rezaei M. Coexistence of periorbital lichen planus pigmentosus and pemphigus vulgaris: Report of an unusual case and a rare association. Clin Case Rep 2021; 9:e04480. [PMID: 34295494 PMCID: PMC8283847 DOI: 10.1002/ccr3.4480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 04/23/2021] [Accepted: 04/25/2021] [Indexed: 01/18/2023] Open
Abstract
Lichen planus pigmentosus is a rare variant of lichen planus with different patterns and manifestations. The coexistence of LPP and PV suggests that there might be a relationship between these two conditions in terms of immunologic mechanisms.
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Affiliation(s)
- Fatemeh Mohaghegh
- Department of DermatologyIsfahan University of medical sciencesIsfahanIran
| | - Zahra Talebzadeh
- Department of DermatologySkin Diseases and Leishmaniasis Research CenterSchool of MedicineIsfahan University of Medical SciencesIsfahanIran
| | - Mahsa Bahraminejad
- Department of DermatologySkin Diseases and Leishmaniasis Research CenterSchool of MedicineIsfahan University of Medical SciencesIsfahanIran
| | - Mina Rezaei
- School of MedicineIsfahan University of Medical SciencesIsfahanIran
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20
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Gupta V, Yadav D, Satapathy S, Upadhyay A, Mahajan S, Ramam M, Sharma VK. Psychosocial burden of lichen planus pigmentosus is similar to vitiligo, but greater than melasma: A cross-sectional study from a tertiary-care center in north India. Indian J Dermatol Venereol Leprol 2021; 87:341-347. [PMID: 33943064 DOI: 10.25259/ijdvl_877_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 09/01/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Lichen planus pigmentosus can have a negative impact on the quality of life; however, this has not been studied in detail. OBJECTIVES To study the quality of life in patients with lichen planus pigmentosus and compare it with patients with vitiligo and melasma. METHODS This was a cross-sectional study conducted in a tertiary-care center in north India from January 2018 to May 2019. Patients ≥ 18 years of age with lichen planus pigmentosus (n = 125), vitiligo (n = 113) and melasma (n = 121) completed the Dermatology Life Quality Index (DLQI) questionnaire and answered a global question on the effect of disease on their lives. In addition, patients with vitiligo completed the Vitiligo Impact Scale (VIS)-22 questionnaire, while those with lichen planus pigmentosus and melasma filled a modified version of VIS-22. RESULTS The mean DLQI scores in patients with lichen planus pigmentosus, vitiligo and melasma were 10.9 ± 5.95, 9.73 ± 6.51 and 8.39 ± 5.92, respectively, the difference being statistically significant only between lichen planus pigmentosus and melasma (P < 0.001). The corresponding mean modified VIS-22/VIS-22 scores were 26.82 ± 11.89, 25.82 ± 14.03 and 18.87 ± 11.84, respectively. This difference was statistically significant between lichen planus pigmentosus and melasma, and between vitiligo and melasma (P < 0.001 for both). As compared to vitiligo, patients with lichen planus pigmentosus had a significantly greater impact on "symptoms and feelings" domain (P < 0.001) on DLQI, and on "social interactions" (P = 0.02) and "depression" (P = 0.04) domains on VIS-22. As compared to melasma, patients with lichen planus pigmentosus had significantly higher scores for "symptoms and feelings," "daily activities," "leisure" and "work and school" domains of DLQI, and all domains of VIS-22. Female gender was more associated with impairment in quality of life in patients with lichen planus pigmentosus, while lower education, marriage, younger age and increasing disease duration showed a directional trend. LIMITATIONS Use of DLQI and modified version of VIS-22 scales in the absence of a pigmentary disease-specific quality-of-life instrument. CONCLUSION Patients with lichen planus pigmentosus have a significantly impaired quality of life. The psychosocial burden of lichen planus pigmentosus is quantitatively similar to that of vitiligo, but significantly greater than melasma.
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Affiliation(s)
- Vishal Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepika Yadav
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Sujata Satapathy
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Upadhyay
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Soniya Mahajan
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - M Ramam
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Kumar Sharma
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
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Bishnoi A, Vinay K, Parsad D, Kumar S, Chatterjee D, Nahar Saikia U, Sendhil Kumaran M. Oral mycophenolate mofetil in the treatment of acquired dermal macular hyperpigmentation: An open-label pilot study. Australas J Dermatol 2021; 62:278-285. [PMID: 33660856 DOI: 10.1111/ajd.13567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 11/23/2020] [Accepted: 12/30/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Literature on treating acquired dermal macular hyperpigmentation is sparse. AIMS AND OBJECTIVES To assess treatment response of mycophenolate mofetil in patients having acquired dermal macular hyperpigmentation. MATERIAL AND METHODS In this open-label, pilot study, patients of acquired dermal macular hyperpigmentation affecting at least the face and/or neck were included. Each participant was treated with mycophenolate mofetil 2 g/day for 24 weeks, with a follow-up of 12 weeks. Two aspects of disease severity were measured: activity (appearance of new lesions/extension of existing lesions), and degree of hyperpigmentation (measured using 'dermal pigmentation area and severity index'). Patient satisfaction was assessed on a scale of 0-10. RESULTS Forty-three of 46 patients who were prescribed mycophenolate, completed the study (40 females, 6 males; mean disease duration 2.8 ± 1.4 years). Amongst 20 (43.5%) patients with active disease, stability was achieved in 17, after a mean duration of 6.1 ± 2.5 weeks (range 4-12 weeks; median 4; IQR 4 weeks). Mean dermal pigmentation area and severity index at baseline was 18.8 ± 7.1 and decreased to 13.7 ± 6.3 at 24th week (27.5 ± 14.7%; P < 0.001). A significant decreasing trend in dermal pigmentation area and severity index (P < 0.001) was observed, and first significant difference from baseline was noted at the 16th week (P 0.008). Less than 10%, >10-20%, >20%-30%, >30%-40%, >40%-50%, and >50% reduction in dermal pigmentation area and severity index was observed in 8, 5, 4, 15, 10 and 1 patients/patient respectively. The maximum mean grade of pre-treatment dermatoscopic severity was 3 ± 0.7, and decreased to 2.1 ± 0.8 on the face (P < 0.001) and 2.4 ± 0.7 on the neck (P < 0.001) post-treatment. There were 9 (20.1%) non-responders. Self-assessment scores of the rest of the patients fell in the range of moderate/fair improvement (>5 to 7). No significant correlation was seen between patient satisfaction score and degree of reduction in dermal pigmentation area and severity index (r -0.39). Three developed adverse effects (leucopenia, n = 1; transaminitis and hyperbilirubinemia, n = 2) that resolved following discontinuation of mycophenolate. CONCLUSION Mycophenolate mofetil appears to be a promising treatment option in acquired dermal macular hyperpigmentation.
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Affiliation(s)
- Anuradha Bishnoi
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Keshavamurthy Vinay
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Davinder Parsad
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sheetanshu Kumar
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Debajyoti Chatterjee
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Uma Nahar Saikia
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Muthu Sendhil Kumaran
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Alkhowailed MS, Otayf M, Albasseet A, Almousa A, Alajlan Z, Altalhab S. Clinical Approach to Linear Hyperpigmentation: A Review Article. Clin Cosmet Investig Dermatol 2021; 14:23-35. [PMID: 33447068 PMCID: PMC7802900 DOI: 10.2147/ccid.s280819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/24/2020] [Indexed: 12/18/2022]
Abstract
Linear hyperpigmentation is an unusual anatomical configuration in clinical dermatology. Owing to its rarity, consensus on the most effective method of classification is lacking. While linear hyperpigmentation generally follows Blaschko's lines, this is not universal. Clinical findings such as adherence to Blaschko's lines, associated morphological findings (including other cutaneous lesions), and systemic manifestations can be used to further characterize and diagnose variants of the disorder. Early detection of any underlying disease is vital, especially in cases with effective management, because the disorder may make it difficult to manage hyperpigmentation. Herein, we introduce a logical clinical diagnostic approach that represents a useful tool for dermatologists to efficiently evaluate patients presenting with linear hyperpigmentation. A simplified systematic and evidence-based approach is useful for this clinical condition owing to the heterogeneous causes and lack of specific diagnostic tools.
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Affiliation(s)
- Mohammad S Alkhowailed
- Department of Dermatology, College of Medicine, Qassim University, Buraydah, Qassim, Saudi Arabia
| | - Mojahed Otayf
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Ziyad Alajlan
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Saad Altalhab
- Department of Dermatology, College of Medicine, Al-Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
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Verzì AE, Lacarrubba F, Dall'Oglio F, Micali G. Association of Frontal Fibrosing Alopecia with Facial Papules and Lichen Planus Pigmentosus in a Caucasian Woman. Skin Appendage Disord 2020; 6:379-383. [PMID: 33313056 DOI: 10.1159/000509407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/12/2020] [Indexed: 01/06/2023] Open
Abstract
Introduction Frontal fibrosing alopecia (FFA) is a lymphocytic primary cicatricial alopecia typically involving the frontotemporal hairline. It may be associated with the presence of facial papules (FP) that clinically appear as noninflammatory, monomorphic, white-yellowish papules. Lichen planus pigmentosus (LPPigm) is characterized by the presence of asymptomatic grayish pigmented macules, predominantly in sun-exposed and flexural areas. Case Report A 58-year-old, Caucasian, phototype III woman presented with a symmetrical, band-like, frontotemporal alopecia with regression of the hairline; bilateral eyebrow loss; diffuse, symmetrical hyperpigmentation of the face; and some asymptomatic, flesh-colored, monomorphic papules on the chin. Based on clinical, dermoscopic, and histological findings, the diagnosis of FFA associated with FP and LPPigm was established. Discussion/Conclusion The peculiarity of our report is represented by the triple association of FFA, FP, and LPPigm in a Caucasian skin type III woman, as it has been rarely reported. Clinicians should be aware of this association also in subjects with phototype ≤III, as its recognition may be useful for diagnostic and prognostic purposes: the observation of LPPigm of the face may suggest to check for early FFA, and in case of FFA associated with FP, a poorer FFA prognosis may likely be expected.
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24
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Dias MFRG, Dutra Rezende H, Furtado Cardoso de Moraes JR, Dlova N, Ekelem CN, Vilar EAG, Trüeb RM. New insights into lichen planus pigmentosus associated with cicatricial alopecia. J Eur Acad Dermatol Venereol 2020; 35:e200-e203. [PMID: 32885873 DOI: 10.1111/jdv.16918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/10/2020] [Accepted: 08/26/2020] [Indexed: 11/30/2022]
Affiliation(s)
- M F R G Dias
- Department of Dermatology, Antonio Pedro University Hospital, Federal Fluminense University, Niteroi, Brazil
| | | | | | - N Dlova
- Department of Dermatology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - C N Ekelem
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - E A G Vilar
- Department of Patology, Antonio Pedro University Hospital, Federal Fluminense University, Niteroi, Brazil
| | - R M Trüeb
- Center for Dermatology and Hair Diseases Professor Trueeb, Wallisellen, Switzerland
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25
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Miteva M, Goldberg LJ. Lichenoid folliculitis in facial lichen planus pigmentosus-A clue to frontal fibrosing alopecia? J Cutan Pathol 2020; 47:983-985. [PMID: 32301154 DOI: 10.1111/cup.13715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 02/28/2020] [Accepted: 04/13/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Mariya Miteva
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Lynne J Goldberg
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts, USA
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26
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Abstract
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.
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Affiliation(s)
- M Badawy Abdel-Naser
- Department of Dermatology, Andrology and STIs, Ain Shams University Hospital, Cairo, Egypt.
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27
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Ashy Dermatosis and Lichen Planus Pigmentosus: The Histopathological Differences. BIOMED RESEARCH INTERNATIONAL 2019; 2019:5829185. [PMID: 31781623 PMCID: PMC6855079 DOI: 10.1155/2019/5829185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 09/16/2019] [Indexed: 12/22/2022]
Abstract
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.
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28
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Sonthalia S, Vedamurthy M, Thomas M, Goldust M, Jha AK, Srivastava S, Aggarwal I. Modified phenol peels for treatment-refractory hyperpigmentation of lichen planus pigmentosus: A retrospective clinico-dermoscopic analysis. J Cosmet Dermatol 2019; 18:1479-1486. [PMID: 30661300 DOI: 10.1111/jocd.12862] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/08/2018] [Accepted: 09/05/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND 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. OBJECTIVES 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. METHODS The results of a retrospective analysis of the efficacy and safety of six sessions of Croton oil free phenol combination (CFPC) peel done every 3 weeks, 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Sidharth Sonthalia
- Department of Dermatology & Dermatosurgery, Skinnocence: The Skin Clinic & Research Center, Gurugram, India
| | - Maya Vedamurthy
- Department of Dermatology & Dermatosurgery, RSV Skin & Laser Center, Chennai, India
| | - Mary Thomas
- Department of Dermatology, Poornima Hospital, Bengaluru, India
| | - Mohamad Goldust
- Department of Dermatology, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Sakshi Srivastava
- Department of Dermatology and Aesthetic Medicine, Jaypee Hospital, Noida, India
| | - Ishad Aggarwal
- Department of Dermatology, Purnam Skin Clinic, Kolkata, India
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29
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Sasidharanpillai S, Govindan A, Ajithkumar KY, Mahadevan ST, Bindu V, Khader A, Sathi PP. Histological Evaluation of Acquired Dermal Macular Hyperpigmentation. Indian Dermatol Online J 2019; 10:542-546. [PMID: 31544073 PMCID: PMC6743398 DOI: 10.4103/idoj.idoj_426_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
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.
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Affiliation(s)
| | - Aparna Govindan
- Department of Pathology, Govt. Medical College, Kozhikode, Kerala, India
| | | | - Saranya T Mahadevan
- Department of Dermatology and Venereology, Govt. Medical College, Kozhikode, Kerala, India
| | - Valiyaveettil Bindu
- Department of Dermatology and Venereology, Govt. Medical College, Kozhikode, Kerala, India
| | - Anza Khader
- Department of Dermatology and Venereology, Govt. Medical College, Kozhikode, Kerala, India
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30
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Vinay K, Kumar S, Bishnoi A, Aggarwal D, Radotra BD, Parsad D, Sendhil Kumaran M. A clinico‐demographic study of 344 patients with lichen planus pigmentosus seen in a tertiary care center in India over an 8‐year period. Int J Dermatol 2019; 59:245-252. [DOI: 10.1111/ijd.14540] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Keshavamurthy Vinay
- Department of Dermatology, Venereology and Leprology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Sheetanshu Kumar
- Department of Dermatology, Venereology and Leprology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Anuradha Bishnoi
- Department of Dermatology, Venereology and Leprology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Divya Aggarwal
- Department of Histopathology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Bishan Dass Radotra
- Department of Histopathology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Davinder Parsad
- Department of Dermatology, Venereology and Leprology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Muthu Sendhil Kumaran
- Department of Dermatology, Venereology and Leprology Postgraduate Institute of Medical Education and Research Chandigarh India
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Mendiratta V, Sanke S, Chander R. Lichen Planus Pigmentosus: A Clinico-etiological Study. Indian Dermatol Online J 2019; 10:288-292. [PMID: 31149573 PMCID: PMC6536068 DOI: 10.4103/idoj.idoj_253_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Vibhu Mendiratta
- Department of Dermatology and STD, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Sarita Sanke
- Department of Dermatology and STD, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Ram Chander
- Department of Dermatology and STD, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
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Bishnoi A, Vinay K, Arshdeep, Parsad D, Handa S, Saikia U, Sendhil Kumaran M. Contact sensitization to hair colours in acquired dermal macular hyperpigmentation: results from a patch and photo‐patch test study of 108 patients. J Eur Acad Dermatol Venereol 2019; 33:1349-1357. [DOI: 10.1111/jdv.15576] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 02/27/2019] [Indexed: 11/30/2022]
Affiliation(s)
- A. Bishnoi
- Department of Dermatology, Venereology and Leprology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - K. Vinay
- Department of Dermatology, Venereology and Leprology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Arshdeep
- Department of Dermatology, Venereology and Leprology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - D. Parsad
- Department of Dermatology, Venereology and Leprology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - S. Handa
- Department of Dermatology, Venereology and Leprology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - U.N. Saikia
- Department of Histopathology Postgraduate Institute of Medical Education and Research Chandigarh India
| | - M. Sendhil Kumaran
- Department of Dermatology, Venereology and Leprology Postgraduate Institute of Medical Education and Research Chandigarh India
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Vollono L, Bianchi L, Mazzilli S, Orlandi A, Bielli A, Campione E. Drug-induced lichen planus pigmentosus: Do supportive and complementary drugs count? Dermatol Ther 2019; 32:e12871. [PMID: 30843626 DOI: 10.1111/dth.12871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 02/15/2019] [Accepted: 03/05/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Laura Vollono
- Dermatology Unit, Department of "Medicina dei Sistemi", Tor Vergata University, Rome, Italy
| | - Luca Bianchi
- Dermatology Unit, Department of "Medicina dei Sistemi", Tor Vergata University, Rome, Italy
| | - Sara Mazzilli
- Dermatology Unit, Department of "Medicina dei Sistemi", Tor Vergata University, Rome, Italy
| | - Augusto Orlandi
- Department of Anatomic Pathology, Tor Vergata University, Rome, Italy
| | - Alessandra Bielli
- Department of Anatomic Pathology, Tor Vergata University, Rome, Italy
| | - Elena Campione
- Dermatology Unit, Department of "Medicina dei Sistemi", Tor Vergata University, Rome, Italy
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Navarro-Triviño FJ, Naranjo-Díaz MJ, Ruiz-Villaverde R. Annular Pigmented Plaque Under the Chin. ACTAS DERMO-SIFILIOGRAFICAS 2018; 109:911-912. [PMID: 30539730 DOI: 10.1016/j.ad.2017.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 07/23/2017] [Accepted: 08/25/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- F J Navarro-Triviño
- Unidad de Dermatología Médico-Quirúrgica y Venereología, Complejo Hospitalario Universitario de Granada, Granada, España.
| | - M J Naranjo-Díaz
- Unidad de Dermatología Médico-Quirúrgica y Venereología, Complejo Hospitalario Universitario de Granada, Granada, España
| | - R Ruiz-Villaverde
- Unidad de Dermatología Médico-Quirúrgica y Venereología, Complejo Hospitalario Universitario de Granada, Granada, España
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Navarro-Triviño F, Naranjo-Díaz M, Ruiz-Villaverde R. Annular Pigmented Plaque Under the Chin. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2018.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Kumarasinghe SPW, Pandya A, Chandran V, Rodrigues M, Dlova NC, Kang HY, Ramam M, Dayrit JF, Goh BK, Parsad D. A global consensus statement on ashy dermatosis, erythema dyschromicum perstans, lichen planus pigmentosus, idiopathic eruptive macular pigmentation, and Riehl's melanosis. Int J Dermatol 2018; 58:263-272. [PMID: 30176055 DOI: 10.1111/ijd.14189] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 05/18/2018] [Accepted: 07/17/2018] [Indexed: 01/19/2023]
Abstract
Ashy dermatosis (AD), lichen planus pigmentosus (LPP), erythema dyschromicum perstans (EDP), and idiopathic eruptive macular pigmentation are several acquired macular hyperpigmentation disorders of uncertain etiology described in literature. Most of the published studies on these disorders are not exactly comparable, as there are no clear definitions and different regions in the world describe similar conditions under different names. A consensus on the terminology of various morphologies of acquired macular pigmentation of uncertain etiology was a long-felt need. Several meetings of pigmentary disorders experts were held to address this problem. A consensus was reached after several meetings and collation of e-mailed questionnaire responses and e-mail communications among the authors of publications on the above conditions. This was achieved by a global consensus forum on AD, LPP, and EDP, established after the 22nd International Pigment Cell Conference held in Singapore in 2014. Thirty-nine experts representing 18 countries participated in the deliberations. The main focus of the deliberations was terminology of the conditions; as such, we present here the consensus statement of the forum and briefly review the available literature on the subject. We have not attempted to discuss treatment modalities in detail.
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Affiliation(s)
| | - Amit Pandya
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Michelle Rodrigues
- Department of Dermatology, St Vincent's Hospital, Fitzroy, Vic, Australia
| | - Ncoza C Dlova
- Department of Dermatology, College of Health Sciences, Durban, South Africa
| | - Hee Young Kang
- Department of Dermatology, Ajou University, Suwon, South Korea
| | - M Ramam
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi, India
| | - Johannes F Dayrit
- Department of Dermatology, Research Institute for Tropical Medicine, Metro Manila, Philippines
| | | | - Davinder Parsad
- Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Gutierrez D, Gaulding J, Motta Beltran A, Lim H, Pritchett E. Photodermatoses in skin of colour. J Eur Acad Dermatol Venereol 2018; 32:1879-1886. [DOI: 10.1111/jdv.15115] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 05/30/2018] [Indexed: 02/06/2023]
Affiliation(s)
- D. Gutierrez
- The Ronald O. Perelman Department of Dermatology New York University New York NY USA
| | - J.V. Gaulding
- Department of Dermatology Henry Ford Hospital Detroit MI USA
| | | | - H.W. Lim
- Department of Dermatology Henry Ford Hospital Detroit MI USA
| | - E.N. Pritchett
- Department of Dermatology Henry Ford Hospital Detroit MI USA
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Shah DSD, Aurangabadkar DS, Nikam DB. An open-label non-randomized prospective pilot study of the efficacy of Q-switched Nd-YAG laser in management of facial lichen planus pigmentosus. J COSMET LASER THER 2018; 21:108-115. [DOI: 10.1080/14764172.2018.1469770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Dr. Swapnil Deepak Shah
- Ashwini Rural Medical College Hospital and Research Center, Department of Dermatology Dermatology and Venereology, Solapur, India
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Abstract
Pigmented deposits can occur in the skin due to many and varied causes. Some of them are systemic conditions accompanied by involvement of internal organs. Others have serious prognostic implications, and early diagnosis can help in the correct and adequate management of the diseases. In addition, some of them are quite innocuous and the correct diagnosis avoids unnecessary treatments. In this article, we review the morphologic features of some of the most common and some of the less usual pigmented deposits in skin other than tattoos.
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40
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Gupta V, Sharma VK. Ashy dermatosis, lichen planus pigmentosus and pigmented cosmetic dermatitis: Are we splitting the hair? Indian J Dermatol Venereol Leprol 2018; 84:470-474. [PMID: 29667610 DOI: 10.4103/ijdvl.ijdvl_549_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Vishal Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Kumar Sharma
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
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41
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Cheng HM, Chuah SY, Gan EY, Jhingan A, Thng STG. A retrospective clinico-pathological study comparing lichen planus pigmentosus with ashy dermatosis. Australas J Dermatol 2018; 59:322-327. [PMID: 29635779 DOI: 10.1111/ajd.12813] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 02/10/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND/OBJECTIVES Controversy persists as to whether lichen planus pigmentosus and ashy dermatosis are separate clinical entities. This study was conducted to examine the clinicopathological features and treatment outcome of the two conditions. METHODS A retrospective medical chart review of all patients who were diagnosed with lichen planus pigmentosus or ashy dermatosis was conducted. The information collected included the participants' age at onset, site of onset, duration of disease, presence of precipitating factors, distribution of disease, pigmentation and presence of symptoms. In patients from whom a biopsy was taken the histopathological reports were included. RESULTS Altogether 26 patients with ashy dermatosis and 29 with lichen planus pigmentosus were included in the study. Compared with ashy dermatosis, lichen planus pigmentosus had a more localised distribution with a preponderance for facial involvement, compared with the truncal preponderance in ashy dermatosis. Ashy dermatosis tended to have a more stable clinical course than lichen planus pigmentosus, which was more likely to wax and wane. The utility of histopathology in differentiating between the two conditions is low. CONCLUSION Ashy dermatosis and lichen planus pigmentosus, as defined in this study, appear to be two separate clinical entities with distinguishable clinical features and natural histories.
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Affiliation(s)
- Hui Mei Cheng
- Department of Dermatology, National Skin Centre, Singapore City, Singapore
| | - Sai Yee Chuah
- Department of Dermatology, National Skin Centre, Singapore City, Singapore
| | - Emily Yiping Gan
- Department of Dermatology, National Skin Centre, Singapore City, Singapore
| | - Anjali Jhingan
- Department of Dermatology, National Skin Centre, Singapore City, Singapore
| | - Steven Tien Guan Thng
- Department of Dermatology, National Skin Centre, Singapore City, Singapore.,Department of Material Science and Engineering, Nanyang Technological University, Singapore City, Singapore
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42
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Kumaran MS, Dabas G, Parsad D, Vinay K. Lichen planus pigmentosus - An appraisal. Int J Dermatol 2018; 57:748-750. [DOI: 10.1111/ijd.13982] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 03/01/2018] [Accepted: 03/05/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Muthu S. Kumaran
- Department of Dermatology, Venereology and Leprology; PGIMER; Chandigarh India
| | - Garima Dabas
- Department of Dermatology, Venereology and Leprology; PGIMER; Chandigarh India
| | - Davinder Parsad
- Department of Dermatology, Venereology and Leprology; PGIMER; Chandigarh India
| | - Keshavamurthy Vinay
- Department of Dermatology, Venereology and Leprology; PGIMER; Chandigarh India
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43
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Gavazzoni Dias MFR, Rezende HD, Lofeu Cury A, Trüeb RM, Vilar E. Hyperpigmented Upper Eyelid: A Clue to the Diagnosis of Facial Lichen Planus Pigmentosus in a Patient with Frontal Fibrosing Alopecia. Skin Appendage Disord 2018; 4:335-338. [PMID: 30410910 DOI: 10.1159/000487338] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 01/29/2018] [Indexed: 11/19/2022] Open
Abstract
Facial lichen planus pigmentosus (LPPig), a rare variant of classic lichen planus, was first described in patients with frontal fibrosing alopecia (FFA) by Dlova [Br J Dermatol 2013; 168: 439-442] in 2013. The diagnosis of facial LPPig is sometimes not easy, since clinical signs and histopathological features may frequently be confused with melasma or postinflammatory hyperpigmentation. We describe a case of a postmenopausal black woman diagnosed with FFA who presented with an identical brown-grayish pigmentation of the face and upper eyelids and typical dermoscopy analysis on both regions. We suggest that the hyperpigmentation of the upper eyelid with typical LLPig dermoscopy (upper eyelid sign) may be a clue for the diagnosis of LPPig and may avoid a scar-causing face biopsy.
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Affiliation(s)
| | - Hudson Dutra Rezende
- Faculdade de Medicina de Campos Hospital Escola Álvaro Alvim, Campos dos Goytacazes, Brazil
| | | | - Ralph M Trüeb
- Center for Dermatology and Hair Diseases Professor Trüeb and University of Zurich, Zurich, Switzerland
| | - Enoï Vilar
- Universidade Federal Fluminense, Niterói, Brazil
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Gajjar PC, Mehta HH, Nimbark V, Jethwa M. An atypical clinical presentation of lichen planus pigmentosus with typical dermoscopic pattern. Australas J Dermatol 2018; 59:e208-e210. [PMID: 29577239 DOI: 10.1111/ajd.12797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 12/31/2017] [Indexed: 11/28/2022]
Abstract
We report a rare and interesting case of a combined linear, Blaschkoid and zosteriform pattern of lichen planus pigmentosus. Dermoscopy showed discrete bluish-grey dots, globules, blotches and rods against a brownish background. A skin biopsy confirmed the diagnosis from the presence of civatte bodies, melanin incontinence and band-like inflammation.
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Affiliation(s)
- Prachi C Gajjar
- Department of Dermatology, Sir T Hospital, Government Medical College, Bhavnagar, Gujarat, India
| | - Hita H Mehta
- Department of Dermatology, Sir T Hospital, Government Medical College, Bhavnagar, Gujarat, India
| | - Vivek Nimbark
- Department of Dermatology, Sir T Hospital, Government Medical College, Bhavnagar, Gujarat, India
| | - Manisha Jethwa
- Department of Dermatology, Sir T Hospital, Government Medical College, Bhavnagar, Gujarat, India
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45
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Mulinari-Brenner FA, Guilherme MR, Peretti MC, Werner B. Frontal fibrosing alopecia and lichen planus pigmentosus: diagnosis and therapeutic challenge. An Bras Dermatol 2018; 92:79-81. [PMID: 29267454 PMCID: PMC5726685 DOI: 10.1590/abd1806-4841.20175833] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 04/24/2016] [Indexed: 11/21/2022] Open
Abstract
Frontal fibrosing alopecia is a variant of lichen planopilaris with marginal progressive hair loss on the scalp, eyebrows and axillae. We report a case of frontal fibrosing alopecia and lichen planus pigmentosus in a postmenopausal woman, that started with alopecia on the eyebrows and then on the frontoparietal region, with periocular and cervical hyperpigmentation of difficult management. The condition was controlled with systemic corticosteroid therapy and finasteride. Lichen planus pigmentosus is an uncommon variant of lichen planus frequently associated with frontal fibrosing alopecia in darker phototipes. It should be considered in patients affected by scarring alopecia with a pattern of lichen planopilaris and areas of skin hyperpigmentation revealing perifollicular hyperpigmentation refractory to multiple treatments. This case illustrates diagnostic and therapeutic challenge in face of scarring alopecia and perifollicular hyperpigmentation.
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Affiliation(s)
| | | | - Murilo Calvo Peretti
- Department of Dermatology, Hospital de Clínicas da Universidade Federal do Paraná (HC- UFPR) - Curitiba (PR), Brazil
| | - Betina Werner
- Department of Basic Pathology, Universidade Federal do Paraná (UFPR) - Curitiba (PR), Brazil
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46
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Petrof G, Cuell A, Rajkomar VV, Harries MJ, Takwale A, Holmes S, Cunningham F, Kaur MR. Retrospective review of 18 British South Asian women with frontal fibrosing alopecia. Int J Dermatol 2018; 57:490-491. [PMID: 29384198 DOI: 10.1111/ijd.13929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/02/2018] [Accepted: 01/03/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Gabriela Petrof
- Solihull Hospital, Heart of England NHS Foundation Trust, Solihull, UK
| | - Alexis Cuell
- Solihull Hospital, Heart of England NHS Foundation Trust, Solihull, UK
| | - Vikram V Rajkomar
- The Dermatology Centre, University of Manchester, Salford Royal NHS Foundation Trust, Salford, UK
| | - Matthew J Harries
- The Dermatology Centre, University of Manchester, Salford Royal NHS Foundation Trust, Salford, UK
| | - Anita Takwale
- Gloucestershire Hospitals NHS Foundation trust, Gloucester, UK
| | - Susan Holmes
- Queen Elizabeth University Hospital, Glasgow, UK
| | | | - Manjit R Kaur
- Solihull Hospital, Heart of England NHS Foundation Trust, Solihull, UK
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47
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Bilateral Symmetric Hyperpigmented Forehead Patches: Answer. Am J Dermatopathol 2018; 40:150. [PMID: 29381523 DOI: 10.1097/dad.0000000000000753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Robles-Méndez JC, Rizo-Frías P, Herz-Ruelas ME, Pandya AG, Ocampo Candiani J. Lichen planus pigmentosus and its variants: review and update. Int J Dermatol 2017; 57:505-514. [DOI: 10.1111/ijd.13806] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 07/19/2017] [Accepted: 09/15/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Juan Carlos Robles-Méndez
- Department of Dermatology; Hospital Universitario “Dr. José Eleuterio González”; Universidad Autónoma de Nuevo León; Nuevo León México
| | - Paulina Rizo-Frías
- Department of Dermatology; Hospital Universitario “Dr. José Eleuterio González”; Universidad Autónoma de Nuevo León; Nuevo León México
| | - Maira Elizabeth Herz-Ruelas
- Department of Dermatology; Hospital Universitario “Dr. José Eleuterio González”; Universidad Autónoma de Nuevo León; Nuevo León México
| | - Amit G. Pandya
- Department of Dermatology; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Jorge Ocampo Candiani
- Department of Dermatology; Hospital Universitario “Dr. José Eleuterio González”; Universidad Autónoma de Nuevo León; Nuevo León México
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Vinay K, Bishnoi A, Parsad D, Saikia UN, Sendhil Kumaran M. Dermatoscopic evaluation and histopathological correlation of acquired dermal macular hyperpigmentation. Int J Dermatol 2017; 56:1395-1399. [PMID: 28971471 DOI: 10.1111/ijd.13782] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 07/21/2017] [Accepted: 08/23/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Acquired dermal macular hyperpigmentation (ADMH) is a hypernym encompassing Riehl's melanosis, lichen planus pigmentosus, and ashy dermatoses that show significant clinicopathological overlap. We sought to describe the dermatoscopic features of ADMH and correlate them with histopathological findings. METHODS This was a prospective observational study performed in two phases. A detailed clinical and dermatoscopic examination was performed, and skin biopsies were obtained in 51 patients. Two dermatologists and a blinded dermatopathologist studied archived dermatoscopic images and histopathology specimens, respectively. RESULTS Dermatoscopic features noted were (i) pigment structures; dots (82.4%), globules (66.7%) and blotches (56.9%) that spared the eccrine and hair follicle openings; (ii) telangiectasia (82.4%); (iii) accentuation of the normal pseudoreticular pigmentary network (33.3%); (iv) owl's eye structures (15.7%). Four dermatoscopic grades of disease severity were identified: grade 1 - dotted; grade 2 - Chinese letter; grade 3 - reticulate; and grade 4 - diffuse. Density of melanin incontinence on histopathology correlated positively with size of pigment structures (r = 0.7, P < 0.000) and grades of disease severity (r = 0.75, P < 0.000) on dermatoscopy. CONCLUSION Increasing grades of disease severity can be detected dermatoscopically, which correlate well with histopathological features. A carefully performed dermatoscopy aids in better patient counseling regarding disease severity.
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Affiliation(s)
- Keshavamurthy Vinay
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anuradha Bishnoi
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Davinder Parsad
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Uma N Saikia
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Muthu Sendhil Kumaran
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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50
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Silpa-Archa N, Kohli I, Chaowattanapanit S, Lim HW, Hamzavi I. Postinflammatory hyperpigmentation: A comprehensive overview: Epidemiology, pathogenesis, clinical presentation, and noninvasive assessment technique. J Am Acad Dermatol 2017; 77:591-605. [PMID: 28917451 DOI: 10.1016/j.jaad.2017.01.035] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 01/13/2017] [Accepted: 01/22/2017] [Indexed: 01/19/2023]
Abstract
Postinflammatory hyperpigmentation (PIH) commonly occurs after various endogenous and exogenous stimuli, especially in dark-skinned individuals. PIH is one of the most common complications of procedures performed using laser and other light sources. The severity of PIH is determined by the inherent skin color, degree and depth of inflammation, degree of dermoepidermal junction disruption, inflammatory conditions, and the stability of melanocytes, leading to epidermal and dermal melanin pigment deposition. The depth of melanin pigment is the key factor to predict prognosis and treatment outcome. Epidermal hyperpigmentation fades more rapidly than dermal hyperpigmentation. Various inflammatory disorders can eventually result in PIH. The evaluation of pigmentation using noninvasive tools helps define the level of pigmentation in the skin, pigmentation intensity, and guides therapeutic approaches. This first article in this 2-part series discusses the epidemiology, pathogenesis, etiology, clinical presentation, differential diagnoses, and investigation using noninvasive assessment techniques that objectively determine the details of pigmentation.
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Affiliation(s)
- Narumol Silpa-Archa
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan; Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Indermeet Kohli
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Suteeraporn Chaowattanapanit
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan; Department of Medicine, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand
| | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan.
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