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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: 5] [Impact Index Per Article: 1.7] [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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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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Cozzani E, Gariazzo L, Cioni M, Parodi A. Could colchicine represent a new therapeutic approach for lichen planus pigmentosus? Dermatol Ther 2019; 32:e12809. [PMID: 30614614 DOI: 10.1111/dth.12809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 07/23/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Emanuele Cozzani
- Dissal Section of Dermatology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
| | - Lodovica Gariazzo
- Dissal Section of Dermatology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
| | - Margherita Cioni
- Dissal Section of Dermatology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
| | - Aurora Parodi
- Dissal Section of Dermatology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
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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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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.
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Affiliation(s)
- Aparajita Ghosh
- Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India
| | - Arijit Coondoo
- Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India
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Acquired brachial cutaneous dyschromatosis in a 60-year-old male: a case report and review of the literature. Case Rep Dermatol Med 2015; 2014:452720. [PMID: 25610668 PMCID: PMC4294462 DOI: 10.1155/2014/452720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 12/17/2014] [Indexed: 11/30/2022] Open
Abstract
Acquired brachial cutaneous dyschromatosis is an acquired pigmentary disorder that has been
described in only 20 patients but likely affects many more. This case of a man with acquired
brachial cutaneous dyschromatosis is unique as most reports are in women. We report the case of
a 60-year-old male who presents with an asymptomatic eruption characterized by
hyperpigmented and telangiectatic macules coalescing into patches on the bilateral extensor
aspects of the forearms which is consistent clinically and histopathologically with acquired brachial
cutaneous dyschromatosis. Given its presence in patients with clinical evidence of chronic sun
exposure and its histopathological finding of solar elastosis, acquired brachial cutaneous
dyschromatosis is likely a disorder caused by cumulative UV damage. However, a possible
association between angiotensin-converting enzyme inhibitors and acquired brachial cutaneous
dyschromatosis exists. Further investigation is needed to elucidate both the pathogenesis of the
disorder and forms of effective management. Treatment of the disorder should begin with current
established treatments for disorders of dyspigmentation.
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Abstract
Lichen planus pigmentosus (LPP) is a distinct clinical entity commonly encountered in the Indian population. It is considered a variant of lichen planus (LP). A 40-year-old male presented with asymptomatic hyperpigmented macules in a segmental distribution since 10 years that were clinically and histopathologically suggestive of LPP. We propose the terminology “segmental lichen planus pigmentosus” and report this unusual presentation.
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Affiliation(s)
- Y Hari Kishan Kumar
- Department of Dermatology, MVJ Medical College and Research Hospital, Hoskote, Bangalore, India
| | - Anagha Ramesh Babu
- Department of Dermatology, MVJ Medical College and Research Hospital, Hoskote, Bangalore, India
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Abstract
We present here the case of a young Indian male with slowly progressive, diffuse darkening of the face, arms, neck, and trunk. The patient was not taking any medication and there was no history of any previous skin disease and the mucous membrane was not involved. These findings are consistent with a diagnosis for ashy dermatosis of unknown etiology.
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Affiliation(s)
- Nandini Chakrabarti
- From the Department of General Medicine, NRS Medical College and Hospital, 138, AJC Bose Road, Kolkata, India
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Hudacek KD, Schaffer A, James WD. Clinicopathologic challenge. Int J Dermatol 2009; 48:815-6. [PMID: 19673045 DOI: 10.1111/j.1365-4632.2009.04157.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Kristin D Hudacek
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA 19104-6087, USA.
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Correa MC, Memije EV, Vargas-Alarcón G, Guzmán RA, Rosetti F, Acuña-Alonzo V, Martínez-Rodríguez N, Granados J. HLA-DR association with the genetic susceptibility to develop ashy dermatosis in Mexican Mestizo patients. J Am Acad Dermatol 2006; 56:617-20. [PMID: 17116345 DOI: 10.1016/j.jaad.2006.08.062] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2006] [Revised: 07/27/2006] [Accepted: 08/15/2006] [Indexed: 11/23/2022]
Abstract
BACKGROUND Ashy dermatosis, also known as erythema dyschromicum perstans, is an acquired benign disease, characterized by blue-gray pigment patches with erythematous borders. The cause is still unclear, but probably has an immunologic basis. OBJECTIVE The aim of this study was to determine gene frequencies of the HLA-DR alleles in Mexican patients with ashy dermatosis and compare them with ethnically matched healthy control subjects to reveal the genetic susceptibility to develop ashy dermatosis. METHODS We included 23 consecutive patients with clinical and histopathologic confirmed diagnosis of erythema dyschromicum perstans. Patients and control subjects received a questionnaire to determine their ethnic origin and a peripheral blood sample was taken for DNA extraction. Finally, Genetic HLA-DRB1 was performed by polymerase chain reaction sequence-specific oligonucleotide reverse dot blot hybridization. RESULTS Of the 23 patients included in this study, 65% were women and 35% were men. We observed that the disease was located in the trunk in 17 patients (74%) and the upper limbs in 15 patients (65%). The most frequent allele was HLA-DR4 (65%) (pC < 1 x 10(-6), odds ratio = 6.0, 95% confidence interval = 2.8-12.7) whereas in control subjects it was 23%. The most frequent molecular subtype in both patients and healthy control subjects was DRB1( *)0407, being statistically significant after comparing the two groups (pC < 1 x 10(-6), odds ratio = 7.0, 95% confidence interval = 3.1-15.8). LIMITATIONS Since this is a disease strongly influenced by ethnicity, extrapolation to other ethnic groups is limited. CONCLUSIONS Many factors influence the ethiopathogenesis of erythema dyschromicum perstans, but it is strongly suggested to have an important genetic susceptibility conferred by genes located within the major histocompatibility complex region.
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Sebbag N, Lacour JP. [Erythema dyschromicum perstans]. Ann Dermatol Venereol 2006; 133:79-82. [PMID: 16495863 DOI: 10.1016/s0151-9638(06)70853-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- N Sebbag
- Service de Dermatologie, Hôpital Archet-2, CHU de Nice
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Yokozeki H, Ueno M, Komori K, Nishioka K. Multiple linear erythema dyschromicum perstans (ashy dermatosis) in the lines of Blaschko. Dermatology 2005; 210:356-7. [PMID: 15942229 DOI: 10.1159/000084767] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Akagi A, Ohnishi Y, Tajima S, Ishibashi A. Linear hyperpigmentation with extensive epidermal apoptosis: a variant of linear lichen planus pigmentosus? J Am Acad Dermatol 2004; 50:S78-80. [PMID: 15097934 DOI: 10.1016/j.jaad.2003.11.067] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We report 3 female patients who rapidly developed pigmented patches in a linear arrangement. Histologically there was minimum epidermal basal cell damage and bandlike lymphocyte infiltration in the dermis, but focal massive apoptotic materials positively stained with antikeratin antibody were prominently seen in the papillary and subpapillary dermis. We considered these cases as a variant of linear lichen planus pigmentosus with unique histologic change of severe epidermal apoptosis. These histologic features may represent a severe apoptotic change in the end stage of lichenoid tissue reaction.
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Affiliation(s)
- Atsushi Akagi
- Department of Dermatology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan.
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Affiliation(s)
- Robert A Schwartz
- Dermatology, New Jersey Medical School, 185 South Orange Avenue, Newark, NJ 07103-2714, USA.
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Abstract
We report two cases of lichen planus pigmentosus (LPP) that developed in a unilateral linear pattern. The patients presented with unilateral linear brown macules on the extremities. Skin biopsy showed orthokeratosis, basal hydropic degeneration with scarce lymphohistiocytic infiltrates, and numerous melanophages in both patients. These patients, to the best of our knowledge, are the first cases of LPP presenting with a linear pattern. LPP should be considered in the differential diagnosis of linear hyperpigmented skin lesions.
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Affiliation(s)
- Sungho Hong
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
| | - Jeong Hyun Shin
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
| | - Hee Young Kang
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
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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. [PMID: 12950331 DOI: 10.1046/j.1365-2230.2003.01367.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Lichen planus pigmentosus is a fairly common disorder of pigmentation in Indians, but reports comprising a sizeable number of patients are lacking in the literature. We now describe the clinical and epidemiological features and histopathological findings for 124 lichen planus pigmentosus patients. A retrospective analysis of medical records of patients attending our centre during the past 12 years was undertaken. Of the 124 patients (56 male, 68 female), the majority (48.4%) had the disease for 6 months to 3 years. The face and neck were the commonest sites affected with pigmentation varying from slate grey to brownish-black. The pattern of pigmentation was mostly diffuse (77.4%), followed by reticular (9.7%), blotchy (7.3%) and perifollicular (5.6%). Lichen planus was noted in 19 patients with typical histopathological changes of the disorder. Lichen planus pigmentosus, a distinct clinical entity commonly encountered in the Indian population, should be considered in the spectrum of lichenoid disorders as a variant of lichen planus.
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Affiliation(s)
- A J Kanwar
- Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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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. [PMID: 12027092 DOI: 10.1111/j.1346-8138.2002.tb00258.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dominguez-Soto L, Hojyo-Tomoka MT, Vega-Memije ME, Waxtein LM, Cortés-Franco R. Letter to the editor regarding the article: "Erythema dyschromicum perstans in early childhood" by Sang-Ju Lee and Kee-Yang Chung. J Dermatol 1999; 26:621-2. [PMID: 10535261 DOI: 10.1111/j.1346-8138.1999.tb02061.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Lichen planus pigmentosus (LPP) has thus far been described as a condition of unknown etiology which clinically differs from the classical lichen planus (LP) by exhibiting dark brown macules and/or papules mostly in exposed areas and flexural folds and a longer clinical course without pruritus or scalp, nail or mucosal involvement. Histopathologically, LPP shows the typical changes seen in LP, but with thinning of epidermis. We report a case of LPP that developed in a unilateral, zosteriform pattern on the left flank of a 49-year-old man. This case seems to lie in the middle of the spectrum between classical LP and ashy dermatosis, and, to the best of our knowledge, is the first report of LPP presenting in the zosteriform pattern.
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Affiliation(s)
- S Cho
- Department of Dermatology, College of Medicine, Ewha Womans University, Seoul, Korea
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Affiliation(s)
- P Zenorola
- Department of Dermatology, IRCCS, Casa sollievo della Sofferenza Hospital, S. Giovanni Rotondo, Italy
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