Lichen planus pigmentosus-inversus: case report and review of an unusual entity

Lichen planus pigmentosus-inversus is a rare variant of lichen planus, with less than 20 cases reported in the medical literature. It presents as asymptomatic to mildly pruritic, hyperpigmented macules and/or patches involving intertriginous and flexural areas and skin folds in light-skinned individuals. The unique pattern of skin involvement, clinical features, and histology are distinctive. The combination of hyperpigmented lesion(s) isolated to non-sun exposed, intertriginous, and flexural areas with lichenoid histology is unique and separates it from other similar entities, such as lichen planus actinus and erythema dyschromicum perstans/ashy dermatosis. The case well highlights this unusual condition and represents the first case reported in the United States.     

色素性扁平苔藓

报告1例色素性扁平苔藓。患者男,20岁。躯干及四肢出现褐色斑疹半年余,无自觉症状。皮肤科检查见躯干及四肢散在大小不一、边界清楚的褐色斑疹和斑片,部分呈条索状,部分皮损肥厚、浸润。皮损组织病理改变符合色素性扁平苔藓。     

Placas anulares en grandes pliegues: cuatro casos de liquen plano pigmentoso-inverso

We report 4 patients with relatively asymptomatic, annular brownish plaques arising in the skin creases. The lesions had remained stable for months despite many topical treatments. Histological amination revealed an atrophic epidermis with a dermal lichenoid inflammatory infiltrate showing marked pigmentary incontinence. These clinical and pathological features were consistent with lichen planus pigmentosus-inversus, a rare, recently described variant of lichen planus, with only 10 cases reported to date. It has been suggested that the intensity and speed of onset of the inflammatory response could be modulated by keratinocyte surface markers, which could also determine the typical morphology of the lesions of this disease.     

Lichen planus pigmentosus inversus in children: Case report and updated review of the literature

Lichen planus pigmentosus inversus (LPPI) is a rare variant of lichen planus characterized by slate grey to dark black‐brown macules, papules, or patches occurring in the skin folds. We present a case of LPPI in an 11‐year‐old girl, the second‐youngest case and only the third pediatric case. This article also reviews the differential diagnosis and treatment of LPPI.     

Two Cases of Lichen Planus Pigmentosus-inversus Arising from Long-standing Lichen Planus-inversus

Lichen planus pigmentosus-inversus (LPP-inversus) is an extremely rare variant of lichen planus (LP), and only a few cases have been reported. Its course is characterized by exacerbations and remissions, and it is known to be more chronic than classical LP is. We report two cases of LPP-inversus and offer the suggestion that LPP-inversus may originate from LP of flexural areas.     

A case of lichen planus pigmentosus that was recalcitrant to topical treatment responding to pigment laser treatment

Lichen planus pigmentosus is a rare variant of lichen planus for which no effective treatment is currently available. Patients usually present with hyperpigmented, dark brown macules on sun‐exposed areas or flexural folds. Here we describe a 50‐year‐old Chinese woman who had biopsy‐confirmed lichen planus pigmentosus that was recalcitrant to a variety of topical treatments, but responded to treatment with a pigment laser.     

A Case of Linear Lichen Planus Pigmentosus

Lichen planus pigmentosus (LPP) is chronic pigmentary disorder that shows diffuse or reticulated hyperpigmented, dark brown macules on the sun-exposed areas such as the face, neck and other flexural folds. Clinically, it is different from classical lichen planus because LPP has a longer clinical course and it manifests with dark brown macules. In case of LPP, involvement of the scalp, nail or mucosal area is rare. The histopathological findings of the lesions show an atrophic epidermis, the presence of melanophages and a vacuolar alteration of the basal cell layer with a sparse lymphohistiocytic lichenoid infiltration. Although there have been a few reports of LPP, there have only 3 cases of linear LPP along the lines of Blaschko in the Korean dermatologic literature. Our patient had lesions on the neck and chin with a linear pattern. In this report, we describe a very rare case of LPP with a linear distribution related to Blaschko''s lines on the neck and chin areas.     

Linear lichen planus and hepatitis C

A 23-year-old man with hepatitis C was observed with brownish dome-shaped papules in a linear pattern on the chest. The papules were determined clinically and pathologically to be linear lichen planus. These lesions appeared during an interferon-alpha therapy for his hepatitis and resolved after topical treatment with tacrolimus ointment. Linear lichen planus and hepatitis C have been reported only twice previously. The association between these disorders and the potential role of interferon therapy are discussed.     

Actinic lichen planus: a presentation,deviant from the conventional

Actinic lichen planus, a variant of lichen planus usually in people living in the tropics, presents as annular or discoid patches over the sun-exposed regions. We present here a case of actinic lichen planus with papules and plaques over the malar region and dorsum of nose- a rare presentation of this entity.     

A histochemical profile of lichen simplex

Enzyme histochemical tests were performed on biopsies taken from patches of lichen simplex in eighteen patients and the results were contrasted with previous findings in psoriasis and lichen planus. The mitochondria! enzyme reactions were found to be increased within the epidermis, differing from those in lichen planus, in which there is a decreased density of reaction product for these tests. The non-specific esterase band was increased in width in lichen simplex contrasting with the absence of a discrete band in psoriasis. The DOPA reaction demonstrated the presence of positively reacting cells in the basal layer, and the ATPase reaction showed that there were many ATPase positive dendritic cells within the epidermis. It appears that in lichen simplex there is hyperplasia of all components of the epidermis in contrast to psoriasis where it seems the hyperplasia is almost restricted to keratinocytes.     

Clinical variants of lichen planus

Lichen planus is characterized by lichenoid, polygonal papules with fine white lines, called Wickham striae. Lesions most commonly occur on the limbs and on the dorsal aspect of the trunk. At the same time often leukoplakia of mucous membranes as well as nail disorders are seen. There are numerous variants of lichen planus which can be distinguished from the classical form on the basis of morphology and distribution of the lesions. The typical primary lesion of lichen planus may be replaced by other forms, such as patches, hyperkeratoses, ulcerations, or bullous lesions. Moreover, distribution patterns of these lesions may vary and include erythrodermic, inverse or linear arrangements. In contrast to these numerous clinical features, histologic findings remain characteristic in the variants, so that the diagnosis can be made securely. Differential diagnoses of lichen planus include diverse dermatoses such as bullous pemphigoid or paronychia.     

Lichen planus pemphigoides with circulating autoantibodies against 200 and 180 kDa epidermal antigens

We describe a case of lichen planus pemphigoides with circulating autoantibodies against 200 and 180 kDa epidermal antigens. A 24-year-old man presented pruritic erythematous patches with occasional central blister formation on the face, neck, and trunk and erythematous hyperkeratotic patches on the elbows and feet for 10 months. Histopathological findings of the neck and plantar lesions were consistent with lichen planus. Direct immunofluorescence studies from both lesions showed a linear deposition of IgG and C3 and cytoid bodies along the basement membrane zone. Indirect immunofluorescence studies demonstrated circulating IgG antibodies deposited on the epidermal side of salt-split skin. Immunoblot analysis using epidermal extract showed that the patient's serum reacted with 180 kDa bullous pemphigoid antigen (BPAG2) and a 200 kDa antigen. The cutaneous lesions almost cleared with a low dose of prednisolone and acitretin.     

沿静脉分布的色素性扁平苔藓

报告1例沿静脉分布的色素性扁平苔藓.患者男,39岁.双上臂与静脉走向一致的紫色斑5个月.皮肤科检查:双前臂数条紫色或褐色色素沉着带,与浅表静脉走向大致相同.自身抗体及乙肝、丙肝抗体榆查均阴性.组织病理检查示正性角化过度,基底层液化变性,表、真皮交界处可见到Civatte小体,真皮血管周围淋巴细胞浸润明显,并可见噬黑素细胞.诊断为色素性扁平苔藓.     

A Case of Childhood Lichen Aureus

Lichen aureus is a rare type of chronic pigmented purpuric dermatosis. The eruptions consist of discrete or confluent golden to brownish lichenoid macules and papules, and are usually asymptomatic. Lichen aureus commonly occurs in young adults, but less frequently in children. We report the first case of multiple lichen aureus occurring in a Korean child.     

Idiopathic eruptive macular pigmentation: report on two cases

Idiopathic eruptive macular pigmentation (IEMP) is a rather under-reported condition of unknown etiology. Clinically consisting of benign hyperpigmented macules, the condition is characterized histopathologically by dermal melanization. It must be differentiated from lichen planus pigmentosus, erythema dyschromicum perstans, fixed drug eruption and mastocytosis.     

扁平苔藓样角化症3例

报告3例扁平苔藓样角化症。3例患者中男2例,女1例,年龄均>50岁。皮损均表现为单个有少量鳞屑的红褐色斑,无自觉症状。组织病理改变主要为角化过度伴灶状角化不全,基底层液化变性,真皮浅层可见淋巴细胞大致呈带状分布,并可见嗜酸性粒细胞和浆细胞浸润。扁平苔藓样角化症是一种不同于扁平苔藓和脂溢性角化病的疾病。     

Annular lichen planus: study of the cellular mechanisms of annularity

Annular lichen planus is a rare, unique subtype of lichen planus. We report a 34-year-old Japanese male who had multiple, dark red to purple, annular macules with slightly raised borders. Histopathological examination of a skin biopsy specimen from the peripheral region of the macule showed the typical features of lichen planus. Immunohistochemical stainings revealed that a number of CD1a-positive, S-100-protein-positive Langerhans cells were present at the border zone of the annular lesion and most of the infiltrating cells were CD4-positive, CD8-negative lymphocytes. Conversely, inside the annular lesion, the number of Langerhans cells was decreased, and an equal number of CD4-positive cells and CD8-positive cells was present in the sparse infiltration. These results suggest that activation of Langerhans cells initiated a lichenoid tissue reaction but a subsequent depletion of Langerhans cells suppressed the lymphocyte infiltration. These sequential events might be involved in the formation of the unique annular structure in this condition.     

Annular atrophic lichen planus

We describe a new case of annular atrophic lichen planus. Annular atrophic lichen planus is a rare variant of lichen planus that is clinically characterized by violaceous plaques of annular morphology with central atrophy and histopathologic findings of annular and atrophic lichen planus, respectively. There have been 4 cases of this entity reported previously.     

Wolf's isotopic response: a case of zosteriform lichen planus

Lichen planus is a lichenoid disorder characterized by shiny, flat papules. In addition to the classical appearance, there are several variants. Zonal or zosteriform lesions have been described. A 25-year-old male with a complaint of increasing numbers of erythematous swellings on his left groin for twenty days was admitted to our out-patient clinic. He had a history of herpes zoster in the same localization which had been treated with topical acyclovir two weeks prior to his admission. Dermatological examination revealed multiple, shiny, erythematous, umblicated papules localized to the left inguinal region in a linear pattern. A biopsy was taken from the lesions. According to the clinical and pathological findings the diagnosis was zosteriform lichen planus. Zosteriform lichen planus is a rare variant of lichen planus; its differentiation from zona zoster and other linear dermatoses is difficult. We presented our case because of its rarity as a variant of lichen planus and its appearance in the area of healed herpes zoster as an isotopic response.     

An atypical clinical presentation of lichen planus pigmentosus with typical dermoscopic pattern

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.