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Dermoscopy has traditionally been used for the diagnosis of neoplasms and more recently in the evaluation of inflammatory conditions. Recent observational studies have suggested a role for dermoscopy in identifying and differentiating acquired pigmentary disorders. This comprehensive review will summarize the growing literature on the use of dermoscopy for pigmentary disorders. A literature review was performed on PubMed dating from inception to October 2020. The following pigmentary disorders were included in this study: melasma, solar lentigines, poikiloderma of Civatte, exogenous ochronosis, lichen planus pigmentosus, erythromelanosis follicularis faciei et colli, pigmented contact dermatitis, Riehl's melanosis, postinflammatory hyperpigmentation, erythema dyschromicum perstans, ashy dermatosis, confluent and reticulated papillomatosis, acanthosis nigricans, pityriasis versicolor, tinea versicolor, idiopathic guttate hypomelanosis, and vitiligo. Search terms used included each pigmentary disorder along with the terms "dermoscopy" or "dermatoscopy." Relevant case reports and case series were included. Many pigmentary disorders have unique and distinguishable features on dermoscopy. Given that these disorders can be clinically challenging for clinicians and emotionally distressing for patients, dermoscopy provides an additional, useful tool in the evaluation and assessment process.

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.

Literature on treating acquired dermal macular hyperpigmentation is sparse.To assess treatment response of mycophenolate mofetil in patients having acquired dermal macular hyperpigmentation.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.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%, and50% 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.Mycophenolate mofetil appears to be a promising treatment option in acquired dermal macular hyperpigmentation.

Lichen planus (LP) is a mucocutaneous immune-mediated disease of unknown etiology. It is more prevalent in women and usually occurs between the third and sixth decades of life. Oral lesions may or may not be associated with skin and genital lesions. Although the role of genetic factors is still undetermined, reports of LP in more than one family member are not uncommon. However, the occurrence of LP in monozygotic twins is rare. We report a rare case of 42-year-old female monozygotic twins presenting oral LP. This report is even rarer because one of the patients had cutaneous lesions of an unusual variant of LP (LP pigmentosus) and the other had an uncommon association with lichen sclerosus. The etiology and pathogenesis of LP are still uncertain. However, despite being rare, its occurrence in family members and monozygotic twins suggests that genetic factors are involved in its development.

La alopecia frontal fibrosante es un tipo de alopecia cicatrizal que se ha asociado con diferentes lesiones cu­taneas y con liquen plano pigmentoso. Existen mecanismos fisiopatologicos comunes a las dos enfermedades que explican su coexistencia en el mismo paciente. Se presentan los casos de 12 mujeres mestizas con alopecia frontal fibrosante y liquen plano pigmentoso confirmado por histopatologia, y se discuten los mecanismos fisio­patologicos comunes a las dos enfermedades. El mecanismo fisiopatologico mas importante que comparten las dos enfermedades es la respuesta inmunitaria mediada por linfocitos T citotoxicos, que se genera en contra de celulas como los queratinocitos y las celulas madre del foliculo piloso, causa apoptosis y dano de la capa basal, con la consiguiente remodelacion del tejido que determina la aparicion de las lesiones clinicas de alopecia frontal fibrosante y liquen plano pigmentoso. La alopecia frontal fibrosante y el liquen plano pigmentoso son el espectro clinico de una misma enfermedad con manifestaciones clinicas variables.

Facial pigmentary disorder is a common condition in dark-skinned individual which causes significant psychological morbidity to the patients. Some of the well-defined causes of facial melanoses include melasma, Riehl’s melanosis, lichen planus pigmentosus, erythema dyschromicum perstans, and poikiloderma of Civatte. However, most of these conditions share many clinical and histopathological features in common. Sunlight exposure is one of the most common etiological factors, but application of irritant and photochemical substances also plays a role. Treatment of facial pigmentation is difficult and involves mainly the usage of various skin lightening agents acting at different levels of melanogenesis such as hydroquinone, chemical peels, and lasers. There is no universally effective specific therapy – existing agents have varying degrees of efficacy and relapses are frequent. Dermoscopy has been used mostly in the evaluation of pigmented lesions which have shown superiority over clinical examination and is of immense help to the clinicians for the appreciation of subtle features which are invisible to the naked eye.

Frontal fibrosing alopecia (FFA) is a distinctive lymphocytic scarring alopecia with rapid increase in prevalence. Most FFA series are retrospectively reported from Caucasians with only few from Asians. The objective of this study was to characterize the clinical, trichoscopic and histopathological findings as well as treatment outcomes. This was a retro-prospective cohort study of patients diagnosed with FFA from 1 January 2010 to 1 November 2019. All patients were asked to present for re-examination. Clinical, trichoscopic, histopathological and laboratory data were recorded. A questionnaire was used to investigate hair care, hairstyle and facial skin care compared with age-matched normal controls. Multivariate analysis was performed in order to clarify factors associated with severity. All 58 FFA patients were female, of whom 27.6% were premenopausal, 37.7% had a history of surgical menopause, 13.8% had thyroid diseases, 69% had eyebrow loss and 32.8% facial papules. On physical examination, 10.3% showed linear pattern, 46.6% diffuse pattern and 43.1% pseudo-fringe sign. Concomitant lichen planopilaris was found in 25.9%, lichen planus pigmentosus in 24.1% and female pattern hair loss in 48.3%. The most common trichoscopic characteristics in the frontal hairline were lack of follicular ostia (91.4%), perifollicular scales (79.3%) and perifollicular erythema (63.8%). Up to 90% of patients reported FFA as improved or stable after receiving antiandrogen (finasteride or dutasteride) or antimalarial with topical treatment. Multivariate analyses revealed that facial lentiginous macules and trichoscopic perifollicular erythema at the frontal area were FFA severity-associated factors. "Front puff" Thai hairstyle was associated with FFA, while sunscreens and other cosmetic products were not. In conclusion, diffuse and pseudo-fringe sign pattern are common in Asian FFA. The most common autoimmune systemic comorbidity is thyroid disease, while common concomitant dermatological diseases are female pattern hair loss, lichen planopilaris and lichen planus pigmentosus. Antiandrogens or antimalarial plus topical treatment are the most useful therapy.

Erythema dyschromicum perstans (EDP) is an acquired hyperpigmentation disorder characterized by asymptomatic, polycyclic, irregularly shaped light lilac-grey patches surrounded by erythematous borders in the early inflammatory stage and subsequently greyish-blue patches in the later ashy stage. Affected areas include the trunk, neck, face, and upper extremities. Mucous membranes are spared.1 EDP occurs in both children and adults, has a higher frequency noted in women, and is common among Latin American, Asian, and Indian populations.2, 3, 4 The cause remains largely unknown; however, proton pump inhibitors,5 radioactive contrast,6 hypothyroidism, vitiligo,7 and parasitic and hepatitis C infections,1 are among the associations with EDP. Histopathologic findings of EDP include vacuolar interface dermatitis and pigment incontinence.4 EDP is histopathologically indistinguishable from lichen planus pigmentosus8; however, distinct clinical characteristics separate the 2 disorders with lichen planus pigmentosus characterized by pruritic, brown-black macules and patches on the face, upper extremities, and flexures with occasional involvement of mucous membranes.1 EDP is cosmetically disfiguring and poses as a therapeutic challenge. Multiple treatments have been proposed that show inconsistent efficacy. Among these are topical steroids, tretinoin, hydroquinone, clofazimine, dapsone, lasers, and narrow-band ultraviolet light B phototherapy.4 A single case is reported each for the use of isotretinoin9 and prednisone.10 In this case series of 4 adult patients with EDP, we report that a combined treatment regimen of prednisone and isotretinoin initiated in the early inflammatory stage leads to rapid resolution of the erythematous border, arrest of progression, and clearance of the hyperpigmentation.

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.

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.

The epidermal growth factor receptor (EGFR) signaling pathway is one of the oncogenic pathways in non-small cell lung cancer. Gefitinib is classified as a first-generation EGFR-tyrosine kinase inhibitor (TKI). A variety of cutaneous adverse effects related to the drug has been reported. Cutaneous hyperpigmentation is a rare side effect of EGFR inhibitor (EGFRi). Herein, we report a 62-year-old woman with non-small cell lung carcinoma who presented with symmetrical, slate-gray-to-brownish-black macular pigmentation on sun-exposed and non-sun-exposed areas after eight months of gefitinib administration. The clinical features were consistent with lichen planus pigmentosus. This case highlights the unusual hyperpigmented condition occurring in patients taking EGFR-TKIs.

Pigmented lichen planus is a rare variant of lichen planus that is characterized by oval and round shape dark brown macules with indistinct border. Linear pigmented lichen planus is a clinical pattern of planus disease that presents unilaterally along one or more lines of blaschko. We report a 30–year-old female patient with Linear pigmented lichen planus along the lines of blaschko with mucosal involvement. Keywords: Pigmented lichen planus; Blaschko line; Mucosal involvement.

BACKGROUND Lichen planus pigmentosus (LPP) is an acquired disorder of hyperpigmentation affecting certain racial and ethnic groups. OBJECTIVE To retrospectively analyze the demographic and clinical characteristics of LPP. METHODS Clinical and demographic records of all LPP patients attending our pigmentary clinic from January 2011 to June 2018 were reviewed. RESULTS Data of 344 LPP patients (229 females) were analyzed. Affected females had significantly higher age at onset (P

Background Acquired dermal macular hyperpigmentation (ADMH) is an umbrella term including lichen planus pigmentosus, erythema dyschromicum perstans and pigmented contact/cosmetic dermatitis. Objective To establish contact sensitization to hair colours as an aetiological factor for ADMH. Methods Detailed clinical examination, skin biopsies, and patch and photo-patch testing with Indian standard series and patient's own cosmetic products were performed. Results Thirty-nine (36.1%) patients were found to demonstrate a positive patch/photo-patch test with 35/39 reacting to their own products (all were hair colours) and 16/39 reacting to antigens from commercial series (commonly paraphenylenediamine). Fourteen patients developed delayed hyperpigmentation on positive patch-test sites at 1 month. Higher mean age, symptomatic pigmentation (pruritus, burning and photosensitivity), hair margins involvement (outer surface, helix and lobule of ear; temples and preauricular area), ill-defined lesions, epidermal atrophy and epidermal melanization extending >3 layers were significantly common in patch-test-positive patients. Well-defined lesions, perioral involvement and associated lichen planus were clinical pointers towards patch-test negativity. Conclusion Index study exemplifies that patch-test results have distinct clinical and histopathological correlates in ADMH. Hair dye contact sensitization appears to be an important aetiological factor in about one-third patients presenting with ADMH.

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.

Background: Lichen planus is a chronic or sub-acute disorder characterized by small, flat-topped, shiny, erythematous or violaceous, pruritic polygonal papules most commonly involving the wrists and/or ankles in symmetric fashion. The spectrum of clinical diseases related to the lichenoid tissue reaction is getting wider with a recent increase in new subgroups of the lichenoid clinical picture. Lichen Planus contributes to the major bulk of cases of lichenoid tissue reactions. This study is designed to study the histopathology of clinical variants of lichen planus and its distribution in relation to age, sex and site of lesion. Objectives of the study: To study the histopathological features of lichen planus and its variants and clinicopathological correlation with respect to age and sex. Methods: This study was carried out over 5 years (retro and prospective) at Mahadevappa Rampure Medical College, Kalaburagi on clinically diagnosed cases of lichen planus. The tissue was fixed in 10% formalin and paraffin embedded sections were obtained for microscopic examination. Results: We studied 107 skin biopsy specimens. The variants of lichen planus received were classical lichen planus (55), hypertrophic lichen planus (27), follicular lichen planus (12), actinic lichen planus (6), isolated oral lichen planus (3), lichen planus pigmentosus (3), lichen planus pemphigoides (1). Maximum number of cases occurred in 2nd decade (29.9%). A slight female preponderance was noted (53.2%). Extremities were the most common site affected in 59 cases (55.1%). Conclusion: Lichen planus presents with varied morphology and microscopy, hence detailed clinical examination with data collection and proper histopathological examination is necessary for categorization and understanding of lichen planus and differentiation from various, diverse and perplexing lichenoid tissue reactions.

Acquired disorders of hyperpigmentation (ADOH) are a diverse group of disorders that are characterized by increased pigment in the epidermis and/or dermis. ADOH can occur in all skin types but are more pronounced and often more challenging to treat in Fitzpatrick skin types IV–VI. Acquired disorders of hyperpigmentation include melasma, postinflammatory hyperpigmentation, drug-induced pigmentary changes, periorbital hypermelanosis, and confluent and reticulated papillomatosis (an inflammatory disorder that presents with hyperpigmentation).

Lichen planus pigmentosus and lichen planopilaris are two clinically and histologically distinct forms of lichen planus. Lichen planus pigmentosus presents with sudden onset hyperpigmented macules and patches, predominantly in darker skin phototypes. On the other hand, lichen planopilaris is a scarring follicular variant of lichen planus that presents with progressive, permanent patches of alopecia. It is not uncommon for different variants of lichen planus to clinically coexist with each other. However, to our knowledge, there has been no previous reporting of linear lichen planus pigmentosus of the face with histological features of lichen planopilaris. We herein present a hybrid case of these two entities.

Disorders of pigmentation, both hyper- and hypopigmentation, are common entities encountered in dermatology. They can be caused by a variety of underlying systemic diseases and infections, as well as present as primary cutaneous disorders and secondary to injury or trauma. Contributing factors leading to both types of pigmentary alterations include both an effect on melanocytes and the activity and rate of melanin production. The most common disorders of hypopigmentation that will be discussed in this chapter include post-inflammatory hypopigmentation, hypopigmented mycosis fungoides, pityriasis alba, tinea versicolor, progressive macular hypomelanosis, idiopathic guttate hypomelanosis, and vitiligo. Hyperpigmentation disorders to be discussed include post-inflammatory hyperpigmentation, melasma, lichen planus pigmentosus, erythema dyschromicum perstans, and drug-induced and metabolic conditions causing hyperpigmentation.

Frontal Fibrosing Alopecia (FFA) is a chronic lymphocytic cicatricial alopecia that usually involves the fronto-temporal hairline and the eyebrows in women but other presentations such as involvement of the sideburns, occipital scalp, eyelashes and body hair are also possible. Further, its presentation comes in typical and atypical patterns. FFA can be associated with lichen planus pigmentosus, facial papules, red dots, prominent veins, and increases preauricular wrinkles. It is of unknown etiology and there is no cure. Recent works have suggested association with leave in cosmetic products such as sunscreens, and possible sensitization due to cosmetic ingredients. Histopathologic and trichoscopic findings are the mainstay in obtaining an accurate diagnosis. Treatment and prognosis vary depending on severity at presentation, however, reduced progression with treatment has been demonstrated in most patients within a year.

Inflammatory skin conditions are common in all ages and races. These disorders can be disfiguring and cause great discomfort, leading to a negative impact on the patient’s quality of life. Inflammatory conditions can present atypically in skin of color. In darker skin, psoriasis plaques may be violaceous with gray scale, and erythema is sometimes difficult to appreciate. In skin of color, the classic purple color of lichen planus may be black, gray, brown, or violaceous. Lichen planus actinicus and lichen planus pigmentosus are variants that are more common in darker skin. Atypical forms of pityriasis rosea present more commonly in skin of color, including papular pityriasis rosea, and involvement of the face, scalp, and mouth. There is a higher incidence of sarcoidosis in African Americans compared to Caucasians, and African Americans seemed to be diagnosed at an earlier age and have more severe disease. If untreated, inflammatory conditions in patients with skin of color can lead to post-inflammatory hyperpigmentation, which can be very difficult to treat.

This chapter is a compilation of a few uncommon, hyperpigmented enigmatic dermatoses of unclear etiology that are difficult to diagnose and treat. They include lichen planus pigmentosus, erythema dyschromicum perstans, ashy dermatosis, idiopathic eruptive macular pigmentation, and acquired brachial cutaneous dyschromatosis. Most of them are more prevalent in Latin America or India as they usually involve patients with Fitzpatrick skin type IV and V. These dermatoses when present in dark-skinned population have a tremendous psychological impact and are often a sociocultural setback for the patients because pigmentary dermatoses are a bane of the colored population. As a result, they desperately seek treatment ranging from self-treatment with steroid-containing creams to home remedies to treatments offered by general practitioners, many of whom are not even qualified to treat. The financial impact of these treatments is significant as well as the impact on the quality of life due to the chronic nature of these diseases. Also, many of these conditions are mired in taxonomical confusion due to their similarity on several counts.

Lichen planus pigmentosus is a rare variant of classic lichen planus that most commonly affects Fitzpatrick skin phototype III to VI.1,2 The coexistence of lichen planus pigmentosus and frontal fibrosing alopecia (FFA) was first described by Dlova.3,4 In this work we studied lichen planus pigmentosus in female patients with cicatricial alopecia and defined clinical, dermoscopic and histopathological features related to this diagnosis.

Dermatoscopy is a non-invasive, handy tool, which is increasingly being used in diagnosis and prognostication of pigmentary dermatoses. Dermatoscopic changes in pigmentary pattern, scaling, and vasculature help us to differentiate among the myriad of hypo and hyper pigmentary diseases. This review gives a brief overview of the dermatoscopic features of pigmentary diseases, which are commonly encountered in clinical practice. We also provide a diagnostic approach based on salient dermatoscopic features.

The persistent discoloration in lichen planus pigmentosus (LPP) is secondary to persistent melanophages in the superficial dermis in these patients. We evaluated the effect of Q-switched Nd-YAG laser on the clinical, pigmentary, and immunological markers in patients with LPP. Nine females with a clinical diagnosis of LPP were included in the study. After six sessions of laser with toning protocol, performed over a representative area of 5 × 5 cm2 at 2-weekly intervals, the mean clinical improvement as per the physician assessment was 25.7% (10-40%). There was no significant reduction in melanin and erythema index. On expression analysis using quantitative-polymerase chain reaction, the reduction in tyrosinase (p = 0.03) was statistically significant, though, the reduction in other pigment and immunological markers was not significant. The immunohistochemistry quantification data of corresponding proteins also did not show any significant difference. Post inflammatory hypopigmentation was noted in one patient. Q-switched Nd-YAG laser toning protocol resulted in modest clinical and histological improvement in patients of LPP.

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.

Riehl melanosis (RM) is a form of pigmented contact dermatitis that often poses a diagnostic challenge due to overlaps in its clinical, dermoscopic, and histopathological features with other pigmentary disorders. This report highlights significant findings and the proper approach for diagnosis. We present the case of a 47-year-old female with progressive facial hyperpigmentation (irregular, blotchy, grayish patches on the forehead, cheeks, and around the mouth) that acknowledged applying a lightening product before her complaint. Dermoscopy revealed brownish-gray dots and pseudonetwork pigmentation. The histopathological findings were comprised of hypergranulosis, interface dermatitis, and pigment incontinence. The patient's history and clinical, dermoscopic, and histopathological examination results showed features consistent with-but not exclusive to-RM, such that it was not possible to rule out lichen planus pigmentosus (LPP) and ashy dermatosis (AD). We finally diagnosed the patient with RM and treated her with medications consisting of alpha hydroxy acid, tretinoin, hydroquinone, and sunscreen. Patch testing might help because higher positivity rates were found in RM patients compared to LPP and AD. However, positive patch testing favors RM, and, regardless of diagnosis, provides a basis for substance avoidance in the treatment plan.

No data are available in the literature about lichen planus (LP) and psoriasis in migrants. All clinical presentations of LP may be observed in patients with pigmented skin, including children; however, some clinical varieties of lichen, such as actinic LP and LP pigmentosus, occur more often in patients with dark skin.

Background: Various facial and extrafacial lesions have been reported in frontal fibrosing alopecia (FFA). Facial papules have been associated with worse prognosis. Objectives: We sought to detect the prevalence of facial and extrafacial lesions and to analyze their relation to demographic and clinical variables in a large and ethnically diverse series of patients with FFA. Methods: Charts of patients diagnosed with FFA between January 1, 2015, and December 31, 2017, at the Department of Dermatology, University of Miami, were reviewed retrospectively. Results: 91 patients (87 women and 4 men) met inclusion criteria: 45% (n = 41) were of Hispanic/Latino ethnicity, and 34% (n = 30) were premenopausal. Facial papules were most commonly detected (41% among Hispanic/Latino patients). Significant associations were found between: (1) Hispanic/Latino ethnicity and any FFA-associated facial lesions, facial papules alone, or lichen planus pigmentosus alone, as well as premenopausal status; (2) any FFA-associated facial lesions or facial papules alone and premenopausal status; and (3) Hispanic/Latino ethnicity and simultaneous presence of facial and extrafacial lesions. Conclusions: There is a significant association among Hispanic/Latino ethnicity, facial papules, and premenopausal status, which may portend a susceptibility to severer disease and prompt early and aggressive treatment in this group.

Background Frontal fibrosing alopecia (FFA) is a chronic cicatricial alopecia with an increasing incidence and unknown aetiology. Aim To identify possible environmental and hormonal factors related to FFA. Methods We conducted a multicentre case-control study paired by sex and age, and recruited 664 women (335 cases and 329 controls) and 106 men (20 cases and 86 controls). Study subjects completed an exhaustive questionnaire enquiring about pharmacological, environmental, hormonal, social, job exposure, lifestyle, drugs and diet factors to which they were exposed at least 5 years prior to the onset of the disease. Results For women, there was a statistical association between alopecia and history of pregnancy (OR = 1.6; 95% CI 1.06-2.41), use of facial sunscreen (OR = 1.6; 95% CI 1.06-2.41) and hormone replacement therapy (HRT) (OR = 1.76; 95% CI 1.11-2.8) or raloxifene (no controls exposed therefore OR was not calculated), exposure to alkylphenolic compounds (OR = 1.48; 95% CI 1.05-2.08), and presence of rosacea (OR = 1.91; 95% CI 1.07-3.39), lichen planus pigmentosus (LPP) (OR = 5.14; 95% CI 1.11-23.6) or hypothyroidism (OR = 1.73; 95% CI 1.11-2.69). For men, there was a statistical association between alopecia and use of facial sunscreens (OR = 11.6; 95% CI 1.7-80.9) or antiageing creams (OR = 1.84; 95% CI 1.04-3.23). Conclusions FFA seems to be associated with hormonal exposure (pregnancy, HRT and raloxifene), comorbidities (hypothyroidism, LPP and rosacea) and environmental factors (facial sunscreens, antiageing creams and occupational exposure). Further research is required to analyse the exact mechanism in which these environmental factors participate in the development of this alopecia.

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.

Lichen planus pigmentosus (LPP) is a rare disease characterized by persistent and asymptomatic slate-grey pigmentation, which mostly affects patients with skin types IV-VI. The face and neck are the most commonly involved sites, followed by the trunk and extremities. LPP is believed to spare the palms, soles and nails. In this report, we describe palmoplantar involvement in 10 (4.65%, 10/215) patients with LPP, and compare its clinicodemographic features with those of classic LPP. LPP lesions on the palms and soles present as asymptomatic, well-circumscribed, hyperpigmented, brown-black patches without any history of prior lichen planus lesions. They are mostly observed in young patients with rapidly spreading active disease, who often require systemic treatment to control the disease activity. Strikingly, palmoplantar involvement is frequently associated with other atypical LPP variants. It is important to identify palmoplantar involvement in LPP, as it has a different clinical course and associations compared with classic LPP.

Dermoscopy is a helpful non invasive bedside technique in clinical dermatology practice which allows us to make a quick and accurate diagnosis of many complicated and atypical skin diseases. Hence its acquaintance is imperative for all the dermatologists. The aim of this article is to make the science of dermoscopy lucid and easy. This article is intended to highlight the common signs in dermoscopy which will foster the usage of dermatoscope in regular cutaneous examination. The conditions discussed in this review article are psoriasis vulgaris, lichen planus, lichen planus pigmentosus, vitiligo, pityriasis versicolor, eczema, pityriasis rosea, melasma seborrheic keratosis, discoid lupus erythematosus ,prurigo nodularis, lupus vulgaris, alopecia areata , nevus sebaceous, dermatofibroma, pigmented purpuric dermatosis and cutaneous small vessel vasculitis.

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.

Background: Lichen planus (LP) is a common papulosquamous condition seen by the dermatologists. It can involve the skin, mucous mebranes, hair and nails. There are many subtypes of LP with various clinical, histopathological and dermoscopic features. In this study we intended to study the epidemiological, clinical, histopathological and dermoscopic features of LP.Methods: A total of 73 patients of LP, above the age of 18 years who qualified the inclusion and exclusion criteria were included in the study. A proforma of epidemiological details was noted, clinical and dermoscopic examination of the lesions were done. The punch biopsy specimens of cutaneous lesions were subjected to histopathological examination and the findings noted.Results: Out of the 73 patients included in the study, 44 were males and 29 females with a ratio of 1.51:1. Classic LP was the commonest type of LP. Wickham’s striae (WS) was the most typical and commonest dermoscopic feature of cutaneous LP except lichen planus pigmentosus. Hyperkeratosis, hypergranulosis, acanthosis, band shaped lymphocytic infiltrate, melanophages, basal cell degeneration and saw tooth shaped rete ridges were the significant histopathological features.Conclusions: LP is more common in young adults and shows a male preponderance. WS is the most important diagnostic feature seen on dermoscopy of all the cutaneous types of LP excluding LPP. Interface dermatitis with a band of lymphocytic infiltrates and dermal melanophages is a notable feature of histopathology of LP.

Lichen planus pigmentosus (LPP) is considered a rare variant of lichen planus (LP). It is characterized by acquired dark brown to gray macular pigmentation located on sun-exposed areas of the face, neck, and flexures, commonly found in dark-skinned patients. In patients with LPP, an inflammatory lichenoid response results in marked pigmentary incontinence. It has been associated with hepatitis C virus, sun exposure, and contactants such as mustard oil and nickel. LPP-inversus affects fair and dark skin, predominantly involving flexural and intertriginous areas, while sun-exposed areas are spared; friction is an associated trigger. LPP along Blaschko's lines has been associated with susceptibility to genetic mosaicisms. LPP can present concomitantly with other variants of LP such as frontal fibrosing alopecia, as well as endocrinopathies, and autoimmune diseases. Treatment is difficult and consists of avoidance of triggers and topical and systemic medications in order to stop the inflammatory reaction and reduce pigmentation, improving aesthetic appearance and quality of life.

Lichen planus pigmentosus is uncommon in childhood and its treatment is often challenging. We report a case of cutaneous lichen planus pigmentosus in a 10-year-old boy, without oral mucosal involvement, two months after an amalgam dental restoration. The diagnosis was based on the histopathological examination of a skin biopsy, the positive patch test to mercury, and the improvement after amalgam removal. Our case report suggests that metal allergy may play a role, and amalgam replacement may be followed by clinical improvement.