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Lichen planus pigmentosus inversus (LPPI) is a rare subvariant of Lichen planus pigmentosus (LPP), presenting with sharply defined brown to gray macules, papules, and plaques limited to the intertriginous areas, with only a few cases reported in the medical literature so far. While LPP mostly affects patients with Fitzpatrick skin type III–IV in sun-exposed areas such as the neck, LPPI is seen in Caucasians and spares sun-exposed areas. Skin lesions tend to be very refractory to treatment attempts including potent topical steroids and oral corticosteroids. Given the increased penetration of potent topical steroids and the high risk of skin atrophy, especially when applied to intertriginous areas, this case shows that topical calcineurin inhibitors (tacrolimus 0.1%) might offer an effective and safe treatment option for LPPI.

Lichen planus pigmentosus-inversus (LPP-inversus) is a rare, pigmented variant of lichen planus of unknown etiology. This skin condition typically affects the intertriginous and flexural regions of the body bilaterally. We report an unusual case presentation with unilateral distribution of LPP-inversus in a woman originally from Nepal. The lesions developed rapidly over a three-month period and were recalcitrant to therapy with topical clobetasol and hydroquinone.

Lichen planus pigmentosus (LPP) is an inflammatory dermatosis with an unknown etiology characterized by dark brown-black macules, papules and patches. LPP is considered as a rare variant of lichen planus (LP), but it differs from the LP by the absence of nail and oral area involvement and pruritus. LPP is most common on sun-exposed areas and less frequently seen in the axilla, inguinal or submammary regions. In the literature, very few cases have been reported to be associated with LPP. Herein, we reported two cases with LPP accompanied by ankylosing spondylitis and high levels of adrenocorticotropic hormone along with diabetes mellitus.

Lichen planus pigmentosus (LPP)-inversus has been identified in a few East European cases primarily intertriginous areas such as axilla and groin which is not contacting with sunlight, and involvement in other skin areas was rarely detected. Because the lesions are similar to LPP in clinical and histological appearance, this condition, which is characterized by hyperpigmented, brown macules or plaques, is called LPP-inversus. Until today, actinic LP, linear LP, zosteriform, and LP pigmentosus clinical subtypes of lichen planus have been described. LPP-inversus is a rare form of LP and so far, there have been few case reports. LPP-inversus has been reported mostly in Caucasians and Asians, and axilla was the most involved body region. In a small proportion (approximately 10%) of the cases, classical LP or LPP lesions may be located outside the flexural areas. So far, about 50 cases have been reported; also we presented two new cases that we diagnosed. Liken planus pigmentosus (LPP)-inversus Doğu Avrupalı birkaç olguda primer olarak aksilla ve kasık gibi güneş görmeyen intertriginöz alanlarda tanımlanmış olup, diğer deri bölgelerinde tutulum ise nadiren saptanmıştır. Lezyonlar klinik ve histolojik görünüm olarak LPP’ye benzediğinden dolayı, hiperpigmente, kahverengi makül veya plaklarla karakterize bu durum LPP-inversus olarak adlandırılmıştır. Liken planusun günümüze kadar aktinik LP, lineer LP, zosteriform, LP pigmentosus klinik alt tipleri tanımlanmıştır. LPP-inversus; LP’nin nadir bir formudur ve çok az vaka bildirimi olmuştur. Beyaz ırk ve Asyalılarda en fazla bildirilmiş olup aksilla olgularda en fazla tutulan bölge olmuştur. Olguların az bir kısmında (yaklaşık %10) klasik LP veya LPP lezyonları fleksural alanların dışında bulunabilmektedir. Şu ana kadar yaklaşık 50 olgu bildirimi olmuştur; biz de tanı koyduğumuz iki yeni olguyu sunmayı uygun bulduk.

Lichen planus pigmentosus-inversus (LPP-inversus) which is an uncommon variant of lichen planus, is characterized by well bordered hyperpigmented macules and patches involving intertriginous areas. Since it was first defined, very few cases have been reported worldwide. Herein we report eight new patients with characteristic features of LPP-inversus. The hyperpigmented lesions of our patients were mostly located on axilla and the inguinal region. Two patients also had lesions that were clinically consistent with classic lichen planus. Three patients had lesions with unilateral distribution. In all of the cases a skin biopsy was performed to confirm the clinical diagnosis of LPP-inversus. LPP-inversus is a disease with unique clinical and histopathological features that we should bear in mind in the differential diagnosis of hyperpigmented flexural lesions. The etiopathogenesis and the treatment strategy of this rare entity need to be clarified.

Lichen planus pigmentosus-inversus is a rare variant of lichen planus pigmentosus. The eruption of lichen planus pigmentosus-inversus occurs mainly in the flexural regions and presents with brownish macules and patches. Here we describe three cases of woman who presented with hyperpigmented lesions at the different body folds. Physical examination revealed multiple brownish macules and patches on the intertriginous area without pruritis, and histologic findings showed a regressive pattern of lichen planus. These clinical and histological findings were consistent with a diagnosis of lichen planus pigmentosus-inversus.

A 35-year-old man was referred to our hospital with a 3 months history of itchy cutaneous eruption on the trunk and asymptomatic cutaneous eruption on both groins. Physical examination revealed several, purplish-brown, scaly papules on the trunk and well-circumscribed, brown patchs in a linear distribution, on the bilateral inguinal regions. Dermoscopic examination of papules on the trunk revealed white crossing lines surrounded by brown dots; dermoscopic examination of patchs on groins revealed gray-brown dots and globules. According to histological, dermoscopical and clinical changes, the diagnoses of classical lichen planus (LP) for the lesions on the trunk; and lichen planus pigmentosus inversus (LPPI) for the lesions on the inguinal regions were made. Inhere we have described a rare case of LPPI and classical LP with dermoscopic features; and we suggest that LPPI is a variant of classical LP.

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 examination 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.

We present an interesting case of a patient who had a 5-month history of insidiously developing pigmented macules along skin cleavage lines over the skin of submammary and inguinal folds. There was no history of previous medication. Skin examination revealed multiple discrete and slate-grey macules distributed over the skin cleavage lines of the submammary and inguinal folds. These lesions did not coalesce, forming several, intermittent and brownish lines. Pathologically, it showed atrophic epidermis with foci of colloid bodies. A dense lymphocytic infiltration along with prominent melanophages was noticeable in the superficial dermis. The patient was diagnosed with lichen planus pigmentosus-inversus following skin cleavage lines.

Lichen planus pigmentosus-inversus is rare with only twenty patients (including our patient) formally described in the literature. The reported twenty patients with lichen planus pigmentosus-inversus include eight men and twelve women with ages ranging from 25–84 years (average age of 55.3). Twelve were Caucasian, five were Asian, one was Hispanic and two were of unknown ethnicity. Seventeen out of twenty patients had lesions in the axillae and mild pruritus was present in eight patients. Our patient is the first patient reported to have post-auricular sulcus involvement.

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.

Lichen planus pigmentosus-inversus is a rare variant of lichen planus pigmentosus. The eruption of lichen planus pigmentosus-inversus occurs mainly in the flexural regions and presents with brownish macules and patches. Here we describe the case of a 31-year-old Korean woman who presented with hyperpigmented lesions over her antecubital and popliteal area and groin. Physical examination revealed multiple brownish macules and patches on the intertriginous area without pruritis, and histologic findings showed a regressive pattern of lichen planus. These clinical and histological findings were consistent with a diagnosis of lichen planus pigmentosus-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.