Search

Blepharochalasis syndrome is a condition of the eyelids consisting of episodic inflammation and chronic skin changes. It is usually bilateral and tends to manifest in the upper eyelids. But, there are cases of unilateral presentation also which exclusively affects the lower eyelids. There are multiple theories regarding the etiology of blepharochalasis. Blepharochalasis is believed to be a manifestation of angioneurotic edema. Hormonal changes may play an important role in the disease process. Immunohistochemical analysis of excised eyelid skin has demonstrated the presence of IgA in several studies. These findings suggest that there may be a concomitant inflammatory process accompanying the extravasations’ of fluid and localized edema occurring at the capillary level. Blepharochalasis might also present as part of systemic disease. The disease, lichen planus pigmentosus, is a variant of lichen planus and has also been noted the presence of IgA and IgG along with complement C3 in the epidermal cells in several studies.

Lichen Planus Pigmentosus (LPP) is an uncommon variant of lichen planus characterized by the development of dark greyish-brown macules and patches primarily affecting sun-exposed areas. Histologically, it presents with lichenoid interface dermatitis with many melanophages. In select cases, the presence of melanocytic nests or pseudomelanocytic nests within LPP lesions has been documented, posing a diagnostic challenge. We present a detailed case report of a 32-year-old Eritrean woman with a longstanding history of hyperpigmented macules, alongside an in-depth review of the existing literature on lichenoid dermatoses featuring melanocytic or pseudomelanocytic nests. This paper delves into the clinical presentation, histopathological features, differential diagnosis, and potential mechanisms underlying this intriguing phenomenon.

Idiopathic Eruptive Macular Pigmentation (IEMP) is an uncommon and possibly underdiagnosed dermatosis. It manifests as asymptomatic pigmented macules over the face, trunk and proximal extremities among children and adolescents. Degos et al. first documented this condition in 1978, unveiling its distinct characteristics. The macules, initially dark brown-black, naturally diminish over several months to years, with no lasting pigmentation or scarring. In this report, we highlight the case of a 14-year-old girl displaying all the distinctive traits of IEMP.

Lichen Planus Pigmentosus (LPP) is an uncommon variant of lichen planus characterized by the development of dark greyish-brown macules and patches primarily affecting sun-exposed areas. Histologically, it presents with lichenoid interface dermatitis with many melanophages. In select cases, the presence of melanocytic nests or pseudomelanocytic nests within LPP lesions has been documented, posing a diagnostic challenge. We present a detailed case report of a 32-year-old Eritrean woman with a longstanding history of hyperpigmented macules, alongside an in-depth review of the existing literature on lichenoid dermatoses featuring melanocytic or pseudomelanocytic nests. This paper delves into the clinical presentation, histopathological features, differential diagnosis, and potential mechanisms underlying this intriguing phenomenon. [ABSTRACT FROM AUTHOR]

Lichen planus pigmentosus (LPP) is a distinctive variant of lichen planus described for the first time in 1974. A wide range of presentations and distribution patterns have been reported, mainly presenting as dark brown hyperpigmented macules and patches, typically involving sun-exposed areas such as the face, neck, and flexural folds. It is more common in dark-skinned patients with a female predominance. Infrequently, LPP may present as a Blaschkoid distribution, with only a few cases reported in the medical literature. We report an unusual case of LPP that developed with a unilateral Blaschkoid distribution on the left side of the trunk in a 32-year-old female following weight reduction surgery.

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.

Lichen planus pigmentosus is a macular variant of lichen planus commonly affecting photo-exposed areas. A 45-year-old female presented with asymptomatic blackish pigmentation on the both naso-labial folds, alar grooves, angle of mouth, lower lip, medial canthus, and eyelids since 8 years. Dermoscopy of these pigmented lesions revealed non-uniform accentuation of pseudoreticular pattern with dark brown dots and globules in arcuate and incomplete reticular fashion suggestive of lichen planus pigmentosus. Biopsy from the lesion showed perivascular infiltrate with heavily pigmented melanophages in the upper dermis. Based on clinico-pathological correlation and dermoscopic features, diagnosis of lichen planus pigmentosus was made.

Background: Facial melanosis is a common clinical problem and results in impaired quality of life. Aims: The aim of the study was to compare the quality of life in female patients suffering from melasma and nonmelasma facial melanosis (NMFM) using melasma quality of life (MELASQOL) and dermatology life quality index (DLQI). Methods: It was a prospective cross-sectional study conducted in a dermatology outpatient department of tertiary care center. Modified melasma area severity index (mMASI), MELASQOL, and DLQI were calculated in female patients meeting inclusion criteria of the study. The statistical analysis was performed using statistical package for social sciences (SPSS version 20; Chicago, IL, USA). Categorical data are presented as number with percentage and continuous data as mean with standard deviation. Quantitative data were compared using independent t test and categorical data using Chi-square test. All statistical tests were two sided and were performed at a significance level of α = 0.05. Results: A total of 119 patients were included in the study and consisting of 50 (42%) patients with melasma and 69 (58%) patients with NMFM. The impairment of quality of life was more in NMFM when compared with melasma group. The severity of pigmentation (mMASI) did not show any significant correlation with MELASQOL or DLQI in either of the groups. There was strong correlation between DLQI and MELASQL (Spearman rho = 0.886; P < 0.001). Conclusion: Facial melanosis impacts quality of life adversely. The impact of NMFM is more when compared with melasma. MELASQOL and DLQI should be performed in these patients to understand true impact of these diseases on quality of life. [ABSTRACT FROM AUTHOR]

Abstract A provisional diagnosis of urticaria pigmentosa was revised to lichen planus pigmentosus with dermatographism, after histopathologic examination of specimen from hyperpigmented patch. It is important to keep differential diagnosis of inducible wheals while making a diagnosis.

A provisional diagnosis of urticaria pigmentosa was revised to lichen planus pigmentosus with dermatographism, after histopathologic examination of specimen from hyperpigmented patch. It is important to keep differential diagnosis of inducible wheals while making a diagnosis. [ABSTRACT FROM AUTHOR]

Ashy dermatosis is characterized by asymptomatic, symmetrically-distributed, gray-colored macules located on the trunk, neck, face, and upper extremities. The condition occurs most commonly in patients with Fitzpatrick phototype III-V skin. The etiology is unknown, but drug ingestion, infection, and genetic factors have been suggested to elicit ashy dermatosis. No gold standard treatments have been established yet. The most successful treatment to date has been clofazimine, although topical tacrolimus, oral dapsone, narrowband ultraviolet light B phototherapy, and isotretinoin have shown treatment success. Ashy dermatosis is primarily a cosmetic concern, but can be a very distressing condition, especially for dark skinned individuals. Therefore, an increase in clinician awareness and more studies are needed to further understand the etiology and treatment options for this disease. This review serves as a single source for clinicians to stay up-to-date regarding the history, clinical presentation, histology, pathogenesis, differential diagnosis, and management options for ashy dermatosis. It also suggests an alternative name that more appropriately encompasses the clinical and histopathologic features, while acknowledging our lack of understanding of its etiology: macular hyperpigmentation of indeterminate etiology.

Lichen planus pigmentosus (LPP) is a rare chronic variant of lichen planus (LP). The distribution of LPP tends to be symmetric and frequently seen on the face, neck, and truck. Atypical clinical patterns of LPP including segmental, zosteriform and linear were reported in the literature. Herein, we report here a rare presentation of LPP in a 16-year-old female with a unilateral linear pattern along the blascko lines.

Introduction: The two less-known subtypes of lichen planus (LP) are lichen planus actinicus (LPA) and lichen planus pigmentosus (LPP), with the highest prevalence in the Middle East. Objectives: We aimed to evaluate the clinicopathological profile of these patients. Methods: 307 cases including 184 LPA and 123 LPP patients were recruited from the registered pathology reports of Razi Skin Hospital of Tehran from April 2016 to March 2021. The clinical features and pathological reports were extracted and analyzed. Results: Among 307 patients, 117 (63.9%) in the LPA group and 88 (71.5%) in the LPP group were women. Duration of disease ranged from 1 month to 20 years and 1 month to 12 years in the LPA and LPP groups, respectively. Face (159 patients), limbs (68), and neck (23) were the most frequent sites of involvement in LPA patients, whereas face (60 patients), limbs (47), and trunk (42) were more commonly involved in the LPP patients. Pruritus and oral mucosal lesions were found with similar frequency in both groups. Pathological evaluation showed vacuolar degeneration of basal layer (100%), lymphocytes infiltration (97.3%), and melanin incontinence (58.2%) as the most frequent findings in LPA and vacuolar degeneration of basal layer (100%), lymphocytes infiltration (100%), and melanin incontinence (52/8%) as the most frequent findings in LPP cases.Conclusion: LPA and LPP were both more prevalent among women. Face was the most common site of involvement in both LPA and LPP. Vacuolar degeneration, lymphocyte infiltration, melanin incontinence, and hyperkeratosis were more common histological findings in this study.

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. [ABSTRACT FROM AUTHOR]

Lichen planus pigmentosus is a macular variant of lichen planus commonly affecting photo-exposed areas. A 45-year-old female presented with asymptomatic blackish pigmentation on the both naso-labial folds, alar grooves, angle of mouth, lower lip, medial canthus, and eyelids since 8 years. Dermoscopy of these pigmented lesions revealed non-uniform accentuation of pseudoreticular pattern with dark brown dots and globules in arcuate and incomplete reticular fashion suggestive of lichen planus pigmentosus. Biopsy from the lesion showed perivascular infiltrate with heavily pigmented melanophages in the upper dermis. Based on clinico-pathological correlation and dermoscopic features, diagnosis of lichen planus pigmentosus was made. [ABSTRACT FROM AUTHOR]

Graham-Little-Piccardi-Lassueur syndrome is a rare variant of lichen planopilaris. It is characterized by multifocal, patchy, cicatricial alopecia of the scalp, noncicatricial alopecia of axilla and pubic region, and keratotic follicular papules involving the trunk and extremities. Trichoscopy shows perifollicular erythema, tubular perifollicular scales, fibrotic white dots, and hair casts along the hair shafts. We are reporting this rare syndrome in a 26-year-old pregnant woman with concomitant oral lichen planus and lichen planus pigmentosus. This case is unique as no previous report of coexistence of these variants of lichen planus has been published.

Lichen planus pigmentosus (LPP) is an uncommon variant of lichen planus of unclear etiology that predominantly affects patients of skin types III to VI. We report a case of LPP of two years duration in a 67-year-old man involving upper extremities, chest, abdomen, and upper back.

Competing Interests: Dr Ko is an investigator and/or consultant for Pfizer, Eli Lilly, and AbbVie. Drs Bandali, Voller, and Kibbi have no conflicts of interest to declare.

Idiopathic Eruptive Macular Pigmentation (IEMP) is an uncommon and possibly underdiagnosed dermatosis. It manifests as asymptomatic pigmented macules over the face, trunk and proximal extremities among children and adolescents. Degos et al. first documented this condition in 1978, unveiling its distinct characteristics. The macules, initially dark brown-black, naturally diminish over several months to years, with no lasting pigmentation or scarring. In this report, we highlight the case of a 14-year-old girl displaying all the distinctive traits of IEMP. [ABSTRACT FROM AUTHOR]

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 is a pigmentary disorder of unknown etiology, with diffuse hyperpigmentation of sun-exposed areas, more commonly seen in some ethnic and racial groups. We report an unusual case of lichen planus pigmentosus in a 40-year-old man with Fizpatrick type III skin that was present in a blaschkoid distribution on the trunk, a distribution that has been rarely reported. This unique presentation of lichen planus pigmentosus may contribute to better understanding of the etiology, as the blaschkoid distribution may reflect underlying cutaneous mosaicism that renders those cells more susceptible to an insult that results in lichen planus pigmentosus. This disorder should be considered in the differential diagnosis of macular hyperpigmentation, especially in those from more commonly affected ethnic and racial groups, even when the distribution is atypical and in the absence of history of sun exposure.

Lichen planus pigmentosus is characterized by slaty-gray pigmentation, predominantly on sun-exposed sites. It is considered to be a type IV hypersensitivity reaction to unknown antigen with lichenoid inflammation which may lead to melanin incontinence and superficial dermal pigmentation. This report presents a rare case of lichen planus pigmentosus caused due to tamoxifen intake.

Background: Thyroid abnormalities are a well-documented endocrine association seen in numerous dermatological conditions. However, there are few Indian studies analyzing the thyroid status in various dermatoses. Materials and Methods: This cross-sectional, observational study was conducted on 805 willing patients with various dermatoses, irrespective of the disease classification. Serum samples were taken and assayed for triiodothyronine (T3), thyroxine (T4 ), and thyroid-stimulating hormone (TSH). Results: Out of the 805 patients, 14.2% (n = 115) had abnormal thyroid function. Hypothyroidism accounted for 86.1% (n = 99) and hyperthyroidism for 13.9% (n = 16). Among the 99 hypothyroid patients, 23.2% (n = 23) had overt hypothyroidism while 76.8% (n = 76) had subclinical hypothyroidism. Vitiligo accounted for 36.1% (n = 291) of the patients, among which 12.3% (n = 36) had thyroid dysfunction involving six hypothyroid and three hyperthyroid cases. Out of 58 cases of melasma, 15 (25.8%) had abnormal thyroid function. Among the twenty patients with lichen planus pigmentosus, five had abnormal thyroid levels. Conclusion: This study demonstrates a strong association of thyroid disorders in certain conditions, such as vitiligo, alopecia areata, diffuse hair loss, dry skin, chronic urticaria, and melasma. Thus, the inclusion of thyroid function tests in routine investigations of these conditions would be helpful. [ABSTRACT FROM AUTHOR]

Background: Facial pigmentation includes various entities such as melasma, lichen planus pigmentosus (LPP), and pigmented contact dermatitis. The pathogenesis may involve certain allergens, which may be responsible for causing a disturbance in the dermoepidermal junction. The elimination of such inciting allergens may aid in the successful treatment of these patients. Objective: The aim was to detect contact allergens with patch and photopatch testing in facial pigmentary disorders. Methods: Fifty patients with facial pigmentary disorders were enrolled. After taking a demographic profile and detailed clinical history and performing an examination, patch and photopatch testing was done using a common suspected allergen series. Results: Out of the fifty patients tested, 28 (56%) showed a positive patch test, while 2 (4%) showed a positive photopatch test. The most common allergen found was a fragrance mix in 17 (34%) patients, followed by paraphenylenediamine (PPD) in 11 (22%). Other allergens showing positivity were nickel sulfate, benzocaine, parthenium, benzophenone-3, octyl methoxycinnamate, etc. Conclusion: Patients with facial pigmentation may have an underlying component of contact dermatitis, which may be a causative or aggravating factor. The avoidance of these allergens may help in increasing the efficacy of treatment in these patients. [ABSTRACT FROM AUTHOR]

Background: Paucity of literature and non consensus on clinicohistopathological features amongst the nonmelasma facial melanosis for example lichen planus pigmentosus (LPP), pigmented contact dermatitis (PCD), macular amyloidosis, acanthosis nigricans, pigmented demarcation line, post inflammatory hyperpigmentation, etc., make them difficult to diagnose and equally challenging to treat. Materials and Methods: It was a prospective, uncontrolled study, conducted at tertiary hospital at eastern India in 100 patients presenting with facial hyperpigmentation who agreed to undergo 3 mm skin biopsy during Jan 2014 to Jun 2015. Cases of melasma were excluded by clinical, Woods lamp examination and if required dermoscopy. Details of history, physical examination, histopathological examination, and Immunohistochemical studies were recorded. Melan A was used as melanocytic differentiation marker while CD4, CD8 were used as inflammatory markers. Mean ± SD, chi-square test or Fisher’s exact test, degree of agreement by Cohen’s Kappa were calculated. P-value was considered significant if ≤0.05. Results: 44 males and 56 females (56%) (M: F=1:1.24) with mean age of 45.98 years and median duration of illness of 28 months (5 months-13 years) were studied. Out of 43 confirmed cases of PCD, 16 had associated hypothyroidism (chi square 6.11, P-value 0.0134). Maximum patients belonged PCD (n = 47) followed by LPP (n = 27). Maximum concordance of clinical and histopathological diagnosis was present in PCD and LPP (Cohen kappa more than 0.9). Epidermal atrophy and band like inflammatory infiltrate were statistically significant features in LPP (P < 0.001). There was no histopathological and immunohistochemical correlation. Overall, clinical histopathological concordance rate was 77%. Conclusion: Subset of nonmelasma facial melanosis is difficult to diagnose clinically which require further confirmation by histopathological examination. Small number of patients in other groups apart from PCD and LPP and uncontrolled study were major limitations of this study.

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.

Background: Pigmented contact dermatitis (PCD) is a non-eczematoid variant of contact dermatitis, mainly characterised by hyperpigmentation. It occurs due to contact with a low amount of allergen over a long duration of time. PCD is frequently seen in Indians but is often misdiagnosed or underdiagnosed because of the asymptomatic nature of the entity. The aetiology and the allergens implicated in PCD in the Indian subcontinent is still an enigma because of the limited studies done. Materials and Methods: This was an institution-based cross-sectional study, done at a tertiary hospital. Patch testing with Indian Cosmetic Series was conducted in a standardised method. Readings were taken at 48 hrs/72 hrs and on the 7th day [Figure 2]a and [Figure 2]b. The International Contact Dermatitis Research Group (ICDRG) scoring system was used to grade the readings. Results: Out of the 38 biopsy proven cases of PCD, 18 (47%) showed lichenoid features, 17 (45%) showed spongiotic features, 3 (8%) showed a mixed lichenoid and spongiotic pattern. Among total 1216 (32 patches × 38 patients) patch applied, 42 (3.4%) showed positivity in 30 patients. Among allergen categories, colorant (PPD) was found to be most common (37%) followed by fragrances (18%), preservatives (15%), anti-microbial (11%) and emulsifier and anti-oxidants (each 8%). Conclusion: It is important to identify the allergens implicated in PCD to help in better management of the condition. Patch testing proves to be a non invasive, low cost method and its role is indispensable in identifying the correct allergen.

Graham-Little-Piccardi-Lassueur syndrome is a rare variant of lichen planopilaris. It is characterized by multifocal, patchy, cicatricial alopecia of the scalp, noncicatricial alopecia of axilla and pubic region, and keratotic follicular papules involving the trunk and extremities. Trichoscopy shows perifollicular erythema, tubular perifollicular scales, fibrotic white dots, and hair casts along the hair shafts. We are reporting this rare syndrome in a 26-year-old pregnant woman with concomitant oral lichen planus and lichen planus pigmentosus. This case is unique as no previous report of coexistence of these variants of lichen planus has been published. [ABSTRACT FROM AUTHOR]

Introduction: Acquired dermal hyperpigmentation (ADMH) presenting on periorbital region has been described as individual case reports. We tried to characterize the features of periorbital ADMH. Materials and Methods: This was a retrospective case-control study among our patients who attended the pigmentary clinic during January 2016–December 2017. Clinical, dermoscopic, and histopathological features of subjects who were recruited during the study period were prospectively evaluated. Results: Total 19 subjects (11%) were identified among 177 ADMH patients. Periorbital ADMH patients had a relatively younger age of onset (23.26 ± 11.06 vs. 36.16 ± 13.41, P < 0.001). Dermoscopy of early periorbital ADMH showed only imperceptible speckled blue-gray dots that accentuated at outer-corner creases of eyes (the “outer-corner crease sign”). Clinicopathological features and prognosis of periorbital ADMH were similar to that of ADMH per se. Conclusion: Periorbital ADMH should be considered as a differential diagnosis of periorbital hyperpigmentation in children and young adults. Outer-corner crease sign on dermoscopy may help to rule out other differentials in its early presentation.

Background: Lichen planus pigmentosus (LPP) is considered an infrequent variant of Lichen planus (LP) clinically characterized by insidious onset of discrete, ill-defined, and dark brown or slate gray macules, primarily appearing over sun-exposed areas and flexures. Materials and method: This was a cross-sectional study conducted over a period of 1 year from July 2017 to July 2018 among the patients attending the OPD of the Department of Dermatology, Government Medical College, Kota, India. This study evaluated the LPP and its association with metabolic syndrome and cutaneous manifestations. Serum high-density lipoprotein (HDL)-cholesterol (HDL-C) and triglycerides (TG) were measured with enzymatic procedures. Plasma glucose was measured using hexokinase method. Results: There were 16 (32.0%) males and 34 (68.0%) females affected with LPP. Majority of the patients were in the age group of 40 to 49 years [15 (30.0%)] and above 50 years [16 (32.0%)]. Diabetes mellitus type 2 was reported among 17 (34.0%), hypertension among five (10.0%), and obesity among five (10.0%) patients. Increased low-density lipoprotein (LDL) and very LDL was found among 15 (30.0%) patients and decreased HDL was found among 19 (38.0%) patients. Conclusion: A 34.0% prevalence of metabolic syndrome was found in patients with LP. Central obesity, increased fasting blood sugar (FBS), and low HDL-C were the metabolic syndrome parameters found to be more common in patients with LP in our study.

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. [ABSTRACT FROM AUTHOR]

Background: Paucity of literature and non consensus on clinicohistopathological features amongst the nonmelasma facial melanosis for example lichen planus pigmentosus (LPP), pigmented contact dermatitis (PCD), macular amyloidosis, acanthosis nigricans, pigmented demarcation line, post inflammatory hyperpigmentation, etc., make them difficult to diagnose and equally challenging to treat. Materials and Methods: It was a prospective, uncontrolled study, conducted at tertiary hospital at eastern India in 100 patients presenting with facial hyperpigmentation who agreed to undergo 3mm skin biopsy during Jan 2014 to Jun 2015. Cases of melasma were excluded by clinical, Woods lamp examination and if required dermoscopy. Details of history, physical examination, histopathological examination, and Immunohistochemical studies were recorded. Melan A was used as melanocytic differentiation marker while CD4, CD8 were used as inflammatory markers. Mean ± SD, chi-square test or Fisher's exact test, degree of agreement by Cohen's Kappa were calculated. P-value was considered significant if =0.05. Results: 44 males and 56 females (56%) (M: F=1:1.24) with mean age of 45.98 years and median duration of illness of 28 months (5 months-13 years) were studied. Out of 43 confirmed cases of PCD, 16 had associated hypothyroidism (chi square 6.11, P-value 0.0134). Maximum patients belonged PCD (n= 47) followed by LPP (n=27). Maximum concordance of clinical and histopathological diagnosis was present in PCD and LPP (Cohen kappa more than 0.9). Epidermal atrophy and band like inflammatory infiltrate were statistically significant features in LPP (P < 0.001). There was no histopathological and immunohistochemical correlation. Overall, clinical histopathological concordance rate was 77%. Conclusion: Subset of nonmelasma facial melanosis is difficult to diagnose clinically which require further confirmation by histopathological examination. Small number of patients in other groups apart from PCD and LPP and uncontrolled study were major limitations of this study. [ABSTRACT FROM AUTHOR]

We describe a rare case of lichen planus pigmentosus (LPP) involving a 10-year-old female child with the involvement of the anterolateral aspect of the left thigh following the lines of Blaschko. LPP is a rare pigmented variant of lichen planus. Lines of Blaschko are lines of normal cell development. Histopathology showed melanophages in the papillary dermis with perivascular lymphocytic infiltrate and focal vacuolar change in basal layer consistent with a diagnosis of LPP.

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.

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. [ABSTRACT FROM AUTHOR]

A 30 year old female came to outpatient department with gradually progressing asymptomatic hyperpigmented lesions over face and neck since 2 years. Patient was a known case of systemic sclerosis and hypothyroidism and was on treatment for the same since 8 years. Differential diagnosis included lichen planus pigmentosus (LPP), ashy dermatoses, drug-induced hyperpigmentation, Riehl’s melanosis. Histopathology confirmed the diagnosis of lichen planus pigmentosus. Patient was put on topical depigmenting agents and topical calcineurin inhibitors along with photoprotection and the response was good. Patient had been regular in follow up.

Lichen planus pigmentosus is an uncommon variant of lichen planus that is characterized by the insidious onset of dark brown macules in sun-exposed areas and flexural folds.Superimposed linear lichen planus is an exceedingly rare disorder, but it has been found in both lichen planopilaris and lichen planus types. A 39-year-old woman is presented showing a segmental and linear lichen planus associated with non-segmental lesions meeting all criteria for the diagnosis of superimposed linear planus pigmentosus. The segmental lesions were always more pronounced.

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.

Lichen planus pigmentosus, erythema dyschromicum perstans and idiopathic eruptive macular pigmentation are the three most commonly accepted subtypes of acquired dermal hyperpigmentary disorders. While some patients fit easily into one of these subtypes, others do not. Overlapping features of several subtypes may also be seen in the one patient. This paper covers these three entities in detail and highlights the diagnostic and classification challenges.

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

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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 is characterized by slaty-gray pigmentation, predominantly on sun-exposed sites. It is considered to be a type IV hypersensitivity reaction to unknown antigen with lichenoid inflammation which may lead to melanin incontinence and superficial dermal pigmentation. This report presents a rare case of lichen planus pigmentosus caused due to tamoxifen intake. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Pigmented contact dermatitis (PCD) is a non-eczematoid variant of contact dermatitis, mainly characterised by hyperpigmentation. It occurs due to contact with a low amount of allergen over a long duration of time. PCD is frequently seen in Indians but is often misdiagnosed or underdiagnosed because of the asymptomatic nature of the entity. The aetiology and the allergens implicated in PCD in the Indian subcontinent is still an enigma because of the limited studies done. Materials and Methods: This was an institution-based cross-sectional study, done at a tertiary hospital. Patch testing with Indian Cosmetic Series was conducted in a standardised method. Readings were taken at 48 hrs/72 hrs and on the 7th day [Figure 2]a and [Figure 2]b. The International Contact Dermatitis Research Group (ICDRG) scoring system was used to grade the readings. Results: Out of the 38 biopsy proven cases of PCD, 18 (47%) showed lichenoid features, 17 (45%) showed spongiotic features, 3 (8%) showed a mixed lichenoid and spongiotic pattern. Among total 1216 (32 patches × 38 patients) patch applied, 42 (3.4%) showed positivity in 30 patients. Among allergen categories, colorant (PPD) was found to be most common (37%) followed by fragrances (18%), preservatives (15%), anti-microbial (11%) and emulsifier and anti-oxidants (each 8%). Conclusion: It is important to identify the allergens implicated in PCD to help in better management of the condition. Patch testing proves to be a non invasive, low cost method and its role is indispensable in identifying the correct allergen. [ABSTRACT FROM AUTHOR]