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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]

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: 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]

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]

Background: Lichen planus pigmentosus (LPP) is a common cause of facial melanosis in the dark-skinned population. At present, information on dermoscopy and patch testing in LPP is limited.Objectives: To describe dermoscopic findings and study the role of patch testing in patients with LPP on the face.Methods: Facial lesions of 50 patients with LPP were studied dermoscopically, followed by histological evaluation. Patch and photopatch tests with the Indian Standard Series and Scandinavian series, respectively, and patient's own cosmetics were performed on all patients.Results: The most common dermoscopic finding was dots and/or globules (43/50, 86%) in different patterns: hem-like (20.9%), arcuate (18.6%), incomplete reticular (39.5%), complete reticular (7%), and not otherwise specified (14%). Other patterns were exaggerated pseudoreticular pattern, accentuation of pigmentation around follicular openings, targetoid appearance, and obliteration of the pigmentary network. There were 26 relevant patch tests in 17 (34%) patients: para-phenylenediamine (n = 5), nickel (n = 3), colophony, perfume mix and fragrance mix (n = 2 each), thiuram mix and 3,3,4,5-tetrachlorosalicylanilide (n = 1 each), and patients' own products (n = 9). The only positive photopatch test was to fentichlor. No clinical or histological finding differed significantly based on patch test results. The only dermoscopic finding to be statistically associated with a positive patch test was the non-characteristic arrangement of dots/globules (P = 0.042).Limitations: Dermoscopic features were not correlated with clinical features or disease duration. Implications of patch testing on the management of LPP cannot be commented upon as ours was a cross-sectional study.Conclusions: The present study describes the dermoscopic findings of facial lesions in LPP. Our patch test results suggest a probable role of allergens in causing LPP on the face. [ABSTRACT FROM AUTHOR]

Lichen planus pigmentosus (LPP) is a distinct clinical entity commonly encountered in the Indian population. It is considered a variant of lichen planus (LP). A 40-year-old male presented with asymptomatic hyperpigmented macules in a segmental distribution since 10 years that were clinically and histopathologically suggestive of LPP. We propose the terminology "segmental lichen planus pigmentosus" and report this unusual presentation. [ABSTRACT FROM AUTHOR]

Abstract: Lichen planus (LP) is a chronic inflammatory dermatological condition usually affecting adults, but rare in children. Lichen planus pigmentosus (LPP) is an uncommon variant of LP seen mostly in India or Middle East. LPP as such is rare and its presentation as childhood LPP rarer. We report a case of LPP in a 3year old Kashmiri male child, which is a rare presentation. [Copyright &y& Elsevier]