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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.

Keywords: acquired dermal macular hyperpigmentation; CAS no. 302776-68-7; case report; cinnamal; cinnamyl alcohol; diethylamino hydroxybenzoyl hexyl benzoate; frontal fibrosing alopecia; lichen planus pigmentosus; pigmented contact dermatitis; sunscreens EN acquired dermal macular hyperpigmentation CAS no. 302776-68-7 case report cinnamal cinnamyl alcohol diethylamino hydroxybenzoyl hexyl benzoate frontal fibrosing alopecia lichen planus pigmentosus pigmented contact dermatitis sunscreens 287 289 3 08/16/22 20220901 NES 220901 We report a patient with pruritic hyperpigmentation of the face and neck, who subsequently developed frontal fibrosing alopecia (FFA), and who was shown to be sensitized to fragrances and to the ultraviolet (UV)-filter diethylamino hydroxybenzoyl hexyl benzoate. Co-sensitizations to cinnamal and cinnamyl alcohol have recently been described in patients' photo-allergic to ketoprofen,10 the latter also being a benzophenone derivative, similar to benzophenone-3 (oxybenzone) and diethylamino hydroxybenzoyl hexyl benzoate (Figure S1). Case report, acquired dermal macular hyperpigmentation, CAS no. 302776-68-7, diethylamino hydroxybenzoyl hexyl benzoate, cinnamal, cinnamyl alcohol, frontal fibrosing alopecia, lichen planus pigmentosus, pigmented contact dermatitis, sunscreens. [Extracted from the article]

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]

Background: Literature on treating acquired dermal macular hyperpigmentation is sparse. Aims and objectives: To assess treatment response of mycophenolate mofetil in patients having acquired dermal macular hyperpigmentation. Material and Methods: 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. Results: 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%, and >50% 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. Conclusion: Mycophenolate mofetil appears to be a promising treatment option in acquired dermal macular hyperpigmentation. [ABSTRACT FROM AUTHOR]

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]

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 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]

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.

2 Bishnoi A, Vinay K, Parsad D, Handa S, Saikia UN, Sendhil Kumaran M. Contact sensitization to hair colours in acquired dermal macular hyperpigmentation: results from a patch and photo-patch test study of 108 patients. Allergic contact dermatitis, case report, frontal fibrosing alopecia, gallates, pigmented contact dermatitis, propolis, acquired dermal macular hyperpigmentation, ethylhexyl salicylate, lichen planus pigmentosus, Magnolia officinalis bark extract Keywords: acquired dermal macular hyperpigmentation; allergic contact dermatitis; case report; ethylhexyl salicylate; frontal fibrosing alopecia; gallates; lichen planus pigmentosus; Magnolia officinalis bark extract; pigmented contact dermatitis; propolis EN acquired dermal macular hyperpigmentation allergic contact dermatitis case report ethylhexyl salicylate frontal fibrosing alopecia gallates lichen planus pigmentosus Magnolia officinalis bark extract pigmented contact dermatitis propolis 434 436 3 04/14/22 20220501 NES 220501 Frontal fibrosing alopecia (FFA) and lichen planus pigmentosus (LPP) frequently coexist.1 The umbrella term "acquired dermal macular hyperpigmentation (ADMH)" encompasses disorders with clinicopathological overlap such as LPP and pigmented contact dermatitis.2 Contact sensitization has been described in the contexts of both FFA and ADMH.2-4 CASE REPORT A woman with Fitzpatrick skin phototype IV and hypothyroidism developed pruritic macular hyperpigmentation with punctate hypopigmentation symmetrically on her forehead (Figure 1A) at age 45 which she related to hair dyes. [Extracted from the article]

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]

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

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]

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.

There has been a recent rush of data regarding the combined presentation of lichen planus pigmentosus and frontal fibrosing alopecia in premenoposal women of dark skin. This review article addresses the relationship between the two.

Background: Dermal melanophages are a common histopathological finding in several inflammatory skin diseases and may be seen even in clinically normal-looking skin. Clinically hyperpigmented and hypopigmented conditions as well as nonpigmented lesions show melanophages which cannot always be correlated with the clinical appearance of the lesion biopsied. No literature exists to help assess the significance of dermal melanophages in inflammatory diseases and correlate their presence with the pathophysiology of the disease biopsied. Methodology: This is a retrospective study of 100 skin biopsies in patients with brown skin, which had mentioned dermal melanophages in the histopathological report. A simple-to-use semi-objective scale (score of 3–10) was used to assess the score of the dermal melanophages. This was done by a dermatopathologist who was blinded to the clinical and histopathological diagnoses. A correlation of the dermal melanophage score was attempted with the clinical/histological diagnoses and known pathogenesis of the diseases. Results: A variety of skin diseases were included in this study which could be broadly grouped into hypopigmented (10 cases, average scores 4), nonpigmented interface diseases (20 cases, average score 6.66), miscellaneous nonpigmented dermatosis (17 cases, average scores 5.3), and hyperpigmented (53). The hyperpigmented group was subdivided into those that were known to show predominantly epidermal melanin (13 cases, average score 4.58) and those who have predominantly dermal melanin following interface dermatitis (29 cases, average score 8.67) and dermal melanosis without interface dermatitis (11 cases, average score 6.18). Conclusions: This scale can be used to determine the significance of dermal melanophages in inflammatory skin diseases. Scores >6 suggest hyperpigmentary conditions due to the presence of dermal melanophages. Low scores of 3–5 are not significant and are seen in epidermal hypermelanoses, hypopigmented conditions, and other varied nonpigmented dermatoses.

Lichen planus pigmentosus (LPP) is a rare disorder affecting primarily the people with ethnic skin. It results in hyperpigmentation of sun-exposed sites along with the involvement of flexures. In accordance with clinical patterns, different variants such as diffuse, blotchy, reticulate, and perifollicular have been described. Rare variants such as flexural (inversus), mucosal, linear, and zosteriform have been reported scarcely. Inversus LPP refers to the involvement of major flexures such as inframammary area, axillae, and groins in the absence of involvement of photo-exposed sites. We present an unusual case presenting with coexisting linear and inversus variants of LPP.

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

A boy with a 2‐year history of asymptomatic, linear pigmented macules involving the right side of the trunk and right upper limb. RCM revealed the dermal papillary rings were destroyed, and numerous irregular particulate structures with high refractive values were distributed in the superficial dermis. The RCM features implied the possibility of interface dermatitis. RCM was a complementary diagnostic tool for linear pigmented macules. [ABSTRACT FROM AUTHOR]

Background: Lichen planus pigmentosus (LPP), a rare variant of lichen planus, is reported in various ethnic groups, more often from the Indian subcontinent and the Middle East. Aims: Although the condition is encountered quite often by dermatologists of this region, the data on the clinical, pathological, and immunohistochemical (IHC) aspects of LPP are limited. This prospective study is aimed towards filling this lacuna. Materials and Methods: Data were collected from thirty clinically diagnosed cases of LPP who presented to the dermatology outpatient department. Skin biopsy and blood investigations were conducted and the specimens were further analyzed for their histopathological features and IHC staining for CD4+, CD8+ T-lymphocyte subsets along with CD45RO (UCHL-1), and CD68. The results were statistically analyzed. Results: The study showed a female preponderance (56.7%). Photo aggravation as a precipitating cause was seen in 40% of the individuals. The lesions with duration

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. [ABSTRACT FROM AUTHOR]

Recent studies have noticed significant role of interleukin (IL)-17, 22, 23, Foxp3, interferon-gamma (IFN-γ) and Wnt5a in oral and cutaneous lichen planus (LP). This study was undertaken to assess whether similar expression exists in lichen planus pigmentosus (LPP). We recruited 30 patients of treatment-naïve 'LPP' (in absence of cutaneous/mucosal LP elsewhere, group 1), 10 patients having active treatment-naïve cutaneous 'LP' (group 2), 10 patients having 'post-LP' hyperpigmentation (in absence of active LP and off treatment for at least past 3 months, group 3), and 10 controls. Quantitative real-time polymerase chain reaction (qRT-PCR, peripheral blood mononuclear cells [PBMCs] and skin) and immunohistochemistry (IHC, skin) was performed. mRNA expression (in PBMCs) of IL-17A, IL-22, IL-23A, IFN-γ and Foxp3 was significantly decreased in group 1 and 3 as compared to group 2 (p < 0.05). Wnt5a expression was maximal in controls; and while there was no difference between group 1 and 2; whereas expression in group 3 was significantly lesser than group 1 and 2 (p < 0.05). qRT-PCR (skin) and IHC (skin) revealed similar results; and mRNA expression and mean fluorescence intensity of IL-17A, IL-22, IL-23A/R was significantly increased in group 2 and 3 compared to group 1 (p < 0.05). Mean fluorescence intensity and mRNA expression of IFN-γ, Foxp3 and Wnt5a were significantly increased in group 2 compared to group 1 (p < 0.05); whereas the difference between group 1 and 3 was not significant. Mean fluorescence intensity and mRNA expression of IL-17A, 1L-22 and IFN-γ showed no difference between group 2 and 3; whereas that of IL-23A/R, foxp3 and wnt5a were significantly higher in group 2 than group 3 (p < 0.05). Overall, maximal expression of IL-17A, IL-22, IL-23A, IFN-γ and Foxp3 (mRNA PBMCs) was observed in LP. Minimal expression of IL-17A, IL-22, IL-23A/R, IFN-γ and Foxp3 (mRNA skin and IHC skin) was seen in LPP patients. In contrast to LP, LPP lacks the expression of IFN-γ, Foxp3 and the cytokines representing Th17 pathway, and thus seems to have a distinct pathogenesis. [ABSTRACT FROM AUTHOR]

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 <0.001. Conclusion: LPP is a distinct clinical entity caused by diverse etiological factors and shows varied clinical patterns. All the patients should be advised to stop using mustard oil/henna/hair dye/after shave lotions and cosmetics. Hypothyroidism can be considered to be a disease associated with LPP and all the patients should be investigated for the same. [ABSTRACT FROM AUTHOR]

Background: Studies on the co morbidities seen with lichen Planus Pigmentosus (LPP) are limited. Aims: We sought to determine the prevalence of auto immune diseases (AD) associated with LPP. Methods: A total of 30 patients with LPP and 30 age and sex matched controls were examined. Both groups were evaluated for the presence of AD using physical examination and immunological tests. Results: We collected 30 LPP patients. There were 9 men and 21 women. Prevalence of AD was higher in LPP patients (40.0%) than in the control group (3.3%). LPP was significantly associated with AD, the age and gender adjusted OR was 22.9; P: 0.005. Twelve patients had an associated AD. There was no statistically significant difference between the group with ADs and without ADs concerning the sex, the age of onset of the disease, the extent of the lesions and the evolution. The immunological tests were positive in only one patient. Limitations: This study was performed in a little sample with a geographically restricted population. Conclusion: We found a frequent association of LPP with ADs. We suggest that autoimmunity might be a pathogenic factor of LPP. [ABSTRACT FROM AUTHOR]

Background Lichen planus pigmentosus (LPP) and ashy dermatosis (AD) are disorders of hyperpigmentation and differentiation between two can be difficult. They can be close mimickers. Earlier they were considered the same entity but over time various authors enlisted a few clinical and histopathological differences between the two. In this review, we would add the additional dermoscopic differences and review the clinical and histopathological differences between these two confusing entities. Aim To differentiate between lichen planus pigmentosus and ashy dermatosis on the basis of clinical, dermoscopic and histopathological features. Methods We selected ten patients of newly diagnosed lichen planus pigmentosus and ten of ashy dermatosis presenting to dermatology OPD. Clinical examination, dermoscopy and punch biopsy were performed in each case. Results Out of the 20 patients who were included in this study, 10 were diagnosed with lichen planus pigmentosus and 10 with ashy dermatosis. 80% patients presented with pruritus in LPP and all patients were asymptomatic in AD. In LPP, most common pattern was diffuse where on dermoscopic examination, granules were seen arranged in a hem like pattern. In AD, pigment was seen present in a curvilinear fashion. Conclusion Differentiation between lichen planus pigmentosus and ashy dermatosis can be a daunting task. Dermoscopy is a useful and non-invasive modality that can be of immense help. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Lichen planus pigmentosus (LPP) is a cosmetically disfiguring condition. Many treatment options are available which are effective in halting the progression of the disease. The treatment of persistent pigmentation is still a challenge. We describe the use of Q-switched Nd-YAG laser in 13 patients with stable LPP using a standard protocol. Most of our patients showed complete to near-complete resolution of pigment without much complications. [ABSTRACT FROM AUTHOR]

The Q-switched Nd:YAG laser is an established modality of treatment for epidermal and dermal pigmented lesions. The dual wavelengths of 1064nm and 532nm are suited for the darker skin tones encountered in India. Though this laser has become the one of choice for conditions such as nevus of Ota, Hori's nevus and tattoos, its role in the management of melasma and other acquired dermal melanoses is not clear. Despite several studies having been done on the Q-switched Nd:YAG laser in melasma, there is no consensus on the protocol or number of sessions required. Acquired dermal melanoses are heterogenous entities with the common features of pigment incontinence and dermal melanophages resulting in greyish macular hyperpigmentation. This article reviews the current literature on laser toning in melasma and the role of the Q-switched Nd:YAG laser in stubborn pigmentary disorders such as lichen planus pigmentosus. As the pathology is primarily dermal or mixed epidermal-dermal in these conditions, the longer wavelength of 1064nm is preferred due to its deeper penetration. Generally multiple sessions are needed for successful outcomes. Low fluence Q-switched Nd:YAG laser at 1064nm utilizing the multi-pass technique with a large spot size has been suggested as a modality to treat melasma. Varying degrees of success have been reported but recurrences are common on discontinuing laser therapy. Adverse effects such as mottled hypopigmentation have been reported following laser toning; these can be minimized by using larger spot sizes of 8 to 10mm with longer intervals (2 weeks) between sessions. [ABSTRACT FROM AUTHOR]

Background/Objectives: Controversy persists as to whether lichen planus pigmentosus and ashy dermatosis are separate clinical entities. This study was conducted to examine the clinicopathological features and treatment outcome of the two conditions. Methods: A retrospective medical chart review of all patients who were diagnosed with lichen planus pigmentosus or ashy dermatosis was conducted. The information collected included the participants' age at onset, site of onset, duration of disease, presence of precipitating factors, distribution of disease, pigmentation and presence of symptoms. In patients from whom a biopsy was taken the histopathological reports were included. Results: Altogether 26 patients with ashy dermatosis and 29 with lichen planus pigmentosus were included in the study. Compared with ashy dermatosis, lichen planus pigmentosus had a more localised distribution with a preponderance for facial involvement, compared with the truncal preponderance in ashy dermatosis. Ashy dermatosis tended to have a more stable clinical course than lichen planus pigmentosus, which was more likely to wax and wane. The utility of histopathology in differentiating between the two conditions is low. Conclusion: Ashy dermatosis and lichen planus pigmentosus, as defined in this study, appear to be two separate clinical entities with distinguishable clinical features and natural histories. [ABSTRACT FROM AUTHOR]

A pigmented variant of lichen planus (LP) was first reported from India in 1974 by Bhutani et al. who coined the term LP pigmentosus (LPP) to give a descriptive nomenclature to it. LP has a number of variants, one of which is LPP. This disease has also later been reported from the Middle East, Latin America, Korea, and Japan, especially in people with darker skin. It has an insidious onset. Initially, small, black or brown macules appear on sun-exposed areas. They later merge to form large hyperpigmented patches. The disease principally affects the sun-exposed areas of the body such as the face, trunk, and upper extremities. The oral mucosa may rarely be involved. However, the palms, soles, and nails are not affected. Histologically, the epidermis is atrophic along with vacuolar degeneration of basal cell layer. The dermis exhibits incontinence of pigment with scattered melanophages and a sparse follicular or perivascular infiltrate. There is a considerable similarity in histopathological findings between LPP and erythema dyschromicum perstans. However, there are immunologic and clinical differences between the two. These observations have led to a controversy regarding the identity of the two entities. While some dermatologists consider them to be the same, others have opined that the two should be considered as distinctly different diseases. A number of associations such as hepatitis C virus infection, frontal fibrosing alopecia, acrokeratosis of Bazex and nephrotic syndrome have been reported with LPP. A rare variant, LPP inversus, with similar clinical and histopathological findings was reported in 2001. As opposed to LPP, this variant occurs in covered intertriginous locations such as groins and axillae and mostly affects white-skinned persons.

Background: Pigmentary problems are one of the most frequent causes for dermatologic consultation. For accurate diagnosis, histopathological examination is useful. Pathologic examination often serves as a complementary or a confirmative part of the clinical diagnosis. Objective: To study the pattern of hyperpigmented skin lesions and their histopathological features. Materials and Methods: We prospectively studied histopathological features of hyperpigmented skin lesions in all age groups attending the dermatology department of a teaching hospital over a 2-year period. The skin lesions included inflammatory, genetic, metabolic, and endocrine lesions but excluded neoplastic, infectious, and developmental lesions. Results: Of the 980 skin biopsies, 200 (20.4%) were hyperpigmented lesions. Lesions were most common in the second and third decades. Clinically, itching was the most common presentation. Most common biopsy confirmed hyperpigmented lesions included classical lichen planus and its variants (55%). Histopathologically, most lesions showed lichenoid/interface dermatitis. Most hyperpigmented skin lesions were epidermal (75%) with lichen planus pigmentosus being the only dermal hyperpigmented lesion. Conclusion: Classical lichen planus was the most common hyperpigmented lesion seen in our study. Histopathological examination is useful in accurate diagnosis of hyperpigmented skin lesions, particularly in those with unclear or overlapping clinical features.

Keywords: dystrophic xanthomization; frontal fibrosing alopecia; lichen planus pigmentosus; xanthoma EN dystrophic xanthomization frontal fibrosing alopecia lichen planus pigmentosus xanthoma 7251 7252 2 12/30/22 20221201 NES 221201 To the Editor, Frontal fibrosing alopecia (FFA) is nowadays the most frequent type of scarring alopecia and it is associated with other clinical signs such as facial papules, glabellar red dots, frontal veins depression, or liquen planus pigmentosus (LPPigm).[1] Dystrophic xanthomization is a process that corresponds to the accumulation of lipid-rich foam cells within an area of damaged skin. We report the case of a patient with facial LPPigm associated with FFA that secondarily developed dystrophic xanthomas over the areas of LPPigm. [Extracted from the article]

Competing Interests: None disclosed.

Competing Interests: Dr Wambier has served as speaker for Cynosure; as an advisor for Vydence, Incyte, ChemistryRx, Young Pharmaceuticals, and Daniel Alain; and owner of Wambier Dermatologics, LLC.