Pigment International

LETTER TO EDITOR
Year
: 2021  |  Volume : 8  |  Issue : 3  |  Page : 186--187

Unilateral lichen planus pigmentosus inversus: a rare presentation


Divya Kamat, Muthu Sendhil Kumaran 
 Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Correspondence Address:
Dr. Muthu Sendhil Kumaran
Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012
India




How to cite this article:
Kamat D, Sendhil Kumaran M. Unilateral lichen planus pigmentosus inversus: a rare presentation.Pigment Int 2021;8:186-187


How to cite this URL:
Kamat D, Sendhil Kumaran M. Unilateral lichen planus pigmentosus inversus: a rare presentation. Pigment Int [serial online] 2021 [cited 2022 May 26 ];8:186-187
Available from: https://www.pigmentinternational.com/text.asp?2021/8/3/186/330896


Full Text



Sir,

Lichen planus pigmentsosus (LPP) inversus is an unusual variant of LPP with fewer cases of unilateral distribution reported worldwide. In a retrospective cohort from our center, flexural lesions were present in only 2 of 76 (2.6%) cases.[1] We report a rare case of unilateral LPP inversus that like other variants had poor response to treatment.

A 45-year-old female presented with 1-year duration of multiple, slightly pruritic, well-defined slate grey macules on the left axilla [Figure 1]. There were no prior inflammatory lesions. The grey macules coalesced together with few smaller discrete macules in the periphery and lacked surrounding erythema. Dermatoscopy showed diffuse grey brown pigmentation with few brownish granular dots [Figure 2]a. Other flexures, nails, mucosa, and scalp were spared. Histopathology demonstrated a lichenoid reaction pattern with prominent pigment incontinence [Figure 2]b. The diagnosis of LPP inversus was made and patient started on topical 0.05% tacrolimus cream daily at night. Due to unsatisfactory response after 4 months of treatment, patient was advised to discontinue the cream.{Figure 1}{Figure 2}

Inverse LPP initially described by Pock et al.[2] in 2001 is a rare variant of LPP. In their report of LPP inversus, upto 10% of cases had lesions outside the flexural areas. Humid environment, sweating, ill-fitting garments leading to koebnerization have all been postulated as triggering factors. Some authors have also reported the simultaneous presence of LP and LPP.[3]

LPP inversus presents with slate grey to brown macules commonly located in the axillae and groin. Other flexures such as neck, anticubital fossae, auricular sulcus, and infra-mammary areas can also be involved.[4] In most cases, lesions are bilaterally symmetrical with only few reports of unilateral LPP.[5] Concurrent presence of atypical variants such as linear and flexural LPP has also been reported.[6] The usual differential diagnoses include ashy dermatosis, acanthosis nigricans, fixed drug eruptions, erythrasma, and post inflammatory hyperpigmentation. Dermoscopic features described in LPP include brown to bluish dots, globules, and blotches that vary with the severity of pigmentation. These features are also common to Riehl’s melanosis, pigmented contact dermatitis, and ashy dermatosis.[7] The histopathology findings are similar to that found in LP like band-like lichenoid pattern of inflammatory infiltrate composed of lymphocytes and prominent pigment incontinence and melanophages in the upper dermis. Few differences compared to LP include less prominent hypergranulosis and variable amount of inflammatory infiltrate.[1]

Other atypical variants of LPP include linear,[8] zosteriform,[9] and follicular.[10] The phenomenon of koebnerization has also been described in LPP.[11]The overall response to treatment in all variants of LPP has been poor. Topical steroids and topical tacrolimus have been tried in earlier reported cases. There have been few reports of spontaneous resolution over few weeks to months.[1]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Kumaran M, Mahajan R, Parsad D. Lichen planus pigmentosus: a retrospective clinico-epidemiologic study with emphasis on the atypical variants. Pigment Int 2014;1:90.
2Pock L, Jelinkova L, Drlik L et al. Lichen planus pigmentosus-inversus. J Eur Acad Dermatol Venereol 2001;15:452-4.
3Chen S, Sun W, Zhou G, Chen S, Lu X. Lichen planus pigmentosus-inversus: report of three Chinese cases and review of the published work. J Dermatol. 2015;42:77-80.
4Ohshima N, Shirai A, Saito I, Asahina A. Lichen planus pigmentosus‐inversus occurring extensively in multiple intertriginous areas. J Dermatol 2012;39:412-4.
5Patel K, Arballo O, Wohltmann W. Unilateral hyperpigmented flexural lesion in the left axilla. JAAD Case Rep 2020;6:131-2.
6Bishnoi A, Parsad D, Saikia UN, Kumaran MS. Coexistence of linear and inversus variants of lichen planus pigmentosus: a rare occurrence. Indian J Dermatol 2019;64:152-4.
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9Manjunath S, Kamat D, Kumaran MS. Multidermatomal zosteriform lichen planus pigmentosus-a unique presentation. Int J Dermatol 2019;58:343-4.
10Daroach M, Guliani A, Keshavmurthy V, Vishwajeet V, Saikia UN, Kumaran MS. Follicular lichen planus pigmentosus in blaschkoid pattern: superimposed segmental mosaicism. Indian J Dermatol Venereol Leprol 2020;86:305-7.
11Manjunath S, Kamat D, Kumaran MS. Koebnerization and lichen planus pigmentosus: is it a reality? Pigment Int 2019;6:115-6.