Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Net Letter
ARTICLE IN PRESS
doi:
10.25259/IJDVL_868_2023

Glimpses of gold: Unveiling the enigma of multiple lichen aureus

Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
Department of Histopathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
Corresponding author: Dr. Dipankar De, Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. dr_dipankar_de@yahoo.in
Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Sharma A, De D, Chatterjee D. Glimpses of gold: Unveiling the enigma of multiple lichen aureus. Indian J Dermatol Venereol Leprol. doi: 10.25259/IJDVL_868_2023

Dear Editor,

A 53-year-old woman presented with a six-month history of multiple, mildly itchy, reddish-brown lesions on both legs. The lesions started appearing after four months of surgery for varicose veins and gradually increased in number over the next 4 months. On examination, there were multiple, well-defined, variably sized and shaped, reddish-brown papules and plaques on both legs ranging between 1 × 1 cm to the largest being 5 × 3 cm. The two most prominent plaques on her left leg showed a classic reddish-brown appearance surrounded by a yellowish-golden rim with the surface showing mild scaling forming a collarette at some places and punctate red to brown vascular structures [Figures 1a and 1b]. The surrounding skin showed signs of venous flares, such as dilated tortuous capillaries and veins on a generalised yellowish-to-brownish background. Dermoscopic examination revealed the presence of multiple discrete red dots and globules in a coppery brown background, serpentine vessels, reticular brown lines and subtle brown dots [Figure 2].

Figures 1a & 1b:
Two prominent plaques showing a classic reddish-brown appearance surrounded by a yellowish-golden rim. Note the signs of venous flares surrounding these plaques.
Figure 2:
Dermatoscopic examination revealed multiple discrete red dots (black star) and globules (black circle) on a coppery brown background, serpentine vessels (black arrows) and subtle brown dots (black square) (DermLite™ DL4;10x polarised mode).

A skin biopsy performed on one of the lesions for histopathological examination revealed epidermal hyperkeratosis, focal patchy parakeratosis with focal basal cell vacuolisation and lymphocytic exocytosis [Figure 3]. The upper dermis showed moderate lymphocytic inflammatory infiltrate, predominantly in the perivascular region. The dermal vessels had endothelial swelling, and extravasated red blood cells (RBCs) were noted in the upper dermis. No evidence of vasculitis was identified.

Figure 3:
Epidermal hyperkeratosis, focal basal cell vacuolisation and lymphocytic exocytosis. The upper dermis showed moderate lymphocytic inflammatory infiltrate, which was also seen in the perivascular location. Vessels showed endothelial swelling and extravasated RBCs (Haematoxylin and Eosin, 100x).

Based on the clinical, dermatoscopic and histopathological findings, a diagnosis of multiple lichen aureus was made. Mid-potency topical steroid, once daily application, in combination with oral vitamin C supplementation and avoidance of prolonged standing, were suggested for treatment. The acute appearance of characteristic, rust-yellow or gold-coloured papules or circumscribed patches and plaques characterises lichen aureus. The name “lichen aureus” draws attention to the eruption’s traditional gold-brown hue. Notably, lesions that are copper-orange or violaceous may also be seen in lichen aureus. Unilateral lower extremity involvement is more common than bilateral involvement. 1 The lesions can appear in the upper extremities and trunk and can occur in segmental, dermatomal, and blaschkoid patterns. 2,3 The lesions can follow the course of superficial or deep veins. Aberrant distributions and patterns have been observed more frequently in children. 1

Multiple lichen aureus has been rarely reported. Torraca et al. 4 described a case of multiple segmental lesions of lichen aureus that evolved over six years. One of the possible factors for the multiplicity of lesions in our patient can be the presence of venous insufficiency. In a previous study by Kim et al. 5 venous insufficiency was detected in 35 of the 56 (62.5%) patients with pigmented purpuric dermatosis. Significant correlations were found between pigmented purpuric dermatosis and venous insufficiency. Longer duration of pigmented purpuric dermatosis, darker, and widespread lesions were seen in patients with established venous insufficiency.

Managing a case of widespread pigmented purpuric dermatosis in the presence of established venous insufficiency, when surgical management for venous insufficiency has already been tried without much improvement in lichen aureus, remains a challenge. Patients need counselling and an understanding of the interplay of various factors involved in the genesis of these skin lesions. Topical steroids, in combination with oral vitamin C supplementation, can be tried. Behavioural modifications, like intermittent sitting during hours of prolonged standing, elevation of limbs while sitting and interrupting the itch-scratch cycle, must be emphasised to the patients.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Use of artificial intelligence (AI)-assisted technology for manuscript preparation

The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript, and no images were manipulated using AI.

References

  1. , , . Lichen aureus in childhood. Pediatr Dermatol. 1991;8:280-3.
    [CrossRef] [PubMed] [Google Scholar]
  2. , , , , , . Segmental lichen aureus: Combination therapy with pentoxifylline and prostacyclin. J Eur Acad Dermatol Venereol. 2006;20:1378-80.
    [CrossRef] [PubMed] [Google Scholar]
  3. , . Segmental lichen aureus in a child. Int J Dermatol. 1991;30:654-5.
    [CrossRef] [PubMed] [Google Scholar]
  4. , , , , . Segmental lichen aureus: An uncommon presentation. An Bras Dermatol. 2017;92:704-6.
    [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
  5. , , , , , . Venous insufficiency is a clear provoker of pigmented purpuric dermatosis. Ann Dermatol. 2022;34:34-9.
    [CrossRef] [PubMed] [PubMed Central] [Google Scholar]

Fulltext Views
1,266

PDF downloads
2,478
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections