Generic selectors
Exact matches only
Search in title
Search in content
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 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 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
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
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 Reviews and Meta-analysis
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Net Letter
2014:80:6;580-580
doi: 10.4103/0378-6323.144234
PMID: 25382538

Lichen planus pigmentosus inversus

Houda Hammami Ghorbel1 , Talel Badri1 , Ehsen Ben Brahim2 , Samy Fenniche1 , Rym Benmously1 , Insaf Mokhtar1
1 Department of Dermatology, Habib Thameur Hospital, Tunis, Tunisia
2 Department of Anatomopathology, Habib Thameur Hospital, Tunis, Tunisia

Correspondence Address:
Houda Hammami Ghorbel
Department of Dermatology, Habib Thameur Hospital, Ali Ben Ayed Street, 1008 Montfleury, Tunis
Tunisia
How to cite this article:
Ghorbel HH, Badri T, Brahim EB, Fenniche S, Benmously R, Mokhtar I. Lichen planus pigmentosus inversus . Indian J Dermatol Venereol Leprol 2014;80:580
Copyright: (C)2014 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

Lichen planus is a common inflammatory dermatosis of unknown origin that presents in a variety of morphologic patterns. Lichen planus pigmentosus inversus (LPPI) is one of the rarer clinical forms. We report six cases of LPPI from North Africa [Table - 1].

Table 1: Clinical, histological, and therapeutic features of our patients

Case 1

A 74-year-old woman presented with a 2-week history of brown macules of the neck [Figure - 1]a, axillae, inter- and submammary folds, and groin. Medical history included hypertension treated for many years by captopril, furosemide, and nifedepine. A 1-month application of clobetasol propionate produced no significant response.

Figure 1: (a) Lichen planus pigmentosus inversus: Pigmented brownish-grey, well-defined macules and plaques located on the neck. (b) Brown, well-demarcated macules and plaques in the submammary folds

Case 2

A 60-year-old woman, presented with pruriginous and pigmented patches located in the neck, inframammary folds [Figure - 1]b, and presacral area which developed over the last 3 years. The patient received oral prednisone (0.5 mg/kg/day) for 2 months but no improvement was noted.

Case 3

A 54-year-old woman presented with a 2-week history of pruriginous purple-brown macules and plaques in the sub-mammary folds, groin, and genitalia. She received topical betamethasone for several months with no improvement.

Case 4

A 60-year-old woman with a history of diabetes, consulted for pruritic, scaly, violaceous-brown macules, and annular brownish plaques arising in the submammary folds and groin. The patient received topical betamethasone with slight improvement.

Case 5

A 49-year-old woman presented with a 2-week history of pruriginous brownish plaques located symmetrically in the axillae, groin, and vulva. No improvement was obtained with topical betamethasone.

Case 6

A 76-year-old woman presented with a 3-month history of pruriginous, brownish macules and plaques in the sub-mammary folds. The patient was treated with topical betamethasone for 2 months with no improvement.

In all these cases, histological examination revealed atrophic epidermis with hypergranulosis, band-like lymphocytic infiltrate of the upper dermis with abundant colloid bodies, and marked pigmentary incontinence [Figure - 2]. Hyperkeratosis was noted in four cases. Clinical and histological features were consistent with the diagnosis of lichen planus pigmentosus inversus in all patients.

Figure 2: Thinning of the epidermis, a band-like lymphocytic infiltrate with basal vacuolar change, necrosis of keratinocytes and prominent melanin incontinence in the upper dermis (hematoxylin and eosin, ×40)

Lichen planus pigmentosus inversus is a rare variant of lichen planus, described by Pock et al. [1] We found previous reports of 21 cases of whom 13 were females and eight males. [1],[2],[3],[4],[5] In our series, all patients were women. The mean duration of symptoms before the diagnosis ranges from 2 months to 15 years. [2] It has been postulated that this condition occurs mainly in Caucasians from central Europe. [1] However, Kashima et al., have described two Japanese patients with the disease. [3] We found only one report of lichen planus pigmentosus inversus in a phototype IV woman [4] and did not find previous reports of the disease in North African dark-skinned persons like our patients. Clinically, the condition is characterized by well-circumscribed violaceous-brown macules confined to intertriginous areas [1] It affects mainly the axillae and groin. [2] In our patients, the submammary folds and groin were the most common sites. Skin lesions of classic lichen planus have been described in non-intertriginous areas in 10% of patients [1] but we did not find them in our patients. Histopathological features are similar to lichen planus but there is a marked pigmentary incontinence in the upper dermis.

The differential diagnosis includes fixed drug eruption, acanthosis nigricans, candida intertrigo, erythrasma, post-inflammatory pigmentation, lichenoid toxic dermatitis or ashy dermatosis. The etiopathogenesis of the condition remains unknown. Captopril is known to induce lichenoid eruptions and the onset of symptoms 1 year after initiation of captopril in our first patient may indicate an association. External stimuli, such as friction (Koebner phenomenon), may be a triggering factor. [5]

Pigmented plaques tend to persist for months. Some authors suggest that treatment with medium or high potency topical corticosteroids or calcineurin inhibitors could accelerate the healing process. In our retrospective study, different treatment regimens of topical and systemic corticosteroids had been used without success.

Lichen planus pigmentosus inversus should be considered in the differential diagnosis of cutaneous pigmentation exclusively located in flexural areas.

References
1.
Pock L, Jelínková L, Drlík L, Abrhámová S, Vojtechovská S, Sezemská D, et al. Lichen planus pigmentosus-inversus. J Eur Acad Dermatol Venereol 2001;15:452-4.
[Google Scholar]
2.
Bennàssar A, Mas A, Julià M, Iranzo P, Ferrando J. Annular plaques in the skin folds: 4 cases of lichen planus pigmentosus-inversus. Actas Dermosifiliogr 2009;100:602-5.
[Google Scholar]
3.
Kashima A, Tajiri A, Yamashita A, Asada Y, Setoyama M. Two Japanese cases of lichen planus pigmentosus-inversus. Int J Dermatol 2007;46:740-2.
[Google Scholar]
4.
Kim BS, Aum JA, Kim HS, Kim SJ, Kim MB, Oh CK, et al. Coexistence of classic lichen planus and lichen planus pigmentosus-inversus: Resistant to both tacrolimus and clobetasol propionate ointments. J Eur Acad Dermatol Venereol 2008;22:106-7.
[Google Scholar]
5.
Ohshima N, Shirai A, Saito I, Asahina A. Lichen planus pigmentosus-inversus occurring extensively in multiple intertriginous areas. J Dermatol 2012;39:412-4.
[Google Scholar]

Fulltext Views
647

PDF downloads
255
Show Sections