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Dr. Alpana Mohta Ranka, MD, DNB, IFAAD, is a triple-board-certified dermatologist with over 100 research publications in peer-reviewed scientific journals.

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Lichen Planus Pigmentosus: Causes, Symptoms, Treatment, and More

Updated: Jun 1

Lichen Planus Pigmentosus is a lesser-known variant of the common skin condition lichen planus. Characterized by distinctive hyperpigmented, violaceous, or dark brown patches on the skin, the disease primarily affects individuals with skin of color.


This article aims to provide a detailed overview of lichen planus pigmentosus, shedding light on its causes, symptoms, available treatment approaches, and essential management tips.

 

Table of Contents

 

Understanding Lichen Planus Pigmentosus


Lichen planus pigmentosus is a chronic inflammatory disorder that primarily affects sun-exposed areas, such as the face, neck, and forearms. Unlike traditional lichen planus, it doesn't typically exhibit the characteristic itchy, flat-topped, and purplish papules.



Instead, it presents with hyperpigmented, well-defined, flat skin lesions, possibly caused by localized or generalized immune imbalance.


Symptoms and Clinical Presentation


The hallmark symptom of lichen planus pigmentosus is the appearance of asymptomatic dark brown to grayish-black or violaceous patches on the skin. The edges of the patches may have a subtle border, and over time, the affected areas might expand or darken further.


Lichen Planus Pigmentosus appearance near lower lip

The disease predominantly affects people with darker skin tones, including those of South Asian, Hispanic, and African descent.


Causes and Risk Factors

The exact triggers of lichen planus pigmentosus remain a subject of ongoing research. However, several factors may contribute to its development, including genetics, sun exposure, immune system dysfunction, triggering diseases, and hormonal fluctuations, particularly in women.

  1. Genetics: A family history of lichen planus or lichen planus pigmentosus may increase the likelihood of developing the condition.

  2. Sun Exposure: These hyperpigmented patches often occur in sun-exposed areas, suggesting that ultraviolet (UV) radiation might play a role in its pathogenesis.

  3. Immune System Dysfunction: An abnormal immune response targeting melanocytes, the cells responsible for skin pigmentation, may lead to hyperpigmentation.

  4. Triggering Diseases: The immune imbalance might result secondary to auto-immune diseases, diabetes, thyroid disease, hypertension, hepatitis infection, vaccination, drug consumption, etc.

  5. Hormonal Factors: Some cases of LPP have been linked to hormonal fluctuations, particularly in women. However, in many cases, these pigmented lesions might arise spontaneously in the absence of any triggers.

Treatment Options for Lichen Planus Pigmentosus


Treatment may not always require immediate treatment, especially if there is no pain or discomfort. In many cases, the condition resolves on its own over a period of months to years. However, if symptoms like itching, discomfort, or slow healing are present, various treatment options can be considered under the guidance of a healthcare professional.


1. Corticosteroids

Corticosteroids, available as creams or ointments, are often the first-line treatment. These topical medications can effectively reduce inflammation, edema, and discomfort. However, in more severe or extensive cases, oral corticosteroids or injections may be recommended.


It is crucial to follow the prescribed dosage and usage to ensure their safe and effective use.


2. Immunomodulatory Drugs

For individuals with severe symptoms, immunomodulatory drugs may be prescribed to modify the body's immune response. Topical medications like tacrolimus and pimecrolimus can be used as a substitute for or in conjunction with topical corticosteroids to reduce their side effects.


Systemic therapies, including cyclosporine, methotrexate combined with azathioprine, mycophenolate, thalidomide, and sulfasalazine have shown promise, but more studies are required to establish their efficacy.


3. Antihistamines

Oral antihistamines like cetirizine, levocetirizine, bilastine, fexofenadine, desloratadine, etc, can be helpful in alleviating itching.


4. Light Therapy (Phototherapy)

Light therapy, also known as phototherapy, including ultraviolet (UV) B, can improve skin affected by lichen planus pigmentosus. However, it's essential to be cautious as postinflammatory hyperpigmentation may persist after the skin has healed.


5. Retinoids

Retinoid medications, available as topical or oral treatments, can be recommended by your doctor. Acitretin is one such example. However, pregnant women or those planning to become pregnant should avoid retinoids, as they carry the risk of causing birth abnormalities. If pregnant or breastfeeding, alternative treatment options should be considered after consulting with a healthcare professional.


6. Orally Administered Antibiotics

Oral medications like hydroxychloroquine and metronidazole are used in conjunction with steroids. These drugs have shown some success in managing the condition, but further research is needed to understand their full effectiveness.

7. Chemical Peels

Superficial chemical peels can aid in reducing pigmentation and enhancing skin texture. However, their usage is usually limited if there is extensive body surface area involvement.


8. Laser therapy

Nd:YAG laser therapy has shown promising results in a few clinical trials, but more robust data is lacking.


9. Sun Protection

Regular use of broad-spectrum sunscreen and protective clothing is crucial to prevent the worsening of pigmentation due to sun exposure.


Managing Lichen Planus Pigmentosus Effectively

  1. Consult a Dermatologist: If you suspect you have lichen planus pigmentosus, seek a professional diagnosis and personalized treatment plan from a dermatologist.

  2. Sun Safety: Minimize sun exposure and use sunscreen daily to prevent worsening of pigmentation.

  3. Treatment Adherence: Follow your prescribed treatment regimen consistently for optimal results.

  4. Skin Care: Maintain a gentle skincare routine to keep your skin clean and moisturized.

Lichen Planus Pigmentosus Differential Diagnosis

  1. Ashy Dermatosis Ashy dermatosis or erythema dyschromicum perstance is the primary differential diagnosis for lichen planus pigmentosus. These conditions can be indistinguishable from

  2. Fixed drug eruption

  3. Postinflammatory hyperpigmentation

  4. Macular amyloidosis

  5. Frictional melanosis

  6. Berloque dermatitis

  7. Urticaria pigmentosa

  8. Pigmented cosmetic dermatitis

  9. Idiopathic eruptive macular pigmentation

  10. Hyperpigmentation due to drugs and heavy metals.

Conclusion


Lichen planus pigmentosus can be a distressing skin condition, but it can be effectively managed with the right approach. By understanding its causes, recognizing its symptoms, and exploring the available treatment options, individuals can take control of their skin health and achieve a more even complexion.


If you suspect you have lichen planus pigmentosus, consult a dermatologist to receive an accurate diagnosis and guidance on the most suitable treatment plan for your unique needs.


FAQs

Is lichen planus pigmentosus curable?

Just like most auto-immune diseases, the course of lichen planus pigmetosus can be unpredictable. However, overall, lichen planus pigmentosus has a good clearance rate with appropriate topical and systemic therapy.


Itching, discomfort, and healing might all be improved with the use of medications. At times, the disease might resolve on its own in a few months or years. However, the residual hyperpigmentation might not be completely curable.


Is lichen planus pigmentosus an autoimmune disease?


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