Lichen planus pigmentosus inversus: 3 cases

Lichen planus pigmentosus inversus: 3 cases

Asmae Lahlou^1,&, Sara Elloudi¹, Salim Gallouj¹, Fatima-Zohra Mernissi¹

 

¹University Hospital Hassan II, Dermatology Department, Fez, Morocco

 

 

^&Corresponding author
Asmae Lahlou, University Hospital Hassan II, Dermatology Department, Fez, Morocco

 

 

 

 

Lichen planus pigmentosus inversus is a rare variant of lichen planus pigmentosus [1]. The eruption of lichen planus pigmentosus-inversus occurs mainly in the flexural regions and presents with brownish macules and patches with or without pruritus [2]. Approximately 20 cases are reported in the medical literature worldwide. The etiology is unknown, without any causal relation to medications or sun exposure [3]. We report 3 cases of three women who had asymptomatic lesions hyperpigmented at the folds.

 

 

Observation 1: a 53-year old women, phototype IV, followed in gastrology for viral hepatitis C in which no treatment currently, presented with asymptomatic brown macules in the inguinal area, umbilical, and some elements in the axilla (Figure 1). There was an absence of lesions on scalp, mucosae and nails, Histologic examination revealed a dense mononuclear inflammatory infiltrate papillary dermis epidermal performing a sub band image at net lower limit nibbling epidermal ridges and by giving them an arcuate appearance and a pigment incontinence. These clinical and histological findings were consistent with a diagnosis of Lichen planus pigmentosus inversus.

 

Observation 2: a 22 -year old women, phototype IV, without significant pathological antecedents, presented with asymptomatic brown macules in the left inguinal area (Figure 2), which the pathological examination revealed lichen planus, and clinical symptomatology is compatible with lichen Lichen planus pigmentosus inversus.

 

Observation 3: a 28-year old women, phototype IV, without significant pathological antecedents presented of 7 years duration pigmented macules at all the folds, lesions slightly itchy (Figure 3).

 

 

The term lichen planus pigmentosus inversus (LPPI) was proposed by Pock et al in 2001, after the report of 7 cases of lichen planus pigmentosus located predominantly on intertriginous areas [1]. Gaertner and Elstein, in 2012, considered the clinical and histological manifestations of LPPI as distinct from other similar entities [4]. LPPI is a chronic inflammatory affection, it’s a variant of lichen plan pigmentosus, it is a rare disease occurring in the intertriginous areas of individuals with fair skin, while our observations have described the occurrence of these lesions on skin type IV The etiology is unknown, without any causal relation to medications or sun exposure [5]. The pathogenesis appears to be related to a T lymphocyte-mediated, cytotoxic activity against basal keratinocytes [1-3]. The most affected areas were the axillary, inguinal and inframammary regions, There was an absence of lesions on scalp, mucosae and nails in all cases reported, as the case of our patients [6]. The characteristic manifestations of LPPI are hyperchromic macules, usually small, lenticular, with discreet to absent pruritus, affecting intertriginous areas, mainly axillae and also cervical, inguinal and popliteal areas. Wickham striae have also been reported Histopathology, as in the case reported here, revealed marked pigmentary incontinence and discreet lichenoid infiltrate similarly to typical lichen planus, there is a compensatory proliferation of those keratinocytes, which do not develop in intertriginous areas [1, 7]. The differential diagnosis includes fixed drug eruption, acanthosis nigricans, candida intertrigo, erythrasma, post-inflammatory pigmentation, lichenoid toxic dermatitis or ashy dermatosis [8]. Our case presented with asymptomatic brown macules and patches in the flexural areas showing a strong incontinence of pigment and a mild lymphocytic infiltrate in the upper dermis.

 

 

We have described three rare cases of Lichen planus pigmentosus inversus one plane in a patient with hepatitis C serology positive based on clinical appearance of lesions and their location at the folds and a histological confirmation.

 

 

The authors declare no competing interests.

 

 

All authors have read and agreed to the final version of this manuscript.

 

 

Figure 1: inversus lichen at the great folds of the abdomen

Figure 2: lichen inversus in the inguinal folds

Figure 3: inversus lichen at the sub mammary fold

 

 

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 Sep; 15(5): 452-4. PubMed | Google Scholar


2. Kim BS, Park KD, Chi SG, Ko HC, Lee WJ, Lee SJ et al. Two cases of lichen planus pigmentosus-inversus arising from long-standing lichen planus-inversus. Ann Dermatol. 2008 Dec; 20(4): 254-6. PubMed | Google Scholar


3. Hugo RB, José RP, Sandra LM, Angelo S, Ney R. Lichen planus pigmentosus inversus. An Bras Dermatol. 2013 Nov-Dec; 88(6 Suppl 1): 146-9. PubMed | Google Scholar


4. Gaertner E, Elstein W. Lichen planus pigmentosus-inversus: case report and review of an unusual entity. Dermatol Online J. 2012 Feb 15; 18(2): 11. PubMed | Google Scholar


5. Ghorbel HH, Badri T, Brahim EB, Fenniche S, Benmously R, Mokhtar I. Lichen planus pigmentosus inversus . Indian J Dermatol Venereol Leprol. 2014 Nov-Dec; 80(6): 580. PubMed | Google Scholar


6. Kashima A, Tajiri A, Yamashita A, Asada Y, Setoyama M. Two Japanese cases of lichen planus pigmentosus-inversus. Int J Dermatol. 2007 Jul;46(7):740-2. PubMed | Google Scholar


7. Jung YJ, Lee YH, Lee SY, Lee WS. A case of lichen planus pigmentosus-inversus in a Korean patient. Ann Dermatol. 2011 Feb; 23(1): 61-3. PubMed | Google Scholar


8. Ohshima N, Shirai A, Saito I, Asahina A. Lichen planus pigmentosus-inversus occurring extensively in multiple intertriginous areas. J Dermatol. 2012 Apr; 39(4): 412-4. PubMed | Google Scholar