Two Cases of Lichen Planus Pigmentosus-inversus Arising: CASE REPORT

22 Feb
2011

The first patient was a 49-year-old woman who presented complaining of violaceous reticulated patches and scattered rice grain-sized macules localized to the left inguinal area for several months (Fig. 1A). She had no subjective symptoms, such as pruritus or pain. She had not come into contact with any chemicals, animals, or plants, nor had she been using any medications that could prompt an allergic response. Her medical and family history were non-contributory. A skin biopsy from a vio­laceous patch revealed irregular acanthosis, vacuolar alteration of the basal layer, and marked band-like dermal lymphocytic infiltration with pigment in­continence (Fig. 1B). These histological features suggested the presence of classic LP. Thereafter, the lesions slowly flattened and changed color to brown. Although we could not examine the flattened lesions histologically, we hypothesized that lesions of classic LP located only in intertriginous areas may have changed into LPP sometime later.

Fig. 1. (A) Violaceous annular patches

Fig. 1. (A) Violaceous annular patches and scattered rice grain-sized macules are seen in the left inguinal region. (B) Mild hydropic degeneration of the basal keratinocytes and marked, band-like dermal lymphocytic infiltration with pigment incontinence are seen on histopathological examination (H&E, x200).

The second patient was a 25-year-old woman who complained of multiple brownish macules scattered on both axillae for one year (Fig. 2A). Recently, a solitary pigmented atrophic patch was also found on the left inner thigh (Fig. 2B). She was not symptomatic. The size of the lesions increased gradually. There were also some tiny papules around the lesions in the axilla. According to the patient, some of the papules had flattened into macular components. A skin biopsy was performed on the axillary and inner thigh lesions. The papular lesions in the axilla showed histological features consistent with classic LP (Fig. 2C). Thinning of the epidermis and pigmentary incontinence were prominent features of the thigh lesions. These features found in the thigh lesions were consistent with LPP.
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Fig. 2. Several brownish-to-purplish

Fig. 2. Several brownish-to-purplish papules and macules are located in the axillae (A) and in the right inner thigh (B). Histopathological examination of the papular lesions in the axilla shows dense, band-like, predominantly lymphocytic infiltrates in the papillary dermis and vacuolar alteration of the basal layer with some necrotic keratinocytes (C) (H&E, x200).

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