Lichen planus pigmentosus (inversus) L43.8

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 20.01.2021

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Synonym(s)

Inverse lichen planus pigmentosus; Pigmented inverse lichen planus; Pigmented lichen planus inversus; Pigmented lichen ruber planus inversus

History
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Pock, 2001

Definition
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Rare brownish coloured variant of the classic Lichen planus, often located in the large articular flexures, in which the characteristic red-violet colour of the Lichen planus is supplemented or completely replaced by a brown colour component.

Occurrence/Epidemiology
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Has been described preferably in Caucasians and Asians.

Worldwide, about 50 cases have been described so far (Note: such numbers say little about the actual prevalence of the Lichen planus pigmentosus inversus, which every practicing dermatologist has already found in his clients).

Manifestation
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Affected are adults between 40 and 60 years of age. In children this clinical picture has not been described. w>m=2:1

Localization
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The lichen planus pigmentosus occurs mainly in the intertriginous areas, i.e. axillary, in the popliteal fossa, submammary, in the groin region as well as on the vulva and penis.

Clinical features
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Well-demarcated, disseminated, 0.2-0.5 cm, only mildly pruritic, purplish-brown or homogeneous brown patches are found. These may confluence to form extensive, irregularly configured, patches. The lesions tend to be chronic, lasting months or years.

Histology
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The histology of this lichen planus variant shows the characteristic phenomena of lichen planus, with lichenoidal infiltrates in band form, mostly only minor orthohyperkeratosis (intertrigines) and a conspicuous pigment incontinence.

Differential diagnosis
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Literature
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  1. Chen S et al (2015) Lichen planus pigmentosus-inversus: report of three Chinese cases and review of the published work. J Dermatol 42: 77-80
  2. Ghorbel HH et al (2014) Lichen planus pigmentosus inversus. Indian J Dermatol Venereol Leprol 80:580
  3. Murzaku EC et al (2014) Axillary lichen planus pigmentosus-inversus: dermoscopic clues of a rare entity. Diagnosis: lichen planus pigmentosus (LPP). J Am Acad Dermatol 71:e119-20
  4. Pock L et al (2001) Lichen planus pigmentosus inversus. J Eur Acad Dermatol Venereol 15: 452-454
  5. Schmid C et al (2018) Slate grey patches in both armpits. Dermatologist 69: 177-179
  6. Sindhura KB (2015) Lichen planus pigmentosus: a retrospective clinico-epidemiological study with emphasis on the rare follicular variant. J Eur Acad Dermatol Venereol doi: 10.1111/jdv.1345

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Erythema dyschromicum perstans;

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Last updated on: 20.01.2021