What is Lichen Planus Pigmentosus?
LPP is a rare type of lichen planus. Lichen Planus Pigmentosus is a condition in which there is the presence of asymptomatic slaty-grey flakes which are persistently present mainly on the face and sun-exposed areas. The pattern presented in it is mostly actinic in which pigmentation is diffuse and symmetrical. It is known to be a variant of cutaneous Lichen planus in which flexural and sun-exposed areas of the body are affected.
What is the prevalence of LPP?
LPP is a common disease in India as well as in the Middle East found mostly in Middle-aged with a greater incidence in females
Also Read: Lichen Planus
What are the causes of Lichen Planus Pigmentosus?
There is not a particularly known etiology, but some trigger factors can contribute to its development:
- Genetics: A family history of this may increase the risk of developing it
- Sun exposure: As it mainly occurs in sun-exposed areas, UV radiation plays a role in its development.
- Immune response: Abnormal immune response towards melanocytes may cause hyperpigmentation
- Triggering factors: Topical agents like mustard or amla oil, Henna, hair dyes, etc. may also trigger it
- Viral infections: Association of Hepatitis C infection in some cases
- Hormonal factors: Fluctuations in hormones in females are also associated with it
How does LPP develop?
LPP occurs when the CD8+ autoreactive T cells start attacking epidermal keratinocytes, leading to an inflammatory lichenoid response. As a result, the initial inflammatory infiltrate gets resolved quickly and leaves behind marked dermal pigmentary incontinence.
What are the commonly affected areas in lichen planus?
Commonly affected areas include:
- Face
- Neck
- Upper limbs
- Axillae
- Groin
What is the appearance of lesions of Lichen Planus Pigmentosus?
Initially, the lesions are oval macules which are small, and black with diffuse borders and later these merge into grey-brown pigmented areas. The patches of LPP look symmetrical and are found in different patterns like blaschkoid, zosteriform or segmental pattern.
What are the symptoms of Lichen Planus Pigmentosus
LPP is usually a disease in the third and fourth decade of life and the symptoms of the lesions include:
- Mild pruritus
- Slaty grey-brown papules or macules
- Diffuse pigmentation pattern
- No inflammation
How does LPP occur?
Occurs mainly in isolation and in only 20% of cases it occurs along with the following conditions:
- Frontal fibrosing alopecia
- Oral LP
- Classic LP
- Lichen planopilaris
Also Read: Lichen Simplex Chronicus/ Neurodermatitis
What are the diseases that can be associated with LPP?
It can be associated or present along with the following:
- Nephrotic syndrome
- Hepatitis C
- Acrodermatitis of Bazex
What is the differential diagnosis of LPP?
- Ashy dermatosis
- Lichenoid drug eruption
- Maturational hyperpigmentation
- Melasma
- Macular amyloidosis
- Fixed drug eruption
- Pigmented contact dermatitis
- Idiopathic eruptive macular pigmentation
- Actinic lichen planus
- Acanthosis nigricans
- Linear psoriasis
- Linear lichen planus
Also Read: LICHEN PLANUS TREATED SUCCESSFULLY BY HOMEOPATHY
How to manage LPP?
Lichen Planus Pigmentosus is effectively managed in the following ways:
Skincare:
Skin to be kept moisturized and clean
Sun safety:
- Minimize sun exposure
- Sunscreen is to be applied daily
What is the prognosis of Lichen Planus Pigmentosus?
The course and prognosis of the disease are variable as the pigmentation may resolve spontaneously or last from a few weeks to months. The course of LPP is also unpredictable.
How is LPP managed homeopathically?
Following homoeopathic medicines can help treat Lichen Planus Pigmentosus:
- Antimonium crudum: It is the best remedy for LPP where the skin looks dry with intense itching. Eruptions are measles-like and itching and burning on these is worse from the heat of bed. Gastric derangements are present along with this.
- Thuja: Where hyperpigmented eruptions are brown-coloured and present mostly on the face, hands and arms, this medicine is considered effective. Violent itching is presented which gets better by cold bathing.
- Sulphur Iodatum: Papular eruptions are present with intense itching on the ears and neck. Obstinate skin affections and mainly arms are covered with an itching rash.
- Arsenic album: The skin eruptions are burning, and the patient is extremely restless and anxious. Papular, dry eruptions which are worse from itching and cold are present.
- Lachesis: Skin appears blue, and black in appearance and eruptions look bluish. Tight clothing is unbearable around the neck, abdomen and head
