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Twenty-five year old male patient presenting with asymptomatic brown spots, on cervical, axillary, inguinal and popliteal regions, for the last nine months.

Pathological examination showed hydropic degeneration of the basal layer, pigmentary incontinence and moderate inflammatory lymphocytic infiltrate in the dermis. Lichen planus pigmentosus inversus is a rare subtype of lichen planus characterized by hyperchromic, asymptomatic or mildly pruritic macules, measuring from millimeters to centimeters in diameter, with defined borders, affecting intertriginous areas, most commonly in the axillae and groin of Caucasian patients.

It presents unique lichenoid histology. We report a case with typical clinical features, histology and evolution.

Lichen planus pigmentosus inversus LPPI is a pigmentary cutaneous manifestation located on skin-fold areas, and considered a rare variant pigemntoso lichen planus pigmentosus.

The etiology is unknown, without any causal relation to medications or sun exposure. The pathogenesis appears to be related to a T lymphocyte-mediated, cytotoxic activity against basal keratinocytes. Usually, mucosae, scalp, and palmoplantar areas are not affected by the disease. A twenty-five year old male patient, brown-skinned, ipgmentoso that for the past 9 months he had noticed the appearance of asymptomatic brown spots, on the cervical region, axillary, inguinal and popliteal folds.

He denied the appearance of other cutaneous ipgmentoso, pruritus, systemic ppigmentoso, previous diseases or the use of illicit drugs or medications. There were not other lesions either on skin, nails, scalp, or mucosae, nor signs of lymphadenomegaly.

Extensive pigmenyoso confluent hyperchromic liiquen, with smooth surface and well-marked edges, on the right and left axillae. Over the affected skin areas, the direct exams and cultures for fungi and bacteria were all negative. Complete blood counts, liver tests and electrolyte results were all within the normal range. Hepatitis C serology was negative. Anatomopathological exams of the lesions were performed from distinct samples right and left axillaand repeated on a three-month interval with identical characteristics: Epidermis with hyperkeratotic foci and light perivascular inflammatory mononuclear infiltrate HE, x.

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Based on the clinical and histopathological features we reached the diagnosis of lichen planus pigmentosus inversus. After four months, without any further treatment, the patient presented with a discreet improvement on the cervical pigmentodo popliteal regions, whilst axillary lesions remained unaltered.

The term lichen planus pigmentosus inversus LPPI was proposed by Pock et al inafter the report of 7 cases of lichen planus pigmentosus located predominantly on intertriginous areas. LPPI is a chronic inflammatory affection, occurring in the intertriginous areas of individuals with fair skin. Cases affecting Asian patients have been more frequently reported and until the present there were not any cases reported on the indexed national medical literature.

Liauen 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.

Plgmentoso patient described here is a young adult male 25 years-oldof brown skin, with extensive non-pruriginous clinical features, affecting several areas axillary, cervical, inguinal and popliteal.

Also of notice is the absence of other dermatological and systemic abnormalities. These data are in accordance with the previously reported cases. Larger lesions tend to have a linear or angular configuration, with the longitudinal axis following the cleavage lines. Wickham striae have also been reported.

Líquen plano pigmentoso invertido

The main differential diagnoses are erythema dyschromicum perstans, post-inflammatory hyperpigmentation, figurate erythema, fixed drug eruption and lichen planus pigmentosus. The latter, however, appears after sun exposure, and in photoexposed areas, unlike LPPI, which predominates in intertriginous areas.

The most difficult differential diagnosis is with ashy dermatosis, this, however, affects brown skinned patients, with a tropism for the torso and limbs and not for intertriginous areas and with erythematous borders on the edges of active lesions. There is epidermic atrophy with irregular hydropic degeneration on the basal layer and an absence of epidermic hyperplasia usually present on lichen planus.

In the superior dermis, there is exuberant pigmentary incontinence, with melanophages and a lichenoid inflammatory infiltrate containing lymphocytes and pihmentoso, in a variable pattern, according to the clinical stage of lichenoid regression.

Histopathology, as in the case reported here, revealed marked pigmentary incontinence and discreet lichenoid infiltrate. Similarly to typical lichen planus, there is a pigmentosso proliferation of those keratinocytes, which do not develop in intertriginous areas. This disease evolves with a variable clinical course; in general there is a rapid appearance of hyper-chromic macules, those being the most frequently found lesions and not the traditional papules 3 – 9 Some cases will resolve in some weeks without therapy, while others may persist for years.

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National Center for Biotechnology InformationU. Journal List An Bras Dermatol v. Find articles by Hugo Rocha Barros. Find articles by Sandra Lopes Mattos e Dinato.

Oral lichen planus

Find articles by Angelo Sementilli. Find articles by Ney Romiti. Author information Article notes Copyright and License information Disclaimer. Hugo Rocha Barros, Rua Dr.

Received Mar 7; Accepted Oiquen This is pigmentosi Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC. Abstract Twenty-five year old male patient presenting with asymptomatic brown spots, on cervical, axillary, inguinal and popliteal regions, for the last nine months.

Axilla, Groin, Lichen planus, Lichenoid eruptions, Skinfold thickness.

CASE REPORT A twenty-five year old male patient, brown-skinned, informed that for the past 9 months he had noticed the appearance of pigmentoxo brown spots, on the cervical region, axillary, inguinal and popliteal folds.

Open in a separate window. Discreet degeneration on the basal layer and pigmentary incontinence HE, x.

Hyperchromic confluent macules on the posterior cervical region. Gaertner E, Elstein W. Case report and review of an unusual entity.

Lichen Planus and Lichenoid Disorders. J Eur Acad Dermatol Venereol. A case of lichen planus pigmentosus-inversus in a Korean patient. Two Japanese cases of lichen planus pigmentosus-inversus.

Lichen planus pigmentosus: A short review Mathews I, Thappa DM, Singh N, Gochhait D – Pigment Int

Lichen planus pigmentosus-inversus occurring extensively in multiple intertriginous areas. Liquen plano pigmentoso inverso: Support Center Support Center. Please review our privacy policy.