DERMOSCOPY
CASES OF THE MONTH
Axillary lichen planus pigmentosus-inversus: Dermoscopic clues of a rare entity Era Caterina Murzaku, BS,a Tara Bronsnick, BA,a and Babar K. Rao, MDb Piscataway and Somerset, New Jersey
CLINICAL PRESENTATION A 45-year-old Hispanic woman presented with a 2-year history of mildly pruritic ‘‘dark spots’’ on her axilla. Physical examination revealed poorly defined papules coalescing into 3 violaceous, lichenified, scaly, linear plaques on the right axilla (Fig 1). Twice-daily use of 0.25% triamcinolone cream for 4 weeks resulted in no clinical improvement of the lesions.
Fig 1. Clinical appearance of lichen planus pigmentosus-inversus.
DERMOSCOPIC APPEARANCE Dermoscopic evaluation revealed diffuse brown patches containing multiple granular gray-brown dots and an overlying scale (Fig 2).
From Rutgers Robert Wood Johnson Medical School,a Piscataway, and the Department of Dermatology,b Rutgers Robert Wood Johnson Medical School, Somerset. Funding sources: None. Conflicts of interest: None declared. Correspondence to: Era Caterina Murzaku, BS, Rutgers Robert Wood Johnson Medical School, 675 Hoes Ln, Piscataway, NJ 08854. E-mail: [email protected].
J Am Acad Dermatol 2014;71:e119-20. 0190-9622/$36.00 ª 2014 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2014.01.881
e119
e120 Murzaku, Bronsnick, and Rao
J AM ACAD DERMATOL
OCTOBER 2014
Fig 2. Dermoscopic appearance of lichen planus pigmentosus-inversus.
HISTOLOGIC DIAGNOSIS Histopathology was significant for irregular epidermal hyperplasia with hyperkeratosis and parakeratosis. There was interface dermatitis with a lichenoid inflammatory infiltrate. Focal necrotic keratinocytes were observed in the basal layer, and there was prominent pigment incontinence (Fig 3). These findings were consistent with lichen planus pigmentosus (LPP).
Fig 3. Histologic appearance of lichen planus pigmentosus-inversus.
KEY MESSAGE LPP is a rare variant of lichen planus (LP) that, when localized to the groin, axillae, and other intertriginous areas, is termed LPP-inversus (LPP-I).1 The differential diagnosis includes LP, contact dermatitis, acanthosis nigricans, and axillary granular parakaratosis. LPP-I lesions can be recalcitrant to treatment and may persist for years. Determining prognosis is often difficult for physicians and a source of stress for patients. In classic LP, dermoscopy has aided in distinguishing lesions with a longer clinical course; a large number of dotted granules present on dermoscopy have been found to suggest slower lesion resolution.2 In our patient, the dermoscopic observation of multiple granular dots may be indicative of a poorer prognosis, the prolonged persistence of the lesions, and a failure to respond to treatment.
REFERENCES 1. Gaertner E, Elstein W. Lichen planus pigmentosus-inversus: case report and review of an unusual entity. Dermatol Online J 2013;18:11. 2. Vazquez-L opez F, Maldonado-Seral C, L opez-Escobar M, Perez-Oliva N. Dermoscopy of pigmented lichen planus lesions. Clin Exp Dermatol 2003;28:554-5.
CASES OF THE MONTH
Axillary lichen planus pigmentosus-inversus: Dermoscopic clues of a rare entity Era Caterina Murzaku, BS,a Tara Bronsnick, BA,a and Babar K. Rao, MDb Piscataway and Somerset, New Jersey
CLINICAL PRESENTATION A 45-year-old Hispanic woman presented with a 2-year history of mildly pruritic ‘‘dark spots’’ on her axilla. Physical examination revealed poorly defined papules coalescing into 3 violaceous, lichenified, scaly, linear plaques on the right axilla (Fig 1). Twice-daily use of 0.25% triamcinolone cream for 4 weeks resulted in no clinical improvement of the lesions.
Fig 1. Clinical appearance of lichen planus pigmentosus-inversus.
DERMOSCOPIC APPEARANCE Dermoscopic evaluation revealed diffuse brown patches containing multiple granular gray-brown dots and an overlying scale (Fig 2).
From Rutgers Robert Wood Johnson Medical School,a Piscataway, and the Department of Dermatology,b Rutgers Robert Wood Johnson Medical School, Somerset. Funding sources: None. Conflicts of interest: None declared. Correspondence to: Era Caterina Murzaku, BS, Rutgers Robert Wood Johnson Medical School, 675 Hoes Ln, Piscataway, NJ 08854. E-mail: [email protected].
J Am Acad Dermatol 2014;71:e119-20. 0190-9622/$36.00 ª 2014 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2014.01.881
e119
e120 Murzaku, Bronsnick, and Rao
J AM ACAD DERMATOL
OCTOBER 2014
Fig 2. Dermoscopic appearance of lichen planus pigmentosus-inversus.
HISTOLOGIC DIAGNOSIS Histopathology was significant for irregular epidermal hyperplasia with hyperkeratosis and parakeratosis. There was interface dermatitis with a lichenoid inflammatory infiltrate. Focal necrotic keratinocytes were observed in the basal layer, and there was prominent pigment incontinence (Fig 3). These findings were consistent with lichen planus pigmentosus (LPP).
Fig 3. Histologic appearance of lichen planus pigmentosus-inversus.
KEY MESSAGE LPP is a rare variant of lichen planus (LP) that, when localized to the groin, axillae, and other intertriginous areas, is termed LPP-inversus (LPP-I).1 The differential diagnosis includes LP, contact dermatitis, acanthosis nigricans, and axillary granular parakaratosis. LPP-I lesions can be recalcitrant to treatment and may persist for years. Determining prognosis is often difficult for physicians and a source of stress for patients. In classic LP, dermoscopy has aided in distinguishing lesions with a longer clinical course; a large number of dotted granules present on dermoscopy have been found to suggest slower lesion resolution.2 In our patient, the dermoscopic observation of multiple granular dots may be indicative of a poorer prognosis, the prolonged persistence of the lesions, and a failure to respond to treatment.
REFERENCES 1. Gaertner E, Elstein W. Lichen planus pigmentosus-inversus: case report and review of an unusual entity. Dermatol Online J 2013;18:11. 2. Vazquez-L opez F, Maldonado-Seral C, L opez-Escobar M, Perez-Oliva N. Dermoscopy of pigmented lichen planus lesions. Clin Exp Dermatol 2003;28:554-5.
