|THE CLINICAL PICTURE
|Year : 2019 | Volume
| Issue : 2 | Page : 115-116
Koebnerization and lichen planus pigmentosus: Is it a reality?
Seema Manjunath, Divya Kamat, Muthu Sendhil Kumaran
Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
|Date of Web Publication||19-Dec-2019|
Additional Professor Muthu Sendhil Kumaran
Department of Dermatology, Venereology and Leprology, PGIMER, Chandigarh, India 160012
Source of Support: None, Conflict of Interest: None
Keywords: lichen planus pigmentosus, koebnerization
|How to cite this article:|
Manjunath S, Kamat D, Kumaran MS. Koebnerization and lichen planus pigmentosus: Is it a reality?. Pigment Int 2019;6:115-6
Two middle-aged females presented with 6-months history of asymptomatic bluish grey macules over the back and chest conforming to the impression of their undergarment ([Figure 1]a, 1b). They denied any history of preceding erythema or scaling or significant sun exposure, any drug intake, contact with chemicals, perfumes, or plants. On examination, multiple greyish black-colored macules coalescing to form patches surface changes were present on chest and back, localized to the area beneath the undergarments. Few similar greyish blue macules were also seen over both arms. On dermatooscopy, multiple brown-black dots were seen sparing the eccrine glands. In addition, brown to bluish-grey dots, globules, and blotches in diffuse brownish background were noted ([Figure 2]). Histopathology of skin biopsy in both patients revealed orthokeratosis with basal cell vacuolization, pigment incontinence, and upper dermal perivascular lymphocytic infiltrate suggestive of lichen planus pigmentosus ([Figure 3]). Both patients were treated with topical mometasone 0.1% cream and tacrolimus 0.1% ointment for 6 months without any improvement.
|Figure 1 a and 1b Multiple bluish grey macules coalescing to form the shape of the undergarment.|
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|Figure 2 Multiple black and bluish-grey dots, globules, and blotches in diffuse brownish background (Dermlite DL3N,x10).|
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|Figure 3 Basal cell vacuolar degeneration, melanin incontinence, and perivascular mononuclear inflammatory infiltrate seen on H & E stain (200X).|
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Lichen planuspigmentosus (LPP) is considered a variant of lichen planus (LP) with controversial nosological status. It is thought to be a type IV hypersensitivity reaction to unknown antigen with lichenoid inflammation, leading to melanin incontinence and superficial dermal pigmentation without any clinical evidence of inflammation. The face, neck, trunk, arms, and legs are the most common areas of presentation, whereas involvement of the scalp, nails, or oral mucosa is relatively rare. Pigmentation is usually symmetrical, and most frequently seen pattern is diffuse followed by reticular, blotchy, and perifollicular; rare patterns include linear/blaschkoid LPP and zosteriform LPP. Presentation as seen in our patients—undergarment-like distribution pattern is unique and rare. The underlying cause of this varied presentation could be koebnerization due to friction or due to tight clothing. This peculiar distribution leads to speculation about role of the phenomenon of koebnerisation which is commonly reported in LP.
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| References|| |
Kumaran MS, Dabas G, Parsad D, Vinay K. Lichen planus pigmentosus − An appraisal. International Journal of Dermatology 2018;57:748-50. doi:10.1111/ijd.13982.
Kim BS, Park KD, Chi SG et al.
Two cases of lichen planus pigmentosus-inversus arising from long-standing lichen planus-inversus. Annals of Dermatology 2008;20:254. doi:10.5021/ad.2008.20.4.254.
[Figure 1], [Figure 2], [Figure 3]