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| LETTER TO THE EDITOR |
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| Year : 2021 | Volume
: 8
| Issue : 1 | Page : 62-63 |
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Lichen planus pigmentosus mimicking an amateur tattoo: an atypical presentation
Sunmeet Sandhu MD , Prince Yuvraj Singh, Preema Sinha, Shekhar Neema
Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India
| Date of Submission | 24-Mar-2020 |
| Date of Decision | 04-Jun-2020 |
| Date of Acceptance | 27-Jul-2020 |
| Date of Web Publication | 07-Apr-2021 |
Correspondence Address:
Dr. Sunmeet Sandhu
Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/Pigmentinternational.Pigmentinternational_
How to cite this article:
Sandhu S, Singh PY, Sinha P, Neema S. Lichen planus pigmentosus mimicking an amateur tattoo: an atypical presentation. Pigment Int 2021;8:62-3 |
A 39-years-old male, presented with asymptomatic, progressively increasing dark colored pigmentation on nape of neck of two years duration. Patient denied any history of excessive sun exposure, any procedure, tattooing, trauma, hair dye application, repeated friction with an external object, previous inflammatory condition over the same site or any incriminating drug intake prior to the onset of lesion.
Examination revealed a well-defined grey brown hyperpigmented macule with bluish-black hyperpigmented margins measuring around 10 cm × 5cm arranged in a bean-shaped configuration over the nape of neck [Figure 1]. Mucosae, hairs and nails were normal. Dermoscopy showed slate-grey to blue dots and globules in perieccrine and perifollicular pattern suggestive of lichen planus pigmentosus (Dermlite DL4 10X) [Figure 2]. Routine blood and urine examination was within normal limit. Hepatitis B and C profile was negative. Histological examination revealed epidermis with orthokeratosis, hypergranulosis, basal layer vacuolar degeneration and civatte bodies. Dermis showed band like lymphomononuclear infiltrate and melanin incontinence [Figure 3]. Based on clinical, dermoscopic and histopathological features, a final diagnosis of Lichen planus pigmentosus was made. | Figure 1 Grey-brown hyperpigmented macule with bluish-black hyperpigmented margins arranged in a kidney-shaped configuration over the nape of the neck
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 | Figure 2 Dermoscopy (Dermlite DL4 10X) shows slate-grey to blue dots and globules in perieccrine (yellow arrow) and perifollicular pattern (black circle)
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 | Figure 3 Histopathology showing epidermal thinning, basal cell degeneration (red box), Civatte bodies, pigment incontinence and a lymphomononuclear infiltration in the dermis (red arrow) (H&E stain, x10)
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Lichen planus pigmentosus (LPP), first described by Bhutani et al.[1] is a relatively common pigmentary disorder of skin with an unknown etiology. Many authors regard it as a variant of lichen planus (LP) due to its histopathological similarities and association with classic LP. Other etiological hypothesis include use of cosmetics, fragrances, hair dyes, and mustard oil, infections (hepatitis C), post-inflammatory, idiopathic etc.[2] Clinically, it is characterized by asymptomatic slate-grey to bluish-black macules most commonly on sun-exposed areas such as face, neck, and extremities. Different morphologic patterns as described by Kanwar et al. include diffuse, reticular, blotchy and perifollicular.[3] Also several atypical variants of LPP have been reported as linear, inversus, and zosteriform. Histology typically demonstrates a dense, band-like lichenoid infiltrate with necrotic keratinocytes and pigment incontinence. Dermoscopy is characterised by the presence of pigment pattern like slate grey-to-blue dots and globules, perifollicular and peri-eccrine pigment deposition.[4] Our patient presented with atypical form of LPP with a localised bluish black pigmentation in bean-shaped configuration with hyperpigmented margins. Post inflammatory hyperpigmentation with lichenoid hue was ruled out in this case as the patient denied any previous inflammatory dermatosis at the similar site. Differential diagnoses of LPP include Riehl’s melanosis and erythema dyschromicum perstans (EDP). Lack of any history of hair dye application or any exposure to cosmetics/chemicals excluded Riehl’s melanosis. EDP or ashy dermatosis may mimic LPP with similar histology but it typically involves the trunk and is characterized by hyperpigmented patches surrounded by erythema. Another clinical differential considered in this patient was traumatic or amateur tattoo. Tattooing involves making a mark on a part of the body with indelible design by inserting exogenous pigment into punctures in the dermis. These can be divided into professional tattoo, amateur tattoos, cosmetic tattoos, traumatic tattoos and medical tattoos. But lack of history of any procedure or trauma ruled out any form of tattooing in our patient.
In conclusion, LPP presents in many atypical presentations and should be considered as a differential diagnosis in every case of asymptomatic pigmentary disorder irrespective of its site and pattern of presentation.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Bhutani LK, Bedi TR, Pandhi RK, Nayak NC. Lichen planus pigmentosus. Dermatologica 1974;149:43-50.  |
| 2. | Mathews I, Thappa DM, Singh N et al. Lichen planus pigmentosus: a short review. Pigment Int 2016;3:5-10. [Full text] |
| 3. | Kanwar AJ, Dogra S, Handa S et al. A study of 124 Indian patients with lichen planus pigmentosus. Clin Exp Dermatol 2003;28:481-5. |
| 4. | Neema S, Jha A. Lichen planus pigmentosus. Pigment Int 2017;4:48-9. [Full text] |
[Figure 1], [Figure 2], [Figure 3]
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