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 Table of Contents  
Year : 2022  |  Volume : 9  |  Issue : 3  |  Page : 225-226

Lichen planus pigmentosus in linear and zosteriform pattern along the lines of Blaschko: a rare presentation

1 Wizdermpathlab, Kolkata, West Bengal, India
2 Department of Dermatology, Calcutta National Medical College, Kolkata, West Bengal, India
3 Department of Dermatology, Wizderm Specialty Skin and Hair Clinic, Kolkata, West Bengal, India
4 Department of Pediatric Dermatology, Institute of Child Health, Kolkata, West Bengal, India

Date of Submission14-Apr-2021
Date of Decision16-Jun-2021
Date of Acceptance11-Aug-2021
Date of Web Publication30-Nov-2022

Correspondence Address:
Dr. Sandipan Dhar
Department of Pediatric Dermatology, Flat 9C, Palazzo 35, Panditia Road, Kolkata 700029, West Bengal
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/pigmentinternational.pigmentinternational_

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How to cite this article:
Dhar S, De A, Sarda A, Dhar S. Lichen planus pigmentosus in linear and zosteriform pattern along the lines of Blaschko: a rare presentation. Pigment Int 2022;9:225-6

How to cite this URL:
Dhar S, De A, Sarda A, Dhar S. Lichen planus pigmentosus in linear and zosteriform pattern along the lines of Blaschko: a rare presentation. Pigment Int [serial online] 2022 [cited 2023 Mar 28];9:225-6. Available from: https://www.pigmentinternational.com/text.asp?2022/9/3/225/362399

Lichen planus pigmentosus (LPP) is considered to be a rare variant of lichen planus (LP) by most authors considering their similar immunopathogenesis and occasional coexistence in some patients.[1] LPP was first described in 1935 under the name “lichens atypiques ou invisible pigmentogenes” in the French literature and as “lichen pigmentosus” in 1956 in the Japanese literature.[2],[3] LPP is characterized by symmetrical distribution of dark brown to gray or gray-blue, round, or oval macules with irregular and poorly defined borders mainly affecting the face and neck. The lesions are usually asymptomatic but present with mild itching in 27% to 62% of patients. Morphologic variants are diffuse, reticular, blotchy, perifollicular, and annular.[4] We here present a case of LPP which was unique in its distribution.

A 39-year-old female presented with insidious asymptomatic blotched bluish-black pigmentation, which started about 1 year back on the right side of the abdomen and over the last few months spread to involve the right lower limb also. She did not have any history of preceding skin lesions over those areas. The lesions started as erythematous ill-defined macules which gradually become hyperpigmented and bluish-black and coalesced to form ill-defined larger macules and patches. On examination, ill-defined bluish-black macular hyperpigmentation was observed in the zosteriform pattern on the right side of the abdomen in D9 to D11 dermatome [Figure 1]. The patient was earlier treated with topical steroids, oral isotretinoin, and chemical peel with glycolic acid before presenting to our institution. We considered a differential diagnosis of postinflammatory hyperpigmentation, LPP, linear and whorled nevoid melanosis, lichen striatus, and incontinentia pigmenti.
Figure 1 Asymptomatic blotched bluish-black pigmentation, which started about 1 year back on the right side of the abdomen.

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Punch biopsy from the lesion was performed which showed atrophied epidermis, vacuolar degeneration of the basal cell layer, band-like lichenoid infiltrate in the papillary dermis, melanophages, and Civatte bodies [Figure 2] and [Figure 3]. We diagnosed it as a case of LPP in linear and zosteriform pattern along the lines of Blaschko. The patient was treated with topical fluticasone propionate (0.05%) cream once a day for 6 weeks during daytime and topical tacrolimus (0.1%) ointment once at night for 3 months. There was some amount of improvement in pigmentation and the progression stopped totally.
Figure 2 Vacuolar degeneration of the basal-cell layer of epidermis, band-like lymphocytic infiltrate in the papillary dermis, pigment incontinence (hematoxylin-eosin, ×100).

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Figure 3 Effaced rete ridges of epidermis, cluster of Civatte bodies hanging at the dermo-epidermal junction and many melanophages among lymphocytic infiltrate (hematoxylin-eosin, ×400).

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The LPP along the lines of Blaschko is also known as linear LPP if it affects the limbs or the face, or zosteriform LPP if the trunk is affected.[5] Linear LPP can be unilateral or bilateral, distributed along one or many lines of Blaschko.[6] To the best of our knowledge, only two cases of segmental LPP on the abdomen have been reported so far.[7],[8] Linear LPP has been reported predominantly in men aged 5 to 61 years, mostly from South East Asian countries.[9] Mosaicisms, during embryogenesis, resulting in the cell population with different immunologic and antigenic properties, may be the determinant of the susceptibility to developing a variant of LPP.[4],[5] It has also been associated with the hepatitis C virus.[6] Various treatment options are: topical steroids, tacrolimus, depigmenting agents, such as hydroquinone, photoprotection, and treatment with the 1064 nm Q-switched Nd-YAG laser.[9],[10]

We report this case because of its rarity posing diagnostic challenge in clinical practice.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Kanwar AJ, Dogra S, Handa S, Parsad D, Radotra BD. A study of 124 Indian patients with lichen planus pigmentosus. Clin Exp Dermatol 2003;28:481-5.  Back to cited text no. 1
Gougerot M. Lichens atypiques ou invisibles pigmentogenes reveles par des pigmentations. Bull Soc Fr Dermatol Syphiligr 1935;42:792-4.  Back to cited text no. 2
Shima T. Supplementative study on lichen pigmentosus. Nippon Hifuka Gakkai Zasshi 1956;66:346-53.  Back to cited text no. 3
Robles-Méndez JC, Rizo-Frías P, Herz-Ruelas ME, Pandya AG, Ocampo Candiani J. Lichen planus pigmentosus and its variants: review and update. Int J Dermatol 2018;57:505-14.  Back to cited text no. 4
Vineet R, Sumit S, Garg Vijay K, Nita K. Lichen planus pigmentosus in linear and zosteriform pattern along the lines of Blaschko. Dermatol Online J 2015;21:11.  Back to cited text no. 5
Vachiramon V, Suchonwanit P, Thadanipon K. Bilateral linear lichen planus pigmentosus associated with hepatitis C virus infection. Case Rep Dermatol 2010;2:169-72.  Back to cited text no. 6
Kumar YH, Babu AR. Segmental lichen planus pigmentosus: an unusual presentation. Indian Dermatol Online J 2014;5:157-9.  Back to cited text no. 7
[PUBMED]  [Full text]  
Droms RJ, Snadecki H, Deng A, Levin NA. Lichen planus pigmentosus in a blaschkoid distribution. Dermatol Online J 2017; 23:13030/qt4fs9c744.  Back to cited text no. 8
Hong S, Shin JH, Kang HY. Two cases of lichen planus pigmentosus presenting with a linear pattern. J Korean Med Sci 2004;19:152-4.  Back to cited text no. 9
Kim JE, Won CH, Chang S, Lee MW, Choi JH, Moon KC. Linear lichen planus pigmentosus of the forehead treated by neodymium:yttrium-aluminum-garnet laser and topical tacrolimus. J Dermatol 2012;39:189-91.  Back to cited text no. 10


  [Figure 1], [Figure 2], [Figure 3]


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