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Image Number 4887 (Lichen planus actinicus)

 
Morphology:
Hyperpigmentation

Diagnosis: Lichen planus actinicus

Site: Face

Sex: M

Age: 45

Type:

Description: Dark purplish pigmentation

Submitted by: Nameer Al-Sudany

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Differential Diagnosis

History:

 A 45-year old man presented with facial hyperpigmentation of one year duration. Family, drug and systemic histories were non significant.

Lichen planus actinicus can assume many clinical forms like the classical annular form, ordinary lichen planus like form confined to sun-exposed parts and pigmented melasma-like form. Many authorities consider lichen planus pigmentosus as a variant of LPA however, it is more common in Latin American people and usually involves the sun-exposed sites in addition to body flexors (hidden parts). 
In the presented case, the rash has retained the violaceous color of pigmentation and involved the face in a melasma or mask-like pattern. Negative drug intake history excludes pigmented drug eruptions including lichenoid ones. The patient was treated with topical corticosteroid plus topical Calcineurin inhibitor (Tacrolimus 0.1%) and sunscreen. Systemic therapies are usually reserved for severe, topical treatment resistant and more widespread cases.



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