Colocalization of lichen planus and vitiligo associated with selective IgA deficiency

A 28-year-old man with a diagnosis of vitiligo universalis for 6 years presented with reddish polygonal papules that had developed on his left hand first and then on his right hand. On dermatologic examination, porcelain-white hypopigmented appearance was observed all over his body, and there were violaceous, flat-topped papules changing from 2 to 5 mm in diameter localized on the hypopigmented areas of the dorsum of both hands and flexor sites (Figure 1). The physical examination and laboratory investigations including hemogram, erythrocyte sedimentation rate, serum biochemistry, and urinanalysis were normal. Antibodies to thyroid tissue, hepatitis viruses, human immunodeficiency virus, nuclear, and streptolysine were negative. Repeated IgA levels in serum were found to be decreased; however, the other immunoglobulins (IgG, IgM) and C3, C4 and cryoglobulins were in normal ranges. Histopathologic examination of the polygonal papules revealed hyperkeratosis, focal thickening of the granular layer, and irregular acanthosis in triangular saw-tooth pattern. The basal layer was invaded by the lymphocytic inflammatory infiltrate and had numerous necrotic keratinocytes. The infiltrate in the upper dermis was band-like and sharply demarcated at its lower border. There were also a few melanophages in the upper dermis. Melanocytes were decreased in number, and in some areas they were absent at the basal layer of epidermis. Clinical and histopathologic diagnosis were consistent with lichen planus and vitiligo (Figure 2).