Zosteriform Lichen Planus Pigmentosus Altering Segmental Vitiligo

A 22-year-old student presented with a 3-year history of hyperpigmented, minimally pruritic skin lesions over his trunk. They had begun as small discrete macules over the left side of the trunk, with some coalescing to form patches. He had had right-sided segmental vitiligo (SV) for the previous 7 to 8 years (Figure 1A), and this had started to cross the midline, covering a margin over the left side of the chest and back. This coincided with the onset and spread of the hyperpigmented patches. He denied any history of drug intake, or history of inflammatory dermatoses at either the vitiliginous or the hyperpigmented sites.