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Hypopigmented Macules as Manifestation of Lichen Planus and Lichen Planopilaris

David Arnold1, Melissa B Hoffman1, Oluwakemi Onajin2

  • 1Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC.

The American Journal of Dermatopathology
|April 5, 2019
PubMed

Insights

Lichen planus (LP) can present as hypopigmented macules, a rare variant. This finding expands understanding of LP presentations in diverse skin tones.

Area of Science:

  • Dermatology
  • Inflammatory Diseases
  • Pathology

Background:

  • Lichen planus (LP) is an idiopathic inflammatory condition affecting skin, hair, nails, and mucous membranes.
  • Classic cutaneous LP features violaceous papules, while lichen planopilaris causes scarring alopecia.
  • LP pigmentosus typically presents as hyperpigmentation; hypopigmented LP is exceptionally rare.

Observation:

  • Two cases of lichen planus presenting primarily as hypopigmented macules in African American men are reported.
  • Lesions were observed on the face, scalp, trunk, and extremities.
  • One patient also experienced associated alopecia, a common sign of lichen planopilaris.

Findings:

  • Histopathological examination confirmed features consistent with lichen planus in both patients.
  • The study proposes a novel variant of LP characterized by acute onset of hypopigmented lesions.
  • This challenges the typical presentation of LP and its variants.

Implications:

  • Recognizing hypopigmented LP is crucial for accurate diagnosis, especially in individuals with darker skin tones.
  • This expands the differential diagnosis for hypopigmented macules and alopecia.
  • Further research is warranted to understand the pathogenesis and prevalence of this LP variant.

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