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Updated: Jun 14, 2025

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Pigmented actinic lichen planus: a case report.

Katarina Đorđević¹, Jovan Lalošević^1,2, Miloš Nikolić^1,2

¹Clinic of Dermatology and Venereology, University Clinical Center of Serbia, Belgrade, Serbia.

Acta Dermatovenerologica Alpina, Pannonica, Et Adriatica

|September 3, 2024

Summary

Actinic lichen planus (ALP), a rare sun-sensitive skin condition, can affect older individuals, as shown in this case report. Early diagnosis via biopsy and treatment combining topical therapies with photoprotection are key for managing pigmented ALP.

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Area of Science:

Dermatology
Photosensitive dermatoses
Cutaneous oncology

Background:

Actinic lichen planus (ALP) is a rare, photosensitive variant of lichen planus (LP).
It typically affects younger, dark-skinned individuals in tropical/subtropical regions, with limited European case reports.
Common presentations include annular, pigmented (melasma-like), dyschromic, and classic lichenoid forms.

Observation:

A case of a 68-year-old Caucasian male with a 9-year history of a solitary, mildly pruritic, hyperpigmented nasal patch is presented.
The patient's presentation is atypical given the typical demographic and geographic distribution of ALP.

Findings:

Histopathological examination revealed classic lichen planus features, including epidermal atrophy, pigmentary incontinence, and solar elastosis.
These findings led to the diagnosis of pigmented actinic lichen planus.
Treatment with topical pimecrolimus, tretinoin, and strict photoprotection resulted in significant improvement with residual hyperpigmentation.

Implications:

This case expands the known demographic profile of actinic lichen planus to include older Caucasian individuals.
Highlights the importance of histopathological correlation for accurate diagnosis, differentiating ALP from other facial hyperpigmented lesions.
Emphasizes the need for a combined therapeutic approach addressing both pigmentary and inflammatory aspects, alongside rigorous photoprotection, for effective management and recurrence prevention.