Lichen Planus Pigmentosus is a skin condition that causes dark brown or slate gray patches to appear on the skin. These patches typically show up on the face and neck, following a symmetric pattern on both sides of the body. The condition belongs to the lichen planus family of skin disorders but has its own specific features that set it apart.

The patches in lichen planus pigmentosus are flat and smooth to touch, without any scaling or raised areas. Unlike regular sunspots or tanning, these patches don’t fade away on their own and may actually become darker with sun exposure.

The skin changes happen gradually, often without any itching or discomfort – many people only notice the color changes when looking in the mirror.

Who gets it?

• Skin Type: More prevalent among individuals with darker skin tones, particularly those of Asian, African, or Hispanic descent.
• Age: It can affect any age group but is more commonly seen in adults.
• Gender: There’s no significant gender predilection, affecting both men and women equally.

Symptoms

• Appearance:

The skin develops dark brown or grayish patches, which are usually symmetrical and most commonly found on sun-exposed areas like the face, neck, and arms.

These patches are not itchy or painful, setting this condition apart from other types of lichen planus.

• Distribution:

The condition tends to favor areas such as the cheeks, forehead, and around the eyes in facial presentations, but it can also appear on the trunk, extremities, and mucous membranes like the mouth.

What does lichen planus pigmentosus look like?

When lichen planus pigmentosus first appears on the skin, it shows up as dark patches that can range from brown to gray-black in color. These patches don’t simply scatter randomly across the skin – they follow specific patterns that doctors have mapped out through years of observing patients.

The most common spots for lichen planus pigmentosus patches are the face, neck, and upper body.

In some cases, skin rashes appears in body folds like armpits or groin areas. These patches might look slightly different – often darker and more clearly defined than those on the face. They can also show up along scratch marks or in areas where the skin frequently rubs against clothing.

Color and texture

• Lichen Planus Pigmentosus (LPP) manifests as patches of skin that are darker than the surrounding areas, often appearing brown, gray, or slate-blue.
• These patches are flat, meaning they do not protrude from the skin like bumps or nodules. They have a smooth texture, lacking the scale or itchiness associated with other skin conditions.

Distribution and pattern

The pigmentation is typically symmetrical, meaning if one side of the face or body is affected, the other side usually is as well.

Common areas include:

• Face: Cheeks, forehead, around the eyes, and sometimes the lips.
• Neck: Often the front or sides.
• Arms: Specifically, the forearms.

The patches can merge, creating larger areas of pigmentation or remain as distinct, smaller patches.

Border and size

• The edges of these patches can be well-defined or have a more gradual transition into normal skin color.
• Sizes can vary from small, coin-sized spots to larger areas covering significant portions of the skin.

Progression and evolution

• Onset: rash can appear gradually over time or more suddenly, with some patients noticing new patches appearing or existing ones darkening after sun exposure.
• Change Over Time: While not always progressive, some individuals notice an increase in the number or darkness of patches, especially if exposed to triggers like sunlight or certain chemicals.

Why it happens?

The exact cause of Lichen Planus Pigmentosus (LPP) isn’t fully understood, but a combination of genetic, environmental, and immunological factors are believed to contribute to its development. Here’s a breakdown of known and suspected causes:

Autoimmune misjudgment

Our immune system usually protects us, but in lichen planus pigmentosus, it seems to take a wrong turn. It mistakenly sees the melanocytes, the cells giving color to our skin, as enemies. This autoimmune response leads to the dark patches, highlighting how our own defenses can sometimes turn against us.

Sun’s role

Sun exposure isn’t just about getting a tan; for lichen planus pigmentosus patients, it can be a catalyst. Many have noticed that after spending time in the sun, new patches or an increase in pigmentation occurs. UV rays seem to trigger or worsen the condition.

Chemical use

Everyday products we use on our skin or hair, like dyes or strong fragrances, might also play a part. Some chemicals in these products can trigger an allergic reaction or directly damage the skin’s pigment cells, leading to those telltale LPP patches. It’s a reminder to be mindful of what we put on our skin.

Physical trauma and LPP

Interestingly, physical trauma or friction to the skin can sometimes foreshadow LPP. This isn’t always the case, but for some, areas where the skin has been irritated might later develop pigmentation. It’s like the skin remembers the injury and responds with color.

Hormones: a possible link?

There’s a bit of a grey area when it comes to hormones. While not as clearly linked as with other pigmentation disorders, some speculate that hormonal shifts could influence lichen planus pigmentosus.

Medications and pigmentation

Drugs can sometimes cause skin changes, and although not directly tied to the skin condition, certain medications can exacerbate pigmentation issues. If you’re on medication and notice changes in your skin color, it might be worth discussing with your doctor.

Stress and systemic health

Stress doesn’t cause lichen planus pigmentosus directly, but it can make any skin condition worse. For those with lichen planus pigmentosus, managing stress might help in keeping symptoms at bay. Also, systemic health issues, like liver or thyroid problems, have been seen in some cases, suggesting your overall health might influence skin pigmentation.

Treatment

Medical treatment

Topical treatments

• Corticosteroids: These are often the first line of treatment, applied directly to the skin to reduce inflammation and pigmentation. Stronger formulations like clobetasol can be used but should be under medical supervision due to potential side effects like skin thinning.
• Tacrolimus and Pimecrolimus: These non-steroidal ointments are beneficial for sensitive areas like the face, where steroids might be too harsh. They work by modulating the immune response.
• Retinoids: Topical retinoids, such as tretinoin, can help in cell turnover and might lighten pigmented areas over time, though they can cause skin irritation.

Systemic therapy

For severe or widespread cases, systemic treatments might be considered:

• Oral corticosteroids: Used in short bursts to manage widespread inflammation but come with risks like weight gain and increased blood sugar.
• Other immunomodulators: Like methotrexate or azathioprine, are considered for resistant cases, balancing the benefits against potential systemic side effects.

Other treatments

• Narrowband UVB: This involves exposing the skin to specific wavelengths of ultraviolet light, which can help in reducing pigmentation. It’s particularly useful when topical treatments are insufficient.
• Superficial chemical peels: Using substances like glycolic acid or Jessner’s solution, these can be effective in lightening pigmentation through controlled exfoliation. However, multiple sessions might be needed, and they should be performed by a dermatologist.

Home remedies and lifestyle adjustments

• Sun Protection: Since lichen planus pigmentosus often affects sun-exposed areas, protecting your skin from UV rays is essential. Use broad-spectrum sunscreen, wear protective clothing, and avoid direct sunlight during peak hours.
• Moisturization: Keeping the skin well-moisturized can help reduce irritation and the appearance of pigmentation. You need soothing ingredients, check for chamomile or aloe vera gel.
• Dietary Considerations: Although not directly linked to lichen planus pigmentosus, some believe a diet rich in antioxidants (like vitamins C and E) could support skin health. Foods high in these nutrients include citrus fruits, berries, nuts, and leafy greens.

Natural remedies

• Aloe Vera: Known for its soothing properties, applying aloe vera gel might reduce inflammation and promote healing.
• Turmeric: When mixed with water to form a paste, turmeric can be applied as it has anti-inflammatory effects, though it might temporarily stain the skin.
• Licorice Extract: Contains glabridin, which has skin-lightening properties similar to hydroquinone but with fewer side effects.

What to expect?

Living with lichen planus pigmentosus can affect one’s self-esteem due to visible skin changes. It’s important to:

• Seek Support of qualified dermatologist: Talk to dermatologists or join support groups where you can share experiences and coping strategies.
• Set Realistic Goals: Treatment might not completely erase pigmentation but can significantly improve appearance. Understanding this can help manage expectations.