PDF(Pubmed)
Abstract：
Lichen planus pigmentosus is an uncommon subtype of lichen planus and lichen planus pigmentosus inversus is a rare variant of lichen planus pigmentosus. Lichen planus pigmentosus inversus typically presents as hyperpigmented patches or plaques, particularly in the intertriginous areas such as the axillae, the groin and inguinal folds, and in the submammary region. In some patients with lichen planus pigmentosus inversus, the condition can present as a pigmented lichenoid axillary inverse dermatosis (PLAID) when the lesions are in the axillae. A 49-year-old Hispanic man who had hyperlipidemia and diabetes mellitus developed lichen planus pigmentosus inversus and presented with a PLAID. Skin biopsies established the diagnosis of lichen planus pigmentosus inversus. The clinical differential diagnosis of lichen planus pigmentosus inversus includes inherited disorders, primary cutaneous dermatoses, acquired dyschromias, and reactions to topical or systemic medications. Friction in intertriginous areas has been related to the development of lichen planus pigmentosus inversus. Factors that can precipitate lichen planus pigmentosus inversus include not only topical exposure to almond oil, amala oil, cold and cosmetic creams, henna, and paraphenyldiamine but also either topical contact or consumption of mustard oil and nickel. Lichen planus pigmentosus inversus can be associated with autoimmune conditions (hypothyroidism), endocrinopathies (diabetes mellitus), and hyperlipidemia. The dyschromia found in patients with lichen planus pigmentosus inversus is frequently refractory to treatment. Initial management includes removal of potential disease triggers such as eliminating tight clothing to stop friction with the adjacent skin. Topical corticosteroids do not result in improvement; however, topical calcineurin inhibitors such as tacrolimus have been reported to be efficacious. In conclusion, inverse lichen planus and lichen planus pigmentosus inversus can present with a PLAID; whereas topical corticosteroids may be helpful to resolve inverse lichen planus lesions, topical tacrolimus may be useful to improve the dyschromia in lichen planus pigmentosus inversus.
摘要：
色素扁平苔藓是扁平苔藓的一种罕见亚型，而色素扁平苔藓是色素扁平苔藓的一种罕见变体。色素性扁平苔藓倒置通常表现为色素沉着斑或斑块，特别是在中间区域，如腋窝，腹股沟和腹股沟的褶皱,在乳腺下区域。在一些色素性扁平苔藓患者中，当病变位于腋窝时，该疾病可表现为色素性苔藓样腋窝逆皮肤病（PLAID）。一名患有高脂血症和糖尿病的49岁西班牙裔男子发展为色素性扁平苔藓，并出现PLAID。皮肤活检确定了色素性扁平苔藓的诊断。色素性扁平苔藓的临床鉴别诊断包括遗传性疾病，原发性皮肤病，获得性嗜铬，以及对局部或全身药物的反应。中间区域的摩擦与色素扁平苔藓的发育有关。可以沉淀色素扁平苔藓的因素不仅包括局部暴露于杏仁油，amala油,冷霜和化妆霜，指甲花,和对苯二胺，但也可以局部接触或食用芥子油和镍。色素性扁平苔藓可与自身免疫性疾病（甲状腺功能减退）有关，内分泌疾病（糖尿病），和高脂血症。在色素性扁平苔藓患者中发现的色素失调通常难以治疗。初始管理包括去除潜在的疾病诱因，例如消除紧身衣服以阻止与相邻皮肤的摩擦。局部皮质类固醇不会导致改善;然而，据报道,局部钙调磷酸酶抑制剂如他克莫司是有效的.总之,逆扁平苔藓和色素扁平苔藓可以表现为PLAID；而局部皮质类固醇可能有助于解决逆扁平苔藓病变，外用他克莫司可能有助于改善色素性扁平苔藓的色素变性。
