TITLE:
Melasma, Melasma-Like Lichen Planus Actinicus, and Butterfly Lichen Planus Actinicus Build up One Spectrum (Clinico-Histopathological Study)
AUTHORS:
Khalifa E. Sharquie, Adil A. Noaimi, Maha A. Al-Shukri
KEYWORDS:
Melasam, Butterfly Lichen Planus Actinicus, Melasma-Like Lichen Planus Actinicus, Spectrum
JOURNAL NAME:
Journal of Cosmetics, Dermatological Sciences and Applications,
Vol.5 No.3,
September
10,
2015
ABSTRACT: Background: Facial melanosis is a major pigmentery problem seen in the daily
clinical practice. Melasma and lichen planus actinicus are among these common
causes. Still some facial melanosis that had features of melasma and butterfly
lichen planus actinicus but could not be classified to either of them. Objective: To evaluate melasma,
lichen planus actinicus and cases that could not be classified into one or
either of them using clinical picture, Wood’s lump examination, and
histopathological assessment. Patients
and Methods: This is a case descriptive, comparative, clinical and
histopathologicasl study carried out in Department of Dermatology, Baghdad
Teaching Hospital, Baghdad, Iraq during the period from December 2012-May 2014.
Forty patients with facial hyperpigmentation were included in this study.
Twelve (30%) were males and 28 (70%) were females with female to male ratio: 2.3:1.
Mean age ± SD of studied patients was 37.07 ± 9.63 years. History, physical
examination, Wood’s lump examination and photographic pictures were done for
all patients. Punch biopsy was taken from each patient, and processed and
stained with Hematoxylin-Eosin (HE) and Fontana-Masson (FM) for histological
evaluations. Results: These
diseases were classified into: melasma with 11 patients, female to male ratio: 4.5:1
with mean age ± SD was 33.64 ± 6.516 years, melasma-like lichen planus
actinicus with 21 patients, female to male ratio: 2.5:1,mean age ± SD: 39 ±
8.349 years, butterfly lichen planus actinicus with 8 patients, female to male
ratio: 1:1, mean age ± SD: 36.75 ± 15.088 years. This classification depends on
the following findings: some of these results could be more frequent and
intense in one than others; they were the diseases of young age group, that had
more tendency to affect females than males, sun light exposure and outdoor
activities were the main etiological factors, but these factors were more
triggering in lichen planus actinicus followed by melasma-like lichen planus
actinicus and to lesser extent in melasma. The skin types were mostly III, the location
and distribution of pigmentation were almost similar, Wood’s lamp findings were
similar although was not conclusive. The histopathological findings especially
the level of melanin deposition and inflammatory infiltrate were comparable but
the melanin deposition was more intense in butterfly lichen planus and melasma-like
lichen planus actinicus and to lesser extent in melasma. Conclusion: From the epidemiological,
clinical and histopathological findings of the present work, we can suggest a
conclusion that melasma, butterfly lichen planus actinicus, and melasma-like
lichen planus actinicus were inflammatory skin diseases that build up one
spectrum where melasma at one pole and lichen planus actinicus at the other
pole and melasma-like lichen planus actinicus at the middle. The young age
group, during their active reproductive life, will have these diseases in
relation to sun light exposure with seasonal variations.