Dermatology Oasis

Editor: Nameer Al-Sudany, MD (IRAQ)

Lichen Planus Actinicus

Lichen planus actinicus
Synonyms: Actinic LP and LP subtropicus.
* Common in tropical and subtropical regions including Africa, Middle East and India. It is also common in Iraq.
* Aetiology is presumed to be long exposure to sun light (may be regarded as one of photo-sensitive disorders).
* Shows seasonal variation with the onset in spring and summer and may remit or be quiescent during winter.
* Third decade of life (young adults) is the most common age of occurrence in both sexes. However, it may affect children and elderly.
* Classical presentation of LPA is with annular plaques having hyperpigmented centers and violaceous borders. Other patterns of presentation include:
(1) Ordinary LP-like LPA (Confined to sun-exposed areas).
(2) Lichen nitidus-like LPA (Confined to sun exposed areas with no involvement of genitalia especially the male).
(3) Pigmented LPA: Melasma-like LPA.
* Sites: usually sun-exposed parts like the face, neck, V-shaped area of the chest and the dorsa of the hands. The face is almost always most severely affected.
* Itching is usually absent or mild.
* The diagnosis is primarily clinical, however skin biopsy may be arranged in query cases.
* Treatment:
1.Strict avoidance of sun exposure is most important step in management .
2. Use of sunscreens.
3. Topical corticosteroids (intermediate to potent) are the mainstay of treatment.
4. Bleaching agents such as Hydroquinone (+ CS) in pigmented variety of LPA.

Personal experience: Practically, it is very difficult to manage LPA and even success sometimes is gained but it is usually temporary and the rule exacerbation will follow !