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SHORT COMMUNICATION
Blaschkolinear Lichen Planus Pigmentosus in the Setting of Chronic Graft-versus-host Disease
Caterina PINZANI 1,2 and Jean-David BOUAZIZ 2
1
Department of Experimental and Clinical Medicine, Institute of Dermatology, University of Udine, Azienda Sanitaria Universitaria Integrata,
Udine, Italy, and 2 Dermatology Department and Skin Research Center, Saint Louis Hospital, Paris, France. E-mail: [email protected]
Accepted Oct 16, 2018; E-published Oct 17, 2018
Lichen planus pigmentosus (LPP) is a variant of lichen
planus characterized by dark-brown macules usually
distributed on sun-exposed areas or, rarely, on flexural
folds. It is described more often in some ethnic groups
from the Indian subcontinent, the Middle East, Far
East, and Latin America, especially in people with
darker phototypes (1). Blaschkolinear distribution of
LPP, probably resulting from a genetic mosaicism, is
rarely reported and called Blaschkolinear lichen planus
pigmentosus (BLPP) (2). Skin chronic graft-versus-host
disease (cGVHD) lesions after allogeneic hematopoietic
stem cell transplantation (AHSCT) are characterized by
a spectrum ranging from lichenoid to sclerodermoid
manifestations (3).
CASE REPORT
We report here a case of BLPP that occurred in a
34-year-old Mauritian man, who underwent an HLA-
identical peripheral blood AHSCT for a stage IIA
nodular-sclerosis classical Hodgkin lymphoma. Four
months after AHSCT, the patient had cGVHD, namely a
bronchiolitis obliterans, a diffuse interstitial pneumonia
and a mouth/ocular sicca syndrome. Eight months later,
a maculo-papular brownish linear eruption occurred
following the Blaschko lines. These cutaneous lesions
progressively involved the right leg, the right arm, and
the right half-face (Fig. 1). Dermoscopic evaluation
showed diffuse brown dots (peppering) over a brown
background (Fig. 2), representing dermal pigmentary
incontinence resulting from a lichenoid inflammation
and dermal-epidermal interface damage (4). Histological
analysis showed slight interface dermatitis with marked
pigmentary incontinence (Fig. 3). On the basis of the
clinical, dermoscopic, and histological presentation a
diagnosis of extensive form of BLPP in the context
of cGVHD was made. Four months of treatment with
once-daily 0.05% betamethasone valerate cream on the
body lesions and twice-daily 0.1% tacrolimus induced
partial remission.
Fig. 1. Erythematous, maculo-papular brownish linear eruption
following the Blaschko lines involving the right half-face. A written
permission from the patient was given to publish this photo.
DISCUSSION
A case of a lichen striatus (LS) of the left arm as the
only complication after AHSCT (for aplastic anaemia)
has been reported previously (5), but to the best of our
knowledge this is the first report of BLPP after AHSCT.
Cases of LPP in the setting of cGVHD have been repor-
doi: 10.2340/00015555-3075
Acta Derm Venereol 2019; 99: 218–219
Fig. 2. Dermoscopic features of the lesion: diffuse brown dots
(peppering) over a brown background.
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Journal Compilation © 2019 Acta Dermato-Venereologica.