HealthCareMagic is now Ask A Doctor - 24x7 | https://www.askadoctor24x7.com

Suggest Treatment For Facial Pigmentation When Diagnosed With Lichen Planus Pigmentosus

Posted on Wed, 17 Feb 2016

Question: I have hyperpigmentation on my face and neck. I was diagnosed with lichen planus pigmentosus after taking a skin biopsy. (Please find attached report). Doctor has prescribed HCQS 200 mg twice daily for 3 months. And kojiglow ointment once in the morning. He also gave fluticord lotion which is corticosteroid lotion. Can u please suggest on how is this treatment. Is HCQS safe ? And is HCQs used for Lichen planus pigmentosus?

Answered by Dr. Dr. Kakkar (1 hour later)

Brief Answer:
Treatment of lichen planus pigmentosus

Detailed Answer:
Hello. Thank you for writing to us

I have gone through your query and I have also reviewed the attachment.

I have also answered one of your previous related query a few days ago when I had suggested a possibility of Lichen Planus Pigmentosus Or Phototoxic dermatitis, clinically. The biopsy report now confirms it as Lichen Planus Pigmentosus.
This treatment, consisting of Kojiglo cream, Flucort lotion and Oral Hydroxychloroquin is commonly used for treatment of Lichen Planus Pigmentosus.
Kojiglo contains kojic acid which is a skin lightening agent; topical steroid helps control the inflammatory that underlies this skin condition whereas hydroxychloroquin exerts anti-inflammatory and immunomodulatory action in lichen planus.
In addition to these, I would also suggest you to use a broad spectrum sunscreen, throughout the day e.g Sebamed's sunscreen lotion, spf 50 because sun's UVA and UVB rays are of pathogenic significance in Lichen planus pigmentosus.
HCQS is considered to be relatively a safe drug. Though, long term use of hydroxychloroquin in LPP requires monitoring of Liver Function Tests and Ocular/ Ophthalmological check up at regular intervals as it can have hepatic and ocular toxicity, specially when used over a long term

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Kakkar (8 hours later)

Thanks for the info. Yes doctor u have correctly diagnosed it as LPP before. I am still wondering how i got it ? What is the cause of this. My anti ccp and RA factor is also high.. Do i need to take any supplements or vitamins? Is there any diet which i need to follow or any thing which i need to avoid..Will this cure completely? I have lost my confidence because
Of this condition :(. Will laser treatment or chemical peeling be of any help ? The sun screen which i am using right now is PhotoStable SPF 40 and Cetaphil sunscreen. .

Answered by Dr. Dr. Kakkar (12 hours later)

Brief Answer:
Lichen planus pigmentosus responds slowly

Detailed Answer:
Hi.

Lichen planus pigmentosus has an unclear pathogenesis. It is believed to be more common in places where there is lots of sun. UV A and UV B part of electromagnetic spectrum, play an important role in the pathogenesis of LPP. Thus, it is more common on sun exposed sites like face and arms, though it can involve sun protected/ covered sites as well.
There is no need for any supplements or vitamins because this is not due toa deficiency.
Response to treatment is slow and the course is protracted. However, the treatment which you have been prescribed is quite good and you should notice improvements with it, in a few weeks. Chemical peeling is also used effectively to reduce the darkening of skin. This can be combined with topical treatment.
Even Lasers, specially Q switched Nd:Yag laser has been tried in cases who do not respond effectively to topical/ medical treatment.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Kakkar (27 hours later)

I got the LPP 10 months back. I dont have a major improvement in my condition. Its like an ECG graph.. It improves for some time and then it goes back t

Answered by Dr. Dr. Kakkar (9 hours later)

Brief Answer:
Lichen planus pigmentosus is self limiting

Detailed Answer:
Hi.

Lichen planus pigmentosus is a self limiting condition and has a good overall prognosis. Therefore, you can expect results with this treatment even though LPP has a protracted course and requires prolonged treatment.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Kakkar (13 hours later)

I am quite impressed by your good responses. The doctor has asked me to take HCQS 200mg twice daily but as i was skeptical about the side effects, i have only taken HCQS once daily. Is it okay taking it twice for 3 months? Please find attached the treatment plan suggested by another dermatologist. Which do you think is the best for me and which shud i follow ?

Answered by Dr. Dr. Kakkar (2 hours later)

Brief Answer:
Hydroxychloroquin for lichen planus pigmentosus

Detailed Answer:
Hi.

The dose of hydroxychloroquin is 5-6 mg/kg/day. So that means approx 400 mg/day for an adult male of average body weight. Thus twice daily dosing of is recommended. It is Ok and quite safe to take hydroxychloroquin for 3 months or even longer. With hydroxychloroquin, liver function tests should be done at base line and then once every 3 months and ophthalamological check up every 6 months. I think you should follow the plan which you mentioned in this query i.e hydroxychloroquin along with flucort, kojiglo and sunscreen.

Regards

Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar