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Have pigmentation on neck and is spreading. What is the cure for this?

Dear Doctors,
I will really appreciate your time and help if you can answer my concern below. I am 42 years old woman and I am from Indian origin but residing in the USA from last 21 years. I started noticing dark pigmentation on my neck about 2 years back and I have seen many dermatologists in New Jersey. This pigmentation is spreading and right now 90% of my neck and 30 % of my face is covered with this dark pigmentation. As this type of dark pigmentation is not common in Asians residing in US, I was sent from one dermatologist to another and undergone at least 6 to 7 types of biopsies. It took almost 1 year for them to diagnose that it is Lichen Planus Pigmentosis. I was given all the medications they can think off and I am providing the list below. I always use sun screen lotion for my face and neck. I was also presented at a conference hosted for dermatologists to see me. I was also seen by super specialist for skin of color. He thinks that it's not LPP but it's Erythena Dyschromium Perstans and he put me on Clofazamine for 6 months. I haven't seen any improvement for any of the medications I have taken. The dark pigmentation keeps spreading and now it started on my hands (back side of my palms). It's spreading extremely fast on my hands.
I have also seen a dermatologist in India. She prescribed a different group of medications and I have used them for 5 months and have seen no improvement. Please advise what has triggered this problem and what can I potentially do to stop the progression first, and lighten the dark pigmentation if I can. Can you also please briefly explain how do we differentiate between Erythena Dyschromium Perstans and Planus Pigmentosis?

Medications prescribed by doctors in the USA :
1.     Dapsone 100 mg twice a day for 5 months
2.      Hydroxychlor 200 mg twice a day for 2 months
3.      Clofazamine 50 mg twice a day for 2 months
4.      Protopic Ointment 0.1% every time before bed since six months
5.     Clobetasol Propional USP 0.05% Ointment for 3 months
6.     Ketoconazole create 2 % for 2 months
7.     Kenolog 40 injection
8.     Hydroquinonne USP 4%
9.     Sunscreen lotions

Medications prescribed by doctor in India :
1.     Zycholin 0.5 mg 3 times - 3 months
2.     Antoxodant HC 1/day
3.     Vitamin C 2 /day
4.     Elocon Ointment - 3 weeks
5.     Elidel Cream 2/day for 2 months
6.     Liquid Parafin - bedtime
7.     Pioglar 15mg 1/day
8.     Sodox 2/day
9.     Isotroin 1/day - starting it from today.

Asked On : Wed, 17 Apr 2013
Answers:  1 Views:  368
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Dermatologist 's  Response
Dec 2013
Respected Madam.

Hello and thanks for posting your query to HCM.

I can understand your great concern regarding your pigmentation probable and being a woman how much of stress you are facing by this problem. I can see a long list of medications taken and applied by you for the whole two years and the kind of consultations from one doctor to the other.

Now to your problem - whether Lichen Planus Pigmentosus versus Erythema dyschromicum perstans.

Lichen Planus Pigmentosus is a pigmentary disorder seen in Indians with macular hyperpigmentation involving chiefly the face, neck and upper limbs and even intertriginous sites like axillae, although it can be more widespread. the color varies from slate grey to brownish black. It is mostly diffuse but but reticular and blotchy pigmentation is also seen.

Erythema dyschromicum perstans (also known as ashy dermatosis) has a characteristic clinical appearance, it characterized by numerous macules of varying shades of grey with a red, slightly raised and palpably infiltrated margin. They vary in size and tend to coalesce over extensive areas of the trunk, limbs and face. Against the general greyish background are macules of hypomelanosis or hypermelanosis.

Now you can make out that both the conditions appears to be almost similar on reading, in fact according to our best text book (Rook's Text book of Dermatology ) Erythema dyschromicum perstans has been regarded as simply a macular variant of LP (LP pigmentosus). So you can see both are similar conditions clinically as well as theoretically. Mam, as per your history there were 6-7 biopsies done for diagnosing the condition. In our clinical set up we need simple clinical examination only to establish a probable diagnosis and a single biopsy is enough to prove the diagnosis. If at all there is confusion then also the histopathology slide is enough for the review of the diagnosis. There is no point in discriminating them as far as treatment is considered.

Now for the treatment part there is no established therapy for these conditions as are persistent in nature and slowly extends. We try and give as many therapies for reduction of the hyper-pigmentation as well as for reducing the progression but sometimes all proves to be of little help.

I can not comment on any of the treatment at this time but there are certain measures by which you can stop progression:

1. Strict sun avoidance

2. Any oral medications if you take then make it sure that it should not cause progression or even photo aggravation by sun light.

3. Increase the amount of vit A and carotenoids and other related antioxidants in your food.

4. Increase the intake of fruits (all yellow will do) and green vegetables

5.Kindly reduce the stress as it can be one of he aggravating factor in all pigmentary conditions.

You kindly stick to only one doctor who can take he case o long term basis and can give you the best of the therapies required. Hope to help you the best by my knowledge and keep me informed about your problem.

With best health wishes,

Dr Sanjay K Kanodia

Answered: Wed, 17 Apr 2013
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