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