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Duggest treatment for lichen planus pigmentosus

Answered by
Dr.
Dr. Sanjay Kumar Kanodia

Dermatologist

Practicing since :2002

Answered : 4165 Questions

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Posted on Mon, 29 Dec 2014 in Skin Hair and Nails
Question: my wife has linchen planus pigmentosis of face and upper neck, ears and back of neck. She was diagnoses for LPP afer skin biobsy at appollo and firtis hospital. pl suggest me remedy
doctor
Answered by Dr. Sanjay Kumar Kanodia 3 hours later
Brief Answer:
Sun protection and medications to apply.

Detailed Answer:
Respected Sir,

Welcome and thanks for posting your query to the forum.

I can understand your great concern regarding your wife's pigmentation.

I have gone through your complete query and I am quite empathetic to the problem of lichen planus pigmentosus.

Let me tell you certain important points regarding your wife's condition: Our skin is a mutilayered structure. Our skin also contains certain cells which are known as melanocytes. These melanocytes are the cells which regularly produces color/pigment known as melanin in the skin. These are superficially present in the upper skin known as epidermis. These melanocytes can be more active in certain conditions due to unknown causes. Till now we are not able to find the exact cause of the same.

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.

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 suggest you certain measures by which you can stop progression:

1. Strict sun avoidance

2. Avoid any oral medications.

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.

If I were your treating dermatologist then would have prescribed a cream (under dermatological supervision) containing Kojic acid with arbutin and mulberry extract in it. Alternatively Azelaic acid gel can be applied over the affected area of pigmentation. These are one of the best and safest creams to be applied. Apply any of these creams in a very thin layer at night time only so that these should not be visible to naked eye. Apply at night time before sleeping. Sun protection is a must and a proper sun screen should be used.

Diet is also quite important in reducing the pigmentation. Good diet not only helps in renewing the skin better as well as works best to protect our skin. You can eat a lot fruits and green leafy vegetables in your daily schedule.

Again to tell you sun protection is the most important factor in prevention of further spread of pigmentation.

I hope these informations will help you in getting rid of pigmentation marks. I will be glad to reply any further queries.

I wish best and early recovery,

With best health wishes,

Dr Sanjay Kanodia
MD- Dermatology
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sanjay Kumar Kanodia 1 hour later
thanks a lot doctor saheb. can you suggest me the standard name of cream containing kojic acid with arbutin and mulberry extract and also the standard name of crean containing azelaic gel so that i can buy one of them from the market. Rest precautions I will take as suggested and i am really grateful for the full information o otheryou hae given as no other dermatologist shared this information with me. pl be also kind and inform me wheter i can try homeopathy alongwith the above cream. Is the LPP liable to spread or it will be contained when cream is applied. Any other information if you can pass on to me. If you are in XXXXXXX I can call on you with prior appointment. if you do not mind pl communicate me your XXXXXXX number.

one of the dermatologist suggested for my wife a tablet called Psien 500 which contains mycophenolate mofetil 500. she took five six tablets and it caused stoppage of her regular motion. we immediately stopped it. currently she is taking only vitamin A one tablet to be taken for 30 days and then altenatively takes Evion - vit E tablets one a day alternatively. should she stop these tablets as well. pl inform me and i shall be grateful to you.
regards
doctor
Answered by Dr. Sanjay Kumar Kanodia 3 hours later
Brief Answer:
LPP: various suggestions for betterment

Detailed Answer:
Respected Sir,

Welcome again to the forum and thanks for your further follow up.

Regarding the cream: In my patients I use Carofit XXXXXXX cream to be applied at night time.

For the use of Ayurvedic or homeopathy medicines: I am convinced with all these therapies as many a times these specialist say that the disease will increase and then decrease. This is not convincing for me so you can take decision accordingly.

For the use of any oral medication in treatment of LPP : As I suggested no oral medications please. It is not the right age for the same as she is taking so many other medications which are quite essential for her.

All the other medications which she is already taking for other health issue are quite essential so must take under medical supervision.

I am based at XXXXXXX so you can meet a good dermatologist at Medical College level.

I hope the information will help you.

With best regards,


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sanjay Kumar Kanodia 19 hours later
thanks sir. as suggested i have purchased carofit XXXXXXX cream and my wife has started using this. earlier she was using miltan mixed with demelan but it had some little effect during the month. should she also use azelaic acid gel along with carofit XXXXXXX or only one will do?

sir it is said that LPP is as a result of immune desficiency when cells start attacking its own friendly cells resulting in discolouring. If this is so, can you not suggest some oral medicine which can correct this phenomenon? One dermatologist prescribed Psien which contains mycophenalate 500. This medicine is normally given to a patient who has some organ transplant. She used for four to five days but she observed disturbed stool and stopped it immediately, particularly when we found that this drug is not meant for LPP but may be for controlling the cells attacing its own friendly cell. since i am not a physian, i do not know. you can be a judge. in the light of this, will you mind suggesting me any other course of action whereby my wife gets rid of this problem as she is worried about it. thanks sir. an early answer will be gratefully appreciated. regards, XXXX
doctor
Answered by Dr. Sanjay Kumar Kanodia 2 hours later
Brief Answer:
I would not prefer to give any oral medications.

Detailed Answer:
Respected Sir,

I really appreciate your concern for the LPP condition of your wife. Let you first relax yourself and then relax your wife too regarding simplicity of this condition. It is just a pigmentary condition and is not at all serious condition.

So I completely reassure you the part of apprehension of your wife.

I suggest multiple types of topical therapies only and prefer not to give any oral medications in the same. Looking at the age of your wife and other medical conditions I would not prefer to give any oral medications. So from my side if I were your wife's treating dermatologist then would have preferred to give only topical medication to apply.

Kojic acid being the safest of all so I prefer the same in all my patients as first line of therapy.

As I suggested you can meet a dermatologist at Medical college level and get a proper personal opinion regarding the condition.

I reassure you fully that the condition is very simple and not going to cause any problem though out life.

I hope these informations will help you. I will be glad to reply any further queries.

I wish best and early recovery,

With best health wishes,

Dr Sanjay Kanodia
MD- Dermatology
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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