Lichen Planus – Erythema Dyschromicum Perstans

Erythema Dyschromican Perstans is a relatively uncommon form of Lichen Planus, however I do encounter it rather frequently in both my The Woodlands dermatology and Conroe dermatology offices.  Most of the patients I have diagnosed with Erythema Dyschromicum Perstans are females between ages 20 and 40 but it can occur in men as well.  The typical clinical picture of Erytema Dyschromicum Perstans are hyperpigmented flat patches and macules with a gray/blue color that are most commonly found on the chest, back, neck, face and proximal extremities.  On palpation, the lesions are flat but a small ridge may be appreciated on the peripheral rim.  On histology, the central portions of the lesions show only post inflammatory changes with melanin filled macrophages responsible for the distinctive color.  A lichenoid infiltrate can be detected only in active lesions on the raised peripheral border.  Most patients deny any symptoms and the pruritus of classic Lichen Planus is usually absent.  Treatment of Erythema Dyschromicum Perstans is very difficult as it is a very recalcitrant disease.  Antibiotics such as Minocycline and Clofazamine are helpful in some patients.