Indian Journal of Dermatology
  Publication of IADVL, WB
  Official organ of AADV
Indexed with Science Citation Index (E) , Web of Science and PubMed
Users online: 145  
Home About  Editorial Board  Current Issue Archives Online Early Coming Soon Guidelines Subscriptions  e-Alerts    Login  
    Small font sizeDefault font sizeIncrease font size Print this page Email this page

Table of Contents 
Year : 2013  |  Volume : 58  |  Issue : 5  |  Page : 412
Hypopigmented papules over the chest

Department of Dermatology, Dr. D.Y. Patil Medical College and Hospital, Pimpri, Pune, Maharashtra, India

Date of Web Publication30-Aug-2013

Correspondence Address:
Nitin D Chaudhari
Department of Dermatology, Dr. D.Y. Patil Medical College and Hospital, Santtukaram Nagar, Pimpri, Pune, Maharashtra
Login to access the Email id

Source of Support: None, Conflict of Interest: None

PMID: 24082235

Rights and PermissionsRights and Permissions

How to cite this article:
Chaudhari ND, Virmani NC. Hypopigmented papules over the chest. Indian J Dermatol 2013;58:412

How to cite this URL:
Chaudhari ND, Virmani NC. Hypopigmented papules over the chest. Indian J Dermatol [serial online] 2013 [cited 2021 Jul 27];58:412. Available from: https://www.e-ijd.org/text.asp?2013/58/5/412/117372

A 30 year old male presented with multiple, non-pruritic hypopigmented papules over upper one-third of his chest since one year. These lesions at their onset were few in number and pruritic, with no history of trauma preceding their occurrence. The patient also reported past usage of topical steriods with intermittent relief in itching, but no improvement in the physical appearance of these eruptions.

General physical examination was unremarkable. Dermatological examination revealed multiple small, smooth, ivory white, flat topped papules with interspersed prominent brown coloured follicular plugs over the 'V' of the chest [Figure 1]. There were no lesions elsewhere on the body. Genitalia appeared normal. Histopathology of the biopsy of the papule revealed epidermal atrophy, flattened interpapillary crests, a band-like lymphocytic inflammatory infiltrate and dilated vessels in the upper dermis and homogenisation of collagen [Figure 2].
Figure 1: Grouped hypopigmented polygonal papules over the 'V' of the chest

Click here to view
Figure 2: Histopathology showing epidermal atrophy, homogenisation of collagen bundles and upper dermal lymphocytic infiltrate. (H and E, ×100)

Click here to view

   Diagnosis Top

Extragenital lichen sclerosus et atrophicus.

   Discussion Top

Lichen sclerosus et atrophicus (LS) is a rare chronic inflammatory dermatoses that occurs in individuals of any age, with highest prevalence in children below ten years and post menopausal women. [1],[2] Women are affected ten times more than men, [3],[4] and this decreased occurrence in men could be attributed to their early circumcisions. [3] Francois Henri Hallopeau first clinically described LS in 1887, [1],[2],[3] and it was Darier who described the characteristic histological findings in 1892. [1] It occurs predominantly in the genital area (83-98% of all cases) with 15-20% of them also having extragenital involvement; and rarely in 2.5% cases with lesions solely confined to an extragenital site, as were observed in our patient. [1]

The etiology of this dermatoses is unknown but genetic susceptibility appears to play a role in the disease. Its association with HLADQ7 and co-occurence of diseases like Hashimoto's thyroiditis, vitiligo and type 1 diabetes also indicates possible autoimmune process involvement in its causation. [1],[3],[4] Koebnerisation is common in lichen sclerosus - scarring or trauma produce typical skin lesions of the disorder. Extragenital lesions mostly occur over pre-existing scars or damaged areas. [1]

'Craurose vulvar' refers to the genital form of the disease in women that manifests as severely pruritic lesions resulting in painful erosions, vulvar atrophy that progresses to narrowing of the vaginal opening and dyspareunia. In men, the genital form is known as 'balanitis obliterans xerotica', that presents with painful itching, erosions and fissures. [4]

Extragenital lesions are porcelain white papules, plaques, or atrophic patches that may be surrounded by an erythematous or violaceous halo with folliculocentric keratin plugs overlying follicular ostia as observed in our case. Commonest sites include upper anterior torso, neck, arms and legs, ear, face, oral mucosa and nose. Hemorrhagic transformation often occurs and this appears to be due to basal cell degeneration that results in a weak dermal-epidermal junction. [1],[3],[4] Extragenital LS shows decreased expression of the proliferation marker Ki-67 and p53 in comparison to genital LS, and hence decreased malignant transformation in the former type. [3],[5]

Diagnosis is clinical and histopathological. Treatment includes high-potency topical steroids, immunomodulators and systemic retinoids. Combined treatment with 0.1% tacrolimus ointment and PUVA serve as a good option in extensive cases of lichen sclerosus or when other treatment modalities have failed. [3] Low-dose UVA1 phototherapy is well tolerated and an effective alternative. [6] Cryosurgery, vulvectomy, CO2 laser, have been tried with high recurrence rates. [3] Our patient was advised, twice daily application of 0.1% tacrolimus ointment with subsequent relief.

   References Top

1.Ballester I, Bañuls J, Pérez-Crespo M, Lucas A. Extragenital bullous lichen sclerosus atrophicus. Dermatol Online J 2009;15:6.  Back to cited text no. 1
2.Kim CR, Jung KD, Kim H, Jung M, Byun JY, Lee DY, et al. Linear Lichen Sclerosus along the Blaschko's Line of the Face. Ann Dermatol 2011;23:222-4.  Back to cited text no. 2
3.Bergstrom KG, Mengden SJ, Kamino H, Ramsay D. Extragenital lichen sclerosus et atrophicus. Dermatol Online J 2008;14:23.  Back to cited text no. 3
4.Viana Fde O, Cavaleiro LH, Unger DA, Miranda MF, Brito AC. Acral lichen sclerosus et atrophicus--case report. An Bras Dermatol 2011;86 (4 Suppl 1):S82-4.  Back to cited text no. 4
5.Vázquez MG, Navarra R, Martin-Urda MT, Abellaneda C, Quer A. Lichen Sclerosus et atrophicus with cutaneous distribution simulating lichen planus. Case Rep Dermatol 2010;2:55-9.  Back to cited text no. 5
6.Kreuter A, Gambichler T, Avermaete A, Happe M, Bacharach-Buhles M, Hoffmann K, et al. Low-dose ultraviolet A1 phototherapy for extragenital lichen sclerosus: Results of a preliminary study. J Am Acad Dermatol 2002;46:251-5.  Back to cited text no. 6


  [Figure 1], [Figure 2]


Print this article  Email this article
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (996 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  

    Article Figures

 Article Access Statistics
    PDF Downloaded71    
    Comments [Add]    

Recommend this journal