Portal de Periódicos da CAPES

Pigmented actinic lichen planus successfully treated with intense pulsed light

2010; Oxford University Press; Volume: 163; Issue: 3 Linguagem: Inglês

10.1111/j.1365-2133.2010.09857.x

1365-2133

Jorge Santos‐Juanes, A. Mas-Vidal, Pablo Coto‐Segura, J. Sánchez del Río, Cristina Galache,

Lichen and fungal ecology

Conflicts of interest: none declared. Madam, Actinic lichen planus (ALP) is a rare clinical variant of lichen planus. Pigmented actinic lichen planus (PALP) may constitute the final stage of other ALP variants, or may be a distinctive type of ALP with clinical features similar to those of melasma, but restricted to the face.1 In this study, we present a patient with PALP that was successfully treated with intense pulsed light (IPL). To the best of our knowledge, this therapeutic option has not been previously used. An otherwise healthy 55‐year‐old white woman (Fitzpatrick skin type II) was referred to our department because of a 3‐year history of a facial pigment disorder. The dermatosis started in summer, but no remarkable improvement was noticed during the winter season. The clinical findings worsened during the subsequent sunny seasons. The patient had no history of drug contact or intake. There was no family history of any similar condition. The patient had tried treating the skin condition with 4% hydroquinone preparations applied twice daily, to no avail. On physical examination, asymptomatic, large, symmetrical patches of dark brown colour with irregular borders were present in the cheeks, the chin and the neck, sparing the skin under the chin (Fig. 1, left). No further cutaneous or mucosal lesions were found. The Dermatology Life Quality Index (DLQI) score was 27. Biopsy specimens from the skin of the neck showed orthokeratosis, focal hypergranulosis and jagged epidermal hyperplasia. The patient was treated with acitretin 0·25 mg kg−1 daily for 4 months, and 0·1% methylprednisolone ointment applied twice daily for 1 month. Protection measures against natural ultraviolet (UV) radiation were taken, and she was also instructed to avoid sun exposure. No improvement of lesions was observed during the 4 months of treatment. The patient started taking hydroxychloroquine 200 mg daily, without improvement after 2 months. Afterwards, she was treated with oral ciclosporin 3 mg kg−1 daily for 3 months; after the treatment, the hyperpigmentation remained unchanged. Thus, treatment with IPL was proposed. A Harmony® VL/PL module with Advanced Fluorescence Technology (Alma Lasers, Caesarea, Israel) was used with the following settings: wavelength 540–950 nm; pulse width 12 ms; spot size 40 × 16 mm; pulse repetition rate 1/3 Hz; energy density 12 J cm−2 for the first three sessions and 14 J cm−2 from the fourth to seventh sessions. The patient was instructed to avoid the sun. After the seventh session, the patient showed a good improvement (DLQI = 6; Fig. 1, right).