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Dr. Nair
Dr. Nair, Dermatologist
Category: Dermatology
Satisfied Customers: 9182
Experience:  MBBS, MD (Dermatology, Venereology & Leprology)
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I have had these outbreaks of dark spots near my front

Customer Question

I have had these outbreaks of dark spots near my front hairline that turn grey-ish when I get in the shower or sweat dating back to 2009. I went to a dermatologist back in 2009 and he said it was looked like seborrheic dermatitis and gave me some desonide and a Znp bar back in February of 2009. I had a biopsy completed in 2011. PAS stain came back negative for fungal hyphae with appropriate control. Biopsy stated that it was Lichen simplex chronicus with post inflammatory pigmentary alteration. There was no evidence of a primary inflammatory process. It's been seven years and over time the spots have spread and progressively began to eat at my hairline. Over the past 7 years I have seen 4 different dermatologists that has done nothing to solve the problem.
Submitted: 6 months ago.
Category: Dermatology
Customer: replied 6 months ago.
Was also recently prescribed Bactroban' Ointment
Customer: replied 6 months ago.
Things prescribed and tried over the years
Itraconazole 100mg
Fluconazole 200mg
Ketoconazole 200mg
Lamisil Tablets
GriseofulvinAntibioticsDoxycycline 100mg
Erythromycin 250mg
Tetracycline 500mg
Penicillin 250mg
Clindamycin 300 mgSkin Creams, Shampoos and oilsSalytar- COAL TAR, SALICYLIC ACID & SULPHUR OINTMENT
2% Pyrithione Zinc (ZNP) Bar Soap
Nizoral 2% cream
Hibiclens Antimicrobial Skin Cleanser
Kirkland 5% Minoxidil
Fu Li Kang (FuLiKang) Lotion for skin
Selsun Blue Maximum strength
Almond, coconut, hemp, jojoba and tea tree oils
Peppermint oil
miconazole cream
clotrimizole cream 1%
mometasone furoate cream usp 0.1%
desonide cream 0.05
xolegel ketoconazole 2%
Atralin tretinoin gel 0.05%
Acanya clindamycin phosphate and benzoyl peroxide gel 1.2 and 2.5%
Oceral 1% Krem oksikanozal nitrat 10g
Bactroban' Ointment
Customer: replied 6 months ago.
How it started back in 2009 (pic attached titled Screen Shot 2016-08-08 at 7.33.09 PM.jpg)
Expert:  Dr. Nair replied 6 months ago.


Thank you for your question. My name is***** - I am a Dermatologist and will do my best to provide a useful input.

Is this the only area on the body where you have these dark spots?

Customer: replied 6 months ago.
It started back in 2009 and has spread over time. This is the only area that i have the problem in, no other areas at all. No flaking, itching, burning or nothing. It's just there and has continuously grew over time. It is now attacking my hair line. I received a biopsy in 2011(attached)
Expert:  Dr. Nair replied 6 months ago.

Thank you for the information and biopsy report. Okay so I think this might be Lichen Planus Pigmentosus (LPP). This is an inflammatory condition of the skin which starts off for no obvious reason. LPP is common in Asian and other darker races and we see a lot of it here in India. It is uncommon in the west and hence has probably been missed in your case. Your biopsy features are also suggestive of LPP particularly the 'hypergranulosis, acanthosis' and 'melanophages in the dermis'.

Expert:  Dr. Nair replied 6 months ago.

Treatment wise LPP is hard to manage.In most cases though it has a self-limiting course clearing on its own after 5-10 years

Expert:  Dr. Nair replied 6 months ago.

Still the first line of management is a drug called Hydroxychloroquine used in a dose of 200 mg twice a day for 6-12 months along with a mid-potent steroid cream like Fluticasone or Mometasone. Oral antioxidants like Beta Carotene, Omega-3 fatty acid, and Superoxide Dismutase can also be started alongside.

Expert:  Dr. Nair replied 6 months ago.

Please feel free to ask if you have any queries.

Customer: replied 6 months ago.
Wanted to attach a pic from this July because the black areas showed up following a chemical burn suffered from leaving selsun blue on overnight (i know really stupid) but this is what the area usually looks like minus the recent chemical burn (just to confirm diagnosis). If this is Lichen Planus Pigmentosus the treatment plan consist of taking the Hydroxychloroquine (Plaquenil) 2x's a day for 6-12 months. Are there any other alternatives or over the counter treatments I could implement that wouldn't require a prescription? And my main concern is hair loss in the areas where this has spread to. Will the hair grow back once this is under control via the Plaquenil?
Expert:  Dr. Nair replied 6 months ago.

Saw the new photographs. I'm afraid there really is no over the counter treatment for LPP apart from using an SPF 50 sunscreen (e.g Neutrogena SPF 50) twice a day and starting an antioxidant like Beta Carotene (e.g. Capsule Lumitene 30 mg) - and these are just supportive to the main treatment with Plaquenil.

As for hair loss - some hair may come back once Plaquenil is started, however there can be some areas where the hair are permanently lost - that is that nature of LPP. Once the condition is under remission if the hair less areas still bother you, you can consider hair transplantation as an option.

I'd be happy to answer any further queries you have. If there are none kindly consider rating our interaction positively to enable me to get credit for my work with you. You can continue to follow up even after if required. Thank you.