Dermatology Questions? Ask an Online Dermatologist.
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?
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'.
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
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.
Please feel free to ask if you have any queries.
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.
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