10.5826/dpc.1302a119
Introduction: The two less-known subtypes of lichen planus (LP) are lichen planus actinicus (LPA) and lichen planus pigmentosus (LPP), with the highest prevalence in the Middle East. Objectives: We aimed to evaluate the clinicopathological profile of these patients. Methods: 307 cases including 184 LPA and 123 LPP patients were recruited from the registered pathology reports of Razi Skin Hospital of Tehran from April 2016 to March 2021. The clinical features and pathological reports were extracted and analyzed. Results: Among 307 patients, 117 (63.9%) in the LPA group and 88 (71.5%) in the LPP group were women. Duration of disease ranged from 1 month to 20 years and 1 month to 12 years in the LPA and LPP groups, respectively. Face (159 patients), limbs (68), and neck (23) were the most frequent sites of involvement in LPA patients, whereas face (60 patients), limbs (47), and trunk (42) were more commonly involved in the LPP patients. Pruritus and oral mucosal lesions were found with similar frequency in both groups. Pathological evaluation showed vacuolar degeneration of basal layer (100%), lymphocytes infiltration (97.3%), and melanin incontinence (58.2%) as the most frequent findings in LPA and vacuolar degeneration of basal layer (100%), lymphocytes infiltration (100%), and melanin incontinence (52/8%) as the most frequent findings in LPP cases.Conclusion: LPA and LPP were both more prevalent among women.  Face was the most common site of involvement in both LPA and LPP. Vacuolar degeneration, lymphocyte infiltration, melanin incontinence, and hyperkeratosis were more common histological findings in this study.
text/xml
2160-9381
2746
en
Maryam  Nasimi
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
vacuolar degeneration
Clinicopathological Study of 307 Patients with Lichen Planus Actinicus and Pigmentosus Referred to Razi Skin Hospital from 2016 to 2021
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Original Article
2023-04-29
2022-08-04
2023-04-29
2023-06-05
e2023119
Dermatol Pract Concept
Introduction: The two less-known subtypes of lichen planus (LP) are lichen planus actinicus (LPA) and lichen planus pigmentosus (LPP), with the highest prevalence in the Middle East. Objectives: We aimed to evaluate the clinicopathological profile of these patients. Methods: 307 cases including 184 LPA and 123 LPP patients were recruited from the registered pathology reports of Razi Skin Hospital of Tehran from April 2016 to March 2021. The clinical features and pathological reports were extracted and analyzed. Results: Among 307 patients, 117 (63.9%) in the LPA group and 88 (71.5%) in the LPP group were women. Duration of disease ranged from 1 month to 20 years and 1 month to 12 years in the LPA and LPP groups, respectively. Face (159 patients), limbs (68), and neck (23) were the most frequent sites of involvement in LPA patients, whereas face (60 patients), limbs (47), and trunk (42) were more commonly involved in the LPP patients. Pruritus and oral mucosal lesions were found with similar frequency in both groups. Pathological evaluation showed vacuolar degeneration of basal layer (100%), lymphocytes infiltration (97.3%), and melanin incontinence (58.2%) as the most frequent findings in LPA and vacuolar degeneration of basal layer (100%), lymphocytes infiltration (100%), and melanin incontinence (52/8%) as the most frequent findings in LPP cases.Conclusion: LPA and LPP were both more prevalent among women.  Face was the most common site of involvement in both LPA and LPP. Vacuolar degeneration, lymphocyte infiltration, melanin incontinence, and hyperkeratosis were more common histological findings in this study.
Maryam  Nasimi
2023/04/29
10.5826/dpc.1302a119
e2023119
Department of Dermatopathology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
2160-9381
vacuolar degeneration
en
e2023119
Mendiratta V, Sanke S, Chander R. Lichen Planus Pigmentosus: A Clinico-etiological Study. Indian Dermatol Online J. 2019;10(3):288-292. DOI: 10.4103/idoj.IDOJ_253_18. PMID: 31149573. PMCID: PMC6536068.
Clinicopathological Study of 307 Patients with Lichen Planus Actinicus and Pigmentosus Referred to Razi Skin Hospital from 2016 to 2021
https://dpcj.org/index.php/dpc/article/download/2746/2062
    Clinicopathological Study of 307 Patients with
  Lichen Planus Actinicus and Pigmentosus Referred
       to Razi Skin Hospital From 2016 to 2021
   Kambiz Kamyab1, Zahra Gholi1, Maryam Ghiasi2, Marzieh Pirzadeh1, Maryam Nasimi2


1 Department of Dermatopathology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
2 Babol university of Medical Sciences, Babol, Iran



Key words: lichen planus actinicus, lichen planus pigmentosus, clinicopathology, vacuolar degeneration
Citation: Kamyab K, Gholi Z, Ghiasi M, Pirzadeh M, Nasimi M. Clinicopathological Study of 307 Patients with Lichen Planus Actinicus
and Pigmentosus Referred to Razi Skin Hospital from 2016 to 202. Dermatol Pract Concept. 2023;13(2):e2023119. DOI: https://doi.
org/10.5826/dpc.1302a119
Accepted: November 30, 2022; Published: April 2023
Copyright: ©2023 Kamyab et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding author: Maryam Nasimi, Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences,
Vahdate Eslami Street, Tehran, Iran. Zip code: 1199663911 Tel: 00982155618989, Nsm.maryam@gmail.com




  ABSTRACT             Introduction: The two less-known subtypes of lichen planus (LP) are lichen planus actinicus (LPA)
                       and lichen planus pigmentosus (LPP), with the highest prevalence in the Middle East.
                       Objectives: We aimed to evaluate the clinicopathological profile of these patients.
                       Methods: Three hundred and seven cases including 184 LPA and 123 LPP patients were recruited
                       from the registered pathology reports of Razi Skin Hospital of Tehran from April 2016 to March
                       2021. The clinical features and pathological reports were extracted and analyzed.
                       Results: Among 307 patients, 117 (63.9%) in the LPA group and 88 (71.5%) in the LPP group were
                       women. Duration of disease ranged from 1 month to 20 years and 1 month to 12 years in the LPA
                       and LPP groups, respectively. Face (159 patients), limbs (68), and neck (23) were the most frequent
                       sites of involvement in LPA patients, whereas face (60 patients), limbs (47), and trunk (42) were more
                       commonly involved in the LPP patients. Pruritus and oral mucosal lesions were found with similar fre-
                       quency in both groups. Pathological evaluation showed vacuolar degeneration of basal layer (100%),
                       lymphocytes infiltration (97.3%), and melanin incontinence (58.2%) as the most frequent findings in
                       LPA and vacuolar degeneration of basal layer (100%), lymphocytes infiltration (100%), and melanin
                       incontinence (52/8%) as the most frequent findings in LPP cases.
                       Conclusions: LPA and LPP were both more prevalent among women. Face was the most common site
                       of involvement in both LPA and LPP. Vacuolar degeneration, lymphocyte infiltration, melanin inconti-
                       nence, and hyperkeratosis were more common histological findings in this study.




Original Article | Dermatol Pract Concept. 2023;13(2):e2023119                                                                        1
Introduction                                                        Methods
Lichen planus (LP) is a chronic, inflammatory, mucocutane-          This study is a cross-sectional descriptive retro-respective
ous, and autoimmune disease that involves the skin and mu-          study including patients who referred to the outpatient clinic
cous membrane of the mouth and genitalia, scalp, and nails          of Razi Hospital, and their pathology samples had been re-
[1,2]. LP prevalence is unknown, but it is estimated that less      corded in the pathology department of Razi Hospital in Teh-
than 1% of the population are affected by LP [2,3].                 ran, Iran, from April 2016 to March 2021.
    So far, about 13 subtypes of this disease have been re-            Among all patients, the cases whom LPA and LPP were
ported including: classic, annular, hypertrophic, atrophic,         reported as the differential diagnosis were evaluated and
ulcerative, bullous, pemphigoides, erythrodermic, inverse,          cases with final diagnosis of these two entities were selected
linear, follicular, pigmentosus, and actinic [4].                   for final evaluation. Cases that their diagnoses were post-
    LP actinic (LPA) is a photo-distributed type of LP which        poned to clinical follow-up and needed further evaluation
is often reported in darker-skinned people in the Middle East       were excluded from the study.
region and India. Lesions of LPA usually occur in the fore-            Age, sex, clinical features, duration of symptoms, pres-
head, face, neck, and extensor surfaces of the forearm and          ence of pruritus, location of lesions, and pathology registered
hands. The lesions usually flare up in warm seasons (spring         data were extracted and recorded from the records of pa-
and summer) and disappear in the winter. However, in rare           tients. Pathology registered data were also extracted.
cases, areas such as the trunk, legs, genitals, and feet that          Finally, 184 patients with LPA and 123 patients with LP
are not usually exposed to sunlight may also be involved.           were included in the study.
Contrary to the classic LP, the actinic type usually starts at
younger age with a longer duration and more tendency for            Results
involvement of women with darker skin.
    Pigmentosus LP (LPP), which is more common in India             Actinic Lichen Planus
and the Middle East, usually begins in the third and fourth         Among 184 LPA patients, 117 (63.9%) were women, and 67
decades of life and is slightly more common in women. Le-           (36.4%) were men and the female to male ratio was 1.74.
sions usually involve the face, neck, and, less commonly,           The mean age of patients was 48.02±14.83, range of 8-102
flexor areas such as the axilla, groin, and infra-mammary           years. The highest prevalence of LPP was among the age
folds. Similar to LPA, this type of LP is also more common          group of 50-59 years (29.35%). The interval between the on-
in areas exposed to the sun [5,6]. Lesions of both LPP and          set of symptoms and diagnosis varied from one month to 20
LPA often occur in sun-exposed areas such as the face and           years, and the average interval was 23 months. In 44.25%
neck, as well as presenting in the third to fifth decades of life   of patients, it was less than one year, in 22.12% one to two
[5-8]. Thus, these lesions can cause discomfort and anxiety         years, and in 8% of patients more than 5 years (Table 1).
for patients and significantly affect their professional, social,      Considering the site of involvement, 159 (86.4%) of pa-
and family relationships. Therefore, prompt and timely diag-        tients had facial lesions and face was the most common site
nosis and treatment of the disease can improve the quality of       of involvement in LPA. Among 159 patients with facial le-
life of patients.                                                   sions, the forehead, cheeks, nose were the most common sites
    Iran is located in the Middle East region; therefore, the       of facial lesions, respectively. After the face, the limbs were
prevalence of LPP and LPA is higher than in countries out-          the second most common site of involvement (68 out of 184
side the Middle East. However, no extensive study has been          patients), most commonly on the dorsum of the hands, arms,
conducted in Iran to investigate the clinical features of these     forearms, and lower limbs. Followed by the face and limbs,
two types of diseases and to search for their indigenous            the neck, trunk, ears, axilla, and groin were commonly in-
differences compared to other countries. Discovering the            volved, and in one patient, generalized lesions were recorded
common clinical signs and pathological features of LPA and          (Table 1 and Figure 1).
LPP can help to accelerate the process of diagnosis, treat-            Out of 184 patients, 7 had oral mucosal involvement and
ment, and improvement of the disease outcome, saving time           25% of patients experienced pruritus (Table 1).
and money.                                                             Regarding the pathological features found in the skin bi-
                                                                    opsies of patients with LPA, we demonstrated that the most

Objectives                                                          prevalent pathological features were vacuolar degeneration
                                                                    (100%), lymphocyte infiltration (97.3%), melanin inconti-
In this regard, we aimed to evaluate the clinicopathological        nence (58.2%), hyperkeratosis (55.4%), and melanophage
features of patients with LPP and LPA who referred to Razi          (42.9%), respectively. Among 179 skin biopsy slides that had
Hospital, Tehran, Iran, between April 2016 and March 2021.          lymphocytic infiltration, 4 types of infiltration were observed



2                                                                       Original Article | Dermatol Pract Concept. 2023;13(2):e2023119
                                Table 1. Clinicopathological features of lichen planus.
                                                                                           LPA (N = 184)   LPP (N = 123)
                                          Female                                           117 (63.59%)    88 (71.54%)
 Gender
                                          Male                                             67 (36.41%)     35 (28.46%)
                                          Mean ± SD                                        48.02 ± 14.83   41.55 ± 14.23
                                                                         0-9 year            1 (0.5%)        2 (1.6%)
                                                                         10-19               8 (4.3%)        5 (4.1%)
                                                                         20-29               9 (4.9%)       15 (12.2%)
                                                                         30-39              30 (16.3%)      35 (28.5%)
                                                                         40-49               46 (25%)       31 (25.5%)
 Age
                                          Range                          50-59              54 (29.3%)      20 (16.3%)
                                                                         60-69               24 (13%)       13 (10.6%)
                                                                         70-79               9 (4.9%)        2 (1.6%)
                                                                         80-89               2 (1.1%)           0
                                                                         90-99                  0               0
                                                                         100-110             1 (0.5%)           0
                                          Mean ± SD                                          23±36.47        21±31.66
                                                                         <1year             50 (44.2%)      42 (50.6%)
                                                                         1-2                25 (22.1%)     22(26.51%)
 Duration                                                                2-3                13 (11.5%)      3 (3.61%)
                                          Range
                                                                         3-4                 6 (5.3%)       4 (4.81%)
                                                                         4-5                10 (8.8%)        2 (2.4%)
                                                                         5<                   9 (8%)       10 (12.05%)
 Pruritus                                                                                    46 (25%)      30 (24.39%)
                                          Face                                             159 (86.4%)      60 (48.8%)
                                          Limbs                                              68 (37%)       47 (38.2%)
                                          Neck                                              23 (12.5%)      21 (17.1%)
                                          Trunk                                              11 (6%)        42 (34.1%)
 Location                                 Scalp                                              4 (2.2%)        1 (0.8%)
                                          Ears and around                                    3 (1.6%)        3 (2.4%)
                                          Groin                                              1 (0.5%)        8 (2.4%)
                                          Axilla                                             2 (1.1%)       20 (16.3%)
                                          Generalized                                        1 (0.5%)        4 (3.3%)
 Mucosal involvement                                                                         7 (3.8%)        4 (3.3%)
                                          Vacuolar degeneration                             184(100%)       123(100%)
                                          Hyperkeratosis                                   102 (55.4%)      54 (43.9%)
                                          Lymphocyte infiltration                          179 (97.3%)     123 (100%)
                                          Melanin incontinence                             107 (58.2%)      65 (52.8%)
                                          Acanthosis                                        52 (28.3%)      38 (30.9%)
 Histopathology
                                          Hypergranulosis                                   36 (19.6%)      14 (11.4%)
                                          Parakeratosis                                      22 (12%)        4 (3.3%)
                                          Infiltration of melanophages                      79 (42.9%)      74 (60.2%)
                                          Civatte body                                       56 (30%)       40 (32.5%)
                                          Thinning or atrophy of the epidermis               54 (29.3       43 (35.5%)
                                          Band like                                        128 (71.5%)      95 (77.2%)
                                          Deep                                              33 (18.4%)      12 (9.8%)
 Infiltration type
                                          Perifollicular                                    46 (25.7%)      19 (15.4%)
                                          Perivascular                                      85 (47.5%)      72 (58.5%)

LPA = lichen planus actinicus; LPP = lichen planus pigmentosus; SD = standard deviation.



Original Article | Dermatol Pract Concept. 2023;13(2):e2023119                                                             3
    Figure 1. Clinical and histopathological features of lichen planus actinicus (LPA). (A,C) Clinical picture of LPA. (B,D) Photomicrograph
    of lichen planus actinicus showing hyperkeratosis, atrophy of epidermis, wedged shaped hypergranulosis, vacuolar degeneration, melanin
    incontinence, civatte bodies and perivascular lymphocyte infiltration.


as follow: superficial or band-like (71.5%), deep (18.4%),                of involvement and forehead was the most common site on
perifollicular (25.7%), and perivascular (47.5%) (Table 1).               the face. Following the face, limbs were the second common
                                                                          site, that 47 out of 123 (38.2%) patients were presented with
Pigmented Lichen Planus                                                   limb lesions, mainly on the dorsum of the hands, arms, fore-
Evaluating the clinical features of 123 patients with LPP,                arms, and lower limb. Out of 42 patients (34.1%) who had
similar to LPA, LPP was more frequent in the female sex,                  trunk lesions, distribution of lesions were back lesions (15),
88 were women (71.5%) and 35 were men (28.4%). The                        intermammary (4), inframammary (3) chest (5), abdominal
mean age of patients with LPP was 41.55±14.23 years                       (5), lumbar (2), and 1 case of flank and buttock lesions. In
(range 6-77 years). The 53.66% of patients were aged                      addition, only 7 patients with trunk involvement were male,
30-49 years. The interval between the onset of symptoms                   and 35 were female (Table 1 and Figure 1).
and diagnosis was ranging from one month to 12 years                          Regarding pathological findings, vacuolar degeneration
with the average interval of 21 months. In 50.6% of pa-                   (100%), lymphocyte infiltration (100%), melanophage in-
tients, this interval was less than one year, in 26.51% one               filtration (60.2%), melanin incontinence (52.8%), hyper-
to two years, and in 12.05% of patients more than 5 years.                keratosis (43.9%), thinning or atrophy of the epidermis
Among 123 patients, 30 of them experienced itching at the                 (35.5%), civatte body (32.5%), acanthosis (30.9%), and
time of referral or in the past. Mucosal involvement was                  hypergranulosis (11.4%) were the most common findings,
seen in 4 of 123 patients (Table 1).                                      respectively (Table 1).
      Generally, the most common sites of lesions in LPP                      Of the 123 skin biopsy slides that had lymphocytic in-
were: face, limbs, trunk, neck, axilla, and groin, respectively.          filtration, four types of infiltration were found, including
­Furthermore, 4 patients had generalized lesions. Sixty pa-               band-like or superficial (77.2%), deep (9.8%), perifollicular
tients (48.8%) had facial lesions as the most common site                 (15.4%), and perivascular (58.5%) (Table 1).



4                                                                              Original Article | Dermatol Pract Concept. 2023;13(2):e2023119
  Figure 2. Clinical and histopathological features of lichen planus pigmentosus (LPP). (A,C) Clinical picture of LPP. (B,D) Photomicro-
  graph of lichen planus pigmentosus showing epidermal thinning, hyperkeratosis, vacuolar degeneration of basal cell layer, basal cell layer
  pigmentation, and perivascular lymphocyte infiltration.


Conclusions                                                              interval of 23 months. In 44.25% of patients, the period
                                                                         was less than one year. However, 8% of patients have had a
To the best of our knowledge, our study described the clin-              course of more than 5 years, which is a significant number
icopathological features of LPA and LPP patients in a large              compared to previous studies.
population for the first time.                                               Dilaimy et al reported that minimal itching could ac-
    It has been investigated that women suffering from LPA               company LPA lesions only in the summer [11]. Similarly,
outnumbered men suffering from LPA based on previous re-                 M. Salman et al. demonstrated that itching was almost al-
ports similar to our results [9-12].                                     ways absent in LPA patients [12]. In our study, we found
    Dostrovsky et al have shown that LPA was most com-                   that out of 184 patients, 46 patients (25%) had pruritus.
mon in 21 to 31 years (39%) [9]. In the contrary, our results            Therefore, the presence of pruritus cannot rule out the di-
showed that although 90.2% of patients were over 30 years                agnosis of LPA.
old, but the highest prevalence of LPA was in the age group                  In Salman et al study, out of 16 patients with LPA, 15
of 50-59 years (29.35%). Studies reported the majority of                had facial lesions, 12 had involvement of the dorsum of the
LPA cases in young adults from second to forth decade of                 hands or the outer surface of the forearm, and 3 had in-
their lives from middle Eastern descent [13]. This difference            volvement of the V area of the
                                                                                                    ​​ chest. Non-exposed areas and
could be attributed to the ethnic population and geographic              mucus membranes were not involved in these patients [12].
difference [14].                                                         Similarly, our results demonstrated that the involvement of
    According to Salman et al study, the interval between the            sun-exposed areas was predominant. Besides among patients
onset of symptoms and LPA diagnosis in 81% of patients                   with limb involvement, the dorsum of the hands, forearms
was one year or less [12].                                               and arms were the most affected sites, respectively. Oral mu-
    The duration of LPA was reported one year in 74% of                  cosal involvement was also observed in 7 patients. An im-
patients, two years in 11%, and more than two years in 13%               portant finding of our results that is worth to be mentioned
of patients in Dostrovsky et al study [9]. In our study, this            was the involvement of axillary and groin regions which are
interval varied from one month to 20 years with an average               not exposed to the sun.



Original Article | Dermatol Pract Concept. 2023;13(2):e2023119                                                                                 5
    Regarding pathological findings, in our study, vacuolar          and 3.2% of patients, respectively [5]. Mendiratta et al.
degeneration was observed in all samples, which is the main          found that the most common sites of involvement were the
finding of diseases involving dermo-epidermal junction. The          head and neck, followed by the involvement of the upper
next finding was lymphocytic infiltration in 97.3% of cases.         back. The disease did not affect the mucous membranes, pal-
The most common pattern for lymphocyte infiltration was              mar and plantar surfaces [17]. In Al-Mutairi et al study, mu-
superficial, perivascular, perifollicular, and deep, respectively.   cosal lesions were present in only one patient, and the nails,
Unlike previous studies, in many cases, superficial infiltra-        palmar and plantar surfaces were all intact [15].
tion was not band-like and continuous; instead, it was in               In our study, face was the most common site of involve-
the form of patchy and scattered areas. Contrary to expec-           ment (48.8%). Facial involvement was mainly on the fore-
tations, infiltration was not limited to the papillary dermis,       head, cheeks, and eyelids. Followed by the face, the limbs
and in 18.4% of cases, infiltration was also found in the            (38.2%), trunk (34.2%), neck (17%), axilla (16.3%), and
deeper layers of the dermis. Unlike the Salman and Dostro-           groin (6.5%) were the most frequent involved parts, respec-
vsky et al studies, in which hypergranulosis was seen in most        tively. 4 patients (3.3%) had mucosal involvement. Similar to
or all cases, in this study, hypergranulosis was only observed       other studies, palmar and plantar surfaces were not affected
in 19.6% of pathology samples [12].                                  in patients. The back was the most common site of lesions
    Unlike the Salman study, which showed hyperkeratosis             among trunk lesions.
in all samples and parakeratosis in 62.5% samples, in our               Regarding pathological findings, Al-Mutairi et al re-
study, hyperkeratosis was found in 58.2% and parakeratosis           ported that band-like infiltration of lymphocytes was the
in 12% of the slides. Therefore, their absence will not rule         most common form of lymphocyte infiltration pattern in bi-
out the diagnosis of LPA [12]. The difference in histopatho-         opsy samples of LPP patients (63%) [15].
logical patterns may be attributed to different factors includ-         In our study, vacuolar degeneration and lymphocyte
ing the duration of the lesions and biopsy location [7,15,16].       infiltration were found in all samples. The most common
    In our study, among 123 patients with LPP, 88 were               lymphocyte infiltration pattern was superficial. Other
women (71.54%) and 35 men (28.46%). However, In                      pathological findings were macrophage infiltration, melanin
Al-Mutairi et al study of 33 patients with LPP, men outnum-          incontinence, hyperkeratosis, thinning or atrophy of the epi-
bered female [15].                                                   dermis, hypergranulosis, and parakeratosis.
    The mean age of the onset of the disease was 46 years               Our LPA cases had higher mean age. Prevalence of pruri-
(ranging from 9 to 68 years) in Vega et al study. Our results        tus was 25% in LPA patients with 7 patients with oral muco-
showed that patients age ranged from 6 to 77 years with a            sal involvement which were considered absent or rare in some
mean age of 41.5 that 54% of our patients were in the range          studies. In contrast to prior studies, lymphocyte infiltration
of 30-49 years [15].                                                 was not all band-like and confined to the upper dermis, in
    In Kanwar et al study, the duration of the disease was           many cases, they were patchy and involved reticular dermis.
reported to range from 2 months to 21 years [5]. In the              Hypergranulosis, which was considered a constant finding
Al-­
   Mutairi study, the length of the disease period varied            in some studies, was present in 19.6% of cases. Among LPP
from 3 months to 6 years [15].                                       cases, a higher rate of trunk lesions was recorded compared
    In our study, 43.4% of patients were diagnosed for               to previous studies. Vacuolar degeneration, lymphocyte in-
6 months or less, and 50.6% less than one year. It is note-          filtration, epidermal atrophy, and hyperkeratosis were also
worthy that 12 patients (9.8%) in our study have had symp-           more prevalent in this study among LPP patients.
toms for more than 3 years. Longer LPP duration has been
associated with positive anti-HCV antibodies [15].
                                                                     Availability of Data and Materials: The datasets used and/
    According to Kanwar study, 31.5% of patients experi-
                                                                     or analyzed during the current study are available from the
enced itching with their lesions [5]. In Al-Mutairi et al study,
                                                                     corresponding author on reasonable request.
9 patients (27%) complained of itching, and others were
completely asymptomatic [15]. In our study, 24.3% of pa-
tients also presented with itching lesions in the past or when
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Original Article | Dermatol Pract Concept. 2023;13(2):e2023119                                                                               7
