10.5826/dpc.1304a217
text/xml
2160-9381
3174
en
Sanjay Kumar
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
pseudovesicles
Lichenoid Pseudovesicular Papular Eruption on the Nose With Dermoscopic Features: A Case Series
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2023-10-31
2023-01-23
2023-10-31
2024-01-15
e2023217
Dermatol Pract Concept
Sanjay Kumar
2023/10/31
10.5826/dpc.1304a217
e2023217
Department of Pathology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India 
2160-9381
pseudovesicles
en
e2023217
Chauhan P, Adya KA. Dermatoscopy of Cutaneous Granulomatous Disorders. Indian Dermatol Online J. 2021;12(1):34-44. DOI:10.4103/idoj.IDOJ_543_20. PMID: 33768021.
Lichenoid Pseudovesicular Papular Eruption on the Nose With Dermoscopic Features: A Case Series
https://dpcj.org/index.php/dpc/article/download/3174/2340
           Lichenoid Pseudovesicular Papular Eruption
             on the Nose With Dermoscopic Features:
                         A Case Series
           Isha Gupta1, Lovleen Kaur1, Aanchal Bansal1, Surabhi Dayal1, Sanjay Kumar2


1 Department of Dermatology, Venereology and Leprology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences,
  Rohtak, Haryana, India
2 Department of Pathology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India



Key words: LIPEN, lichenoid, pseudovesicles, facial papules, dermoscopy
Citation: Gupta I, Kaur L, Bansal A, Dayal S, Kumar S. Lichenoid Pseudovesicular Papular Eruption on the Nose With Dermoscopic
Features: A Case Series. Dermatol Pract Concept. 2023;13(4):e2023217. DOI: https://doi.org/10.5826/dpc.1304a217
Accepted: April 3, 2023; Published: October 2023
Copyright: ©2023 Gupta 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: Aanchal Bansal, MBBS, Junior Resident, Department of Dermatology, Venereology and Leprology,
Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India. Tel: +917086878303;
Email: aanchal.bansal.ab125@gmail.com




Introduction                                                             asymptomatic skin-colored to erythematous lesions over
                                                                         centro-facial region with duration varying from two months
Lichenoid pseudovesicular papular eruption on nose                       to two years. History of excessive sweating, flushing or ex-
­(LIPEN) is a newly described clinical entity characterized by           acerbation with spicy food and sunlight was absent. Drug,
monomorphic skin-colored to translucent micropapules over                family and occupational history were insignificant.
centro-facial region especially, nose. It resembles various fa-               Clinically, multiple, grouped, skin-colored to slightly
cial papular disorders, hence usually misdiagnosed. We enu-              erythematous micropapules with normal underlying skin
                                                                         ­
merate a case series of four patients having similar lesions             were present on dorsum of nose, bilateral nasal alae, cheeks
over face along with dermoscopic features.                               and forehead. Involvement of cutaneous upper lip was seen
                                                                         in two patients (Figure 1, A-D). Cutaneous examination else-

Case Presentation                                                        where was normal. Diascopy was negative. Routine blood
                                                                         investigations were normal.
Four patients (one male, three females), in the age range of                  Dermoscopic examination revealed multiple pink-clods
20-50 years, North-Indians, skin type IV, presented with                 with brown dots in clusters distributed in the center and rim




Research Letter | Dermatol Pract Concept. 2023;13(4):e2023217                                                                       1
    Figure 1. Multiple grouped pseudovesicles and micropapules over nose, forehead, bilateral cheeks in all patients (A-D), and upper lips
    in two patients (B and D).




                    Figure 2. (A-B) Multiple pink-clods with brown dots in the center and around the clods (yellow
                    ­circles), multiple white dots (blue square), peri-eccrine brown circles (black arrows); in addition white
                     scales (sky-blue triangle), rosettes (red circles), yellow dots (black asterisk) and telangiectasias (blue
                     arrow) in (B); (C) Histopathology showing epidermal thinning, flat rete ridges, focal basal vacuolar
                     degeneration, dense nodular lymphocytic infiltrate along dermo-epidermal junction in upper dermis
                     (H& E, ×100).



of these clods, multiple white dots interspersed between the               Conclusions
pink-clods, brown circles in the peri-eccrine area, and fine
white scales (Figure 2, A-B). Yellow dots, rosettes and telan-             LIPEN presents as asymptomatic, monomorphic, skin-colored,
giectasias were also observed in single patient.                           erythematous or hyperpigmented grouped micropapules and
    Histopathology from two patients (others denied con-                   translucent pseudovesicles in young to middle-aged pop-
sent) revealed epidermal thinning, flattened rete ridges,                  ulation, predominantly over nose and centro-facial region
focal basal hydropic degeneration and dense lymphocytic                    mainly involving cheeks, forehead and less commonly upper
infiltrate along dermo-epidermal junction and around hair                  lips (seen in three previous case reports). Most common site
follicles, admixed with mononuclear cells, consistent with                 is nasal alae. Its exact pathogenesis is unknown. First clin-
diagnosis of LIPEN. Special stains like alcian blue, peri-                 ical and histopathological description of LIPEN was given
odic acid-Schiff and Ziehl-Neelsen were non-contributory                   in a case series in 2019 [1]. The histopathological features
(Figure 2C).                                                               are characterized by focal lymphocytic infiltrate in upper




2                                                                               Research Letter | Dermatol Pract Concept. 2023;13(4):e2023217
 Table 1. Comparison of lichenoid pseudovesicular papular eruption on nose with other differential
                                     diagnoses summarized.
 S.no.     Differential diagnosis        Characteristic dermoscopic findings                 Histopathological findings
   1.     Granulosa rubra nasi          Discrete round pink and red                  Dilated blood vessels and eccrine ducts
                                        structureless areas are present              with surrounding lymphocytic infiltrate
                                        over-erythematous background with
                                        scattered to grouped brown dots
   2.     Papular sarcoidosis           Multiple arborizing vessels over             Non-caseating, lymphocyte-poor,
                                        yellow-orange globular structures            epithelioid cell granulomas in superficial
                                        and scarred areas                            and deep dermis admixed with
                                                                                     multinucleated giant cells
   3.     Micro-papular                 Ring-shaped scales                           Hyperkeratosis, spongiosis, dense dermal
          polymorphic light                                                          perivascular lymphocytic infiltrate
          eruption
   4.     Granulomatous rosacea         Orange-yellow areas with polygonal           Granulomas with adnexal destruction
                                        network of vessels                           and demodex mite infiltration in follicular
                                                                                     infundibulum with peri-follicular
                                                                                     lympho-histiocytic infiltrate
   5.     Lupus miliaris                Perifollicular structureless yellow-         Dermal caseating epithelioid cell
          disseminates faciei           orange areas with keratotic plugs            granulomas with multinucleated giant cells
                                                                                     and lymphohistiocytic infiltrate
   6.     Lichenoid pseudo-          Multiple clustered red clods, white             Focal, dense lymphocytic dermal infiltrate,
          vesicular/papular eruption dots, peri-eccrine brown dots and               focal epidermal atrophy and basal
          of nose                    circles, telangiectasias, fine white scales     epidermal degeneration
                                     and yellow dots; multiple rosettes in
                                     one-case



dermis, basal cell damage (necrotic/ vacuolar) and focal           References
epidermal atrophy. Its various differentials with dermoscopic
features are delineated in Table 1. The clinical distinction of      1. Singh S, Singh A, Mallick S, Arava S, Ramam M. Lichenoid
                                                                        pseudovesicular papular eruption on nose: A papular facial der-
LIPEN from these entities sometimes becomes very difficult
                                                                        matosis probably related to actinic lichen nitidus or micropap-
especially in patients reluctant for facial biopsy. Hence, der-
                                                                        ular polymorphous light eruption. Indian J Dermatol Venereol
moscopy may have a useful adjunctive role. Dermoscopy in                Leprol. 2019;85(6):597-604. DOI:10.4103/ijdvl.IJDVL_347_18.
LIPEN has only been described in six cases previously. In a             PMID: 31293275.
published series of dermoscopic features, multiple structure-        2. Jassi R, Singh S, Sharma T, Kaur M, Patra S. Lichenoid
less clustered red clods (corresponding to lymphohistiocytic            pseudovesicular papular eruption on nose through the dermato-
                                                                        scope. Indian J Dermatol Venereol Leprol. 2022;88(5):660-664.
infiltrate), scattered white dots (empty eccrine openings)
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were most consistent findings [2]. Brown and gray dots or
                                                                     3. Bains A, Beniwal R, Vedant D, Elhence P. Dermoscopy of
globules (suggestive of pigmentary incontinence) appear to              “­Lichenoid Pseudovesicular Papular Eruption on Nose”. Indian
be concentrated in the peri-eccrine and peri-follicular loca-           Dermatol Online J. 2021;12(6):950-951. DOI:10.4103/idoj
tions [3]. Fine scales and yellow dots were not seen in previ-          .IDOJ_865_20. PMID: 34934748. PMCID: PMC8653729.
ously reported cases.                                                4. Chauhan P, Adya KA. Dermatoscopy of Cutaneous Granuloma-
                                                                        tous Disorders. Indian Dermatol Online J. 2021;12(1):34-44.
   The clinical, dermoscopic and histopathological data
                                                                        DOI:10.4103/idoj.IDOJ_543_20. PMID: 33768021. PMCID:
about LIPEN is limited. As it resembles other facial papular
                                                                        PMC7982032.
disorders, apparently the disease has either been misdiag-
nosed or under-diagnosed in previous studies. This study will
aid in the distinction of this uncommonly diagnosed entity.




Research Letter | Dermatol Pract Concept. 2023;13(4):e2023217                                                                        3
