Lichen pigmentosus (also called lichen planus pigmentosus or LPP) is a chronic pigmentary disorder that causes dark brown to greyish-black patches on the skin. It is more common in individuals with darker skin tones and frequently affects the face, neck, underarms, and sun-exposed areas. Although it is not contagious or cancerous, it can be cosmetically distressing and difficult to treat without specialist care.
What causes lichen pigmentosus?
The exact cause is unknown. It is believed to result from inflammation that damages the dermo-epidermal junction cells in the skin, causing melanin to deposit deeper within the skin. Possible triggers include:
- Sun exposure
- Fragrances and cosmetics
- Hair dyes
- Certain medications
- Genetic susceptibility
- Autoimmune factors
Often, no clear trigger can be identified.
*Symptoms*
Common features include:
- Grey, brown, or slate-coloured patches
- Gradual onset over weeks to months
- Mild or no itching
- Symmetrical distribution
- Common involvement of the face, neck, temples, and flexural areas
Unlike classical lichen planus, raised itchy bumps may be absent.
How is it diagnosed?
Diagnosis is usually clinical. Your dermatologist may use dermoscopy and, in uncertain cases, perform a skin biopsy to confirm the diagnosis and exclude other causes of facial pigmentation such as melasma, erythema dyschromicum perstans, or post-inflammatory hyperpigmentation.
Treatment options
Treatment aims to control inflammation and prevent further pigmentation rather than providing an immediate cure.
Management may include:
- Topical corticosteroids for active inflammation
- Calcineurin inhibitors
- Strict daily use of broad-spectrum sunscreen
- Avoidance of identified triggers
- Oral medications in selected patients
- Carefully selected chemical peels or laser treatments after the disease becomes inactive
Since pigmentation fades slowly, visible improvement may take several months.
Can it be prevented?
Although prevention is not always possible, the following measures may reduce flare-ups:
- Daily sunscreen use
- Avoid harsh cosmetics and fragrances if they worsen pigmentation
- Seek early dermatology consultation when new patches appear
Frequently Asked Questions
Is lichen pigmentosus contagious?
No. It cannot spread from one person to another.
Is it permanent?
Many patients improve with treatment, but pigmentation often fades gradually over months to years.
Can home remedies cure it?
No. Home remedies are unlikely to treat the underlying inflammation and may worsen pigmentation.
When should you see a dermatologist?
Persistent dark patches on the face or body should always be evaluated to establish the correct diagnosis and begin treatment early, which offers the best chance of limiting further pigmentation.
At DermcareMD Skin and Hair Clinic by Dr Neha Athalye, we provide personalised evaluation and evidence-based treatment for pigmentary disorders, helping patients achieve healthier and more even-toned skin.
