A. Wu, S. Vaidya
Background: The classification of the conditions lichen planus pigmentosus (LPP), erythema dyschromicum perstans (EDP) and ashy dermatosis (AD) continues to be debated and change over time. Anecdotal cases show varied responses to current treatments. A review of published case series would provide a better understanding of treatment outcomes.
Aim: To review treatment options and outcomes for LPP, EDP and AD.
Method: Literature review of treatment outcomes in case series of LPP, EDP and AD over the 10-year period from 2008 to 2017 inclusive.
Results: 161 cases were identified, with mean age of 38 years (range 3–84). Male to female ratio was 1:1.6. Of LPP cases treated with corticosteroids and topical tacrolimus (n = 6), one improved. Of 13 cases treated with topical tacrolimus alone, four had an excellent response and three had a good response. The five cases treated with topical tacrolimus and oral dapsone showed some improvement. Of 27 cases treated with oral isotretinoin, seven had a good improvement and 15 had a moderate improvement. Two of 22 cases of LPP inversus showed moderate improvement on topical steroids. In a large series of EDP/AD (n = 51) using various treatments including topical steroids, topical calcineurin inhibitors, dapsone and clofazimine, 45% had some improvement. Eight cases of EDP/AD were treated with non-ablative fractional laser therapy, after which two patients would recommend the treatment to friends.
Conclusion: Current treatments tend to produce a limited response in a limited proportion of cases. Ongoing dispute about diagnostic classification poses problems in retrospective literature review.