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E-IJD® - CORRESPONDENCE
Year : 2022  |  Volume : 67  |  Issue : 5  |  Page : 627
Lichenoid pseudovesicular papular Eruption on nose: A rare distinct entity


Department of Skin & VD, SCB Medical College and Hospital, Cuttack, Odisha, India

Date of Web Publication29-Dec-2022

Correspondence Address:
Dinesh R Panda
Department of Skin & VD, SCB Medical College and Hospital, Cuttack, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.ijd_245_21

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How to cite this article:
Mohanty P, Panda DR, Samal SR, Samal K. Lichenoid pseudovesicular papular Eruption on nose: A rare distinct entity. Indian J Dermatol 2022;67:627

How to cite this URL:
Mohanty P, Panda DR, Samal SR, Samal K. Lichenoid pseudovesicular papular Eruption on nose: A rare distinct entity. Indian J Dermatol [serial online] 2022 [cited 2023 Feb 7];67:627. Available from: https://www.e-ijd.org/text.asp?2022/67/5/627/366115




Sir,

Lichenoid pseudovesicular papular eruption on nose (LIPEN) is characterized by pseudovesicular papular eruption involving the nose and adjoining areas that predominantly showed a lichenoid infiltrate on biopsy as termed by Singh et al.[1] It is thought to be related to the actinic lichen nitidus/micropapular variant of polymorphous light eruption (PMLE).

A 37 years old female, housewife by occupation with Fitzpatrick skin type four presented with the gradual development of asymptomatic grouped skin colored to reddish small pinhead sized elevated lesions over the nose, adjoining centrofacial areas, and cheeks for 3 years. No history of facial flushing on sun exposure, food, or emotional stimuli. No history of an increase in sweating over the affected area. No history of any drug intake before the appearance of lesions.

On cutaneous examination, lesions were 1–2 mm sized, skin colored to erythematous, pseudovesicular grouped monomorphic papules uniformly present over the nose, nasal alae, philtrum, and cheeks [Figure 1] and [Figure 2].
Figure 1: Skin colored to erythematous, pseudovesicular grouped monomorphic papules uniformly involving the nose, nasal alae, philtrum, and cheeks

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Figure 2: Skin colored to erythematous, pseudovesicular grouped monomorphic papules uniformly involving the nose, nasal alae, philtrum, and cheeks

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The clinical differential diagnoses considered were granulosis rubra nasi, rosacea, papular sarcoidosis, actinic lichen nitidus, micropapular polymorphous light eruption, Lupus miliaris disseminatus faciei, pseudolymphoma, eccrine hidrocystoma, and papular elastosis [Table 1].
Table 1: Showing clinical differentials and differentiating points

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All routine and specific blood investigations were in the normal range. General and systemic examinations were within normal limits. Skin punch biopsy was done using a 3 mm punch. Histopathology showed thinning of supra papillary epidermis with focal basal cell vacuolar degeneration and expanded dermal papillae with dense histiocytic infiltration [Figure 3] and [Figure 4].
Figure 3: Focal basal cell vacuolar degeneration and expanded dermal papillae with dense histiocytic infiltration in high power (40×) in Hematoxylin and Eosin stain

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Figure 4: 10× view in Hematoxylin and Eosin stain

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Based on clinical and histopathological findings, a diagnosis of LIPEN was made by excluding all the differential diagnoses.[2],[3],[4],[5]

The patient was started on cap doxycycline 100 mg twice daily and topical tacrolimus 0.1% at night. After 1 month, all the lesions subsided with post inflammatory hyperpigmentation [Figure 5]. The patient was followed up for the next 3 months and there was no recurrence.
Figure 5: Response to treatment after 4 weeks (Postinflammatory hyperpigmentation)

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LIPEN is a new form of papular facial dermatosis to include a group of patients with distinct clinical and histopathological findings. We found some clinical and histopathological resemblance to actinic lichen nitidus and micropapular variant of PMLE in our patients through pseudovesicular appearance was unusual for actinic lichen nitidus and in micropapular PMLE face is usually spared. Pseudovesicular variant of either actinic lichen nitidus or micropapular polymorphous light eruption can be thought of it.

The exact etiopathogenesis of the eruption still remains obscure. The exact cause of the pseudovesicular appearance of the lesions is not clear but may be possible because of the overlying epidermal atrophy as evident in histopathology, which is a feature of other translucent lesions such as sarcoidosis and eccrine hidrocystoma. Sunlight can play a role as it was present in the photo-exposed part.[1] Anti-inflammatory drugs like doxycycline and tacrolimus showed good response in our patient which was consistent with Singh et al.[1] study. Due to nonavailability immunohistochemical stains for Clusters of differentiation 4 (CD4) and CD8 could not be done. Here we report this case to categorize this group of patients and facilitate their recognition as a distinctive entity, that is, LIPEN and to help in establishing its nosological position but a large number of studies are required to ascertain the terminology.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Singh S, Singh A, Mallick S, Arava S, Ramam M. Lichenoid pseudovesicular papular eruption on nose: A papular facial dermatosis probably related to actinic lichen nitidus or micropapular polymorphous light eruption. Indian J Dermatol Venereol Leprol 2019;85:597-604.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Sonthalia S, Singal A, Sharma R. Hyperhidrosis, vesicles, and papules over the nose: Granulosis rubra nasi. Indian J Dermatol Venereol Leprol 2012;78:97-8.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Culp B, Scheinfeld N. Rosacea: A review. P T 2009;34:38-45.  Back to cited text no. 3
    
4.
Toda-Brito H, Aranha JMP, Tavares ES. Lupus miliaris disseminatus faciei. An Bras Dermatol 2017;92:851-3.  Back to cited text no. 4
    
5.
Chiam LY, Chong WS. Pinpoint papular polymorphous light eruption in Asian skin: A variant in darkerskinned individuals. Photodermatol Photoimmunol Photomed 2009;25:71-4.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
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