Friday - - Beauty -

Q I’m a 33-year-old In­dian wo­man, and have started notic­ing grey­ish-black patches on my fore­head, tem­ples, chin, and neck. It has be­gun af­fect­ing my self-es­teem se­verely. Please help.

AThe de­scrip­tion of your skin com­plaint is sug­ges­tive of Lichen Planus Ac­tini­cus Pig­men­to­sus (LPAP), also known as ashy der­mato­sis.

LPAP is an im­mune me­di­ated skin dis­or­der where an in­flam­ma­tory re­ac­tion gets trig­gered in skin, par­tic­u­larly on sun-ex­posed ar­eas, caus­ing sig­nif­i­cant cell dam­age. Among the par­tially or to­tally bro­ken skin cells, melanocytes – the pig­ment-con­tain­ing cells – are also in­cluded. The re­leased pig­ment (melanin) from these bro­ken melanocytes gets de­posited in the af­fected lay­ers of skin, which can re­sult in ab­nor­mal dark patches.

The ex­act cause of LPAP is not yet com­pletely known but epi­demi­o­log­i­cal re­search shows that in­di­vid­u­als from the Sub­con­ti­nent are among the most com­mon suf­fer­ers. This sug­gests that LPAP is a ge­net­i­cally in­flu­enced dis­or­der. Sun ex­po­sure also has an in­te­gral causative role.

Treat­ment of LPAP is dif­fi­cult. Ab­so­lute sun avoid­ance/pro­tec­tion re­main the main­stay of the treat­ment plan and also pre­vents fur­ther spread of the con­di­tion. My ap­proach to treat­ing LPAP in­cludes use of moder­ately po­tent top­i­cal steroids for a cou­ple of weeks to sup­press the un­der­ly­ing in­flam­ma­tory re­ac­tion.

Af­ter­wards, cer­tain skin-light­en­ing creams, lo­tions, masks or chem­i­cal peels can be used. A pig­ment-re­duc­ing skin laser can also prove ef­fec­tive in many cases. Please note, these treat­ments are bet­ter done in cooler months to avoid the neg­a­tive ef­fects of a stronger sun in sum­mer.

LPAP, un­for­tu­nately, has a re­oc­cur­ring be­hav­iour, which means the pa­tient and der­ma­tol­o­gist have to be ex­tra vig­i­lant in mon­i­tor­ing it.

DR IKRAMULLAH AL NASIR is a Dubai-based der­ma­tol­o­gist

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