I HAVE DARK PATCHES ON MY FACE
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.