Slate-grey patches of pigmentation, mostly on sun-exposed skin of the face and neck, common in darker skin.
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At a glance
- Who it affects
- Often people with slate-grey pigmentation on sun-exposed face or neck.
- What you notice
- Grey-brown patches that may deepen or spread.
- What helps
- Treatment may be discussed after diagnosis; fading varies with cause and skin.
What we do
Your doctor may look for triggers and discuss options. How far pigmentation fades varies.
What you can do
- Use sun protection advised.
- Do not start bleaching products without advice.
- Bring a list of past treatments.
Read the full page on Lichen planus pigmentosus
What it is
Lichen planus pigmentosus, or LPP, is a condition marked by slate-grey pigmentation, mostly on the face and neck. The pigmentation is classically over sun-exposed areas, spread evenly and symmetrically, and it is common in dark-skinned people. On the face it favours the temples — the sides of the forehead — and the area in front of the ears; on the neck it affects all sides. Arms, legs and trunk can also be involved.
The patches are dark brown to grey or grey-blue, round or oval, with irregular and poorly defined borders that gradually enlarge and join up. LPP is usually symptomless, although it can occasionally cause mild itching, which is a marker of activity and progression; the itch is present in the early, active phase and disappears quickly afterwards. Rarely there is a burning sensation. It is usually seen in the third to fifth decade of life, in both sexes and slightly more often in women, and is commonly seen in India, the Middle East and South America.
What causes it
The cause is not exactly known, but a number of agents have been reported as predisposing factors, with sunlight the principal trigger. Other agents thought to make the skin more sensitive to light include mustard oil, which contains allyl thiocyanate, amla oil, fragrances and hair dyes.
How we treat it
LPP may run a long clinical course. Treatment involves avoiding the triggers and using applied and oral medicines to settle the inflammatory reaction and reduce the pigmentation. How far the pigmentation fades varies from person to person.
Topical agents include hydroquinone, commonly used in combination with retinoic acid, azelaic acid, kojic acid, glycolic acid and tacrolimus. Medicines taken by mouth include corticosteroids and vitamin A, and other options are tranexamic acid and low-dose isotretinoin. Because the lesions seldom clear completely, lasers or chemical peels may be used alongside the topical agents in selected cases.
What you can do
Sun avoidance and photoprotection are a must. Avoid the trigger agents listed above wherever you can.
Reviewed by Dr. D. A. Satish · date to be confirmedUnder clinical review
This page is being updated. The clinical information here comes from the clinic’s own patient leaflet and is under review by the doctor. Please ask at your consultation.
The information on this website is for general education only. It is not a substitute for a consultation, a diagnosis or a prescription. Always see a qualified doctor about your own condition.