Case and Research Letters
Dermoscopic Features of Lichen Planus Pigmentosus-Inversus
Dermatoscopia del liquen plano pigmentado inverso
A. Imbernón-Moya
, M. Churruca-Grijelmo, M. Martínez-Pérez, A. Lobato-Berezo
Corresponding author
Servicio de Dermatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
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Imbernón-Moya, M. Churruca-Grijelmo, M. Martínez-Pérez, A. Lobato-Berezo" "autores" => array:4 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Imbernón-Moya" "email" => array:1 [ 0 => "adrian_imber88@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Churruca-Grijelmo" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Martínez-Pérez" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Lobato-Berezo" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dermatoscopia del liquen plano pigmentado inverso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 600 "Ancho" => 1751 "Tamanyo" => 187803 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Hyperpigmented plaques with a flat surface in the right axilla. B, Dermoscopic image of hyperpigmented plaque in the right axilla. A homogeneous white-bluish pattern (yellow circle) is observed with presence of blue-grayish globules and dots and red lines, predominantly in the periphery (red circle). DermLite II Pro-HR (10<span class="elsevierStyleHsp" style=""></span>x).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Lichen planus pigmentosus-inversus (LPPI) is a clinical variant of lichen planus, first described by Pock in 2001. To date, 44 cases have been published in the medical literature (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). It usually presents as hyperpigmented macules or plaques located in the flexion creases. Dermoscopy is a useful tool for guiding diagnosis in clinically nonspecific pigmented lesions.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was a 32-year-old man, with skin phototype <span class="elsevierStyleSmallCaps">III</span>, and no relevant personal or family history, who attended the clinic because of the spontaneous appearance 3 months earlier of 3 asymptomatic skin lesions on the right axilla. These lesions had been progressively spreading since onset. The patient was not taking any medications and had not been overly exposed to sunlight.</p><p id="par0015" class="elsevierStylePara elsevierViewall">On skin examination, 3 well-defined violaceous-brown plaques were observed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>a). Dermoscopy revealed a homogeneous white-bluish pattern with no pigmented reticulum. In several regions, blue-gray and brown-gray globules and dots were observed along with red lines, predominantly at the periphery (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>b). The lesions were biopsied, and the histologic findings were indicative of lichen planus (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Serology testing for HIV and HCV was negative. Given the absence of symptoms, it was decided not to prescribe treatment. After 12 months of observation, the lesions remained unchanged and no new lesions appeared.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">LPPI usually affects patients with a low phototype of Caucasian or Asian origin, with no predilection for sex. The age of presentation is usually between 25 and 84 years (mean age, 58 years). The etiology of these lesions is unknown. There is no known causal relationship with medications, exposure to sunlight, HCV infection, or malignant tumors. Pathogenesis appears to be related to the T-lymphocyte-mediated cytotoxicity affecting basal keratinocytes.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">This clinical variant is characterized by the insidious appearance of macules or hyperpigmented plaques of a brown-violet color. The lesions are asymptomatic or mildly itchy and have variable size, well-defined borders, and a smooth surface. Wickham striae may be present. The lesions are located in intertriginous and flexion regions, mainly in the axilla (involved in 90% of the cases), groin, inframammary folds, and popliteal region. Less frequently, they can also appear on the neck and posterior auricular furrow. The condition usually involves several folds, and it is rare for it to affect a single area, as was the case in our patient. Lesions do not appear on mucosa, the scalp, skin appendages, or the palms or soles. In 10% of cases, lesions consistent with lichen planus or lichen planus pigmentosus appear simultaneously in areas outside the flexion folds, and can affect up to 10% of the body surface area.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Histologically, these lesions are characterized by a similar pattern to lichen planus and regression may be observed: orthokeratotic epidermal atrophy (although hyperkeratosis and minimal hypergranulosis can also appear), hydropic degeneration of the basal layer, lichenoid inflammatory infiltrate composed of lymphocytes and histiocytes in the superficial papillary dermis, and areas of pigmentary incontinence and melanophagia.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Dermoscopy is a useful diagnostic tool that provides additional information to the clinical workup of inflammatory diseases. We have only encountered 1 previously published case of dermoscopy in LPPI.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Dermoscopy of lichen planus has, in contrast, been described and studied previously in the literature.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4–10</span></a> The most common dermoscopic finding in lichen planus is the presence of whitish striae clinically consistent with Wickham striae. Wickham striae appear in a minority of patients with LPPI, and so whitish striae should be an uncommon dermoscopic finding. Other findings indicative of lichen planus reported previously are yellow-brown dots, blue-gray dots, comedones, corn pearls, milia-like cysts, red globules/dots, and red lines. In our case, 2 dermoscopic findings associated with lichen planus were observed: the blue-grayish and brown-grayish dots/globules, consistent with melanophages in the dermis and the red lines consistent with capillary ectasia in the superficial dermis. The blue-gray and brow-gray dots may be associated with greater persistence of the lesions, greater resistance to treatment, and worse prognosis.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,5,9</span></a> The dermoscopic patterns of LPPI show similarities with those of lichen planus but more cases would be needed to compare the findings of the 2 conditions.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Differential diagnosis should be established with erythema dyschromicum perstans, postinflammatory hyperpigmentation, figurate erythema, fixed drug eruption, lichen planus pigmentosus, acanthosis nigricans, contact dermatitis, and candidal intertrigo.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The outcome ranges from spontaneous resolution in a few weeks to persistence for several months or years, with the latter being the most common. The most commonly used treatments are calcineurin inhibitors and medium-potency topical corticosteroids, though success is limited in both cases. Some authors recommend only symptomatic treatment.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Imbernón-Moya A, Churruca-Grijelmo M, Martínez-Pérez M, Lobato-Berezo A. Dermatoscopia del liquen plano pigmentado inverso. Actas Dermosifiliogr. 2015;106:857–859.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 600 "Ancho" => 1751 "Tamanyo" => 187803 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Hyperpigmented plaques with a flat surface in the right axilla. B, Dermoscopic image of hyperpigmented plaque in the right axilla. A homogeneous white-bluish pattern (yellow circle) is observed with presence of blue-grayish globules and dots and red lines, predominantly in the periphery (red circle). DermLite II Pro-HR (10<span class="elsevierStyleHsp" style=""></span>x).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 750 "Ancho" => 1000 "Tamanyo" => 376512 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hydropic degeneration of the epidermal basal layer, presence of melanophages, and lymphohistiocytic infiltrate in the superficial papillary dermis (hematoxylin-eosin [4<span class="elsevierStyleHsp" style=""></span>x]).</p>" ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Authors \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Number of Cases \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sex \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age, y \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Duration \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Site \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chen (2015) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15-44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6-10 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Neck, axillas, groin, inframammary, antecubital, abdominal, and popliteal folds \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dizen (2014) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 female2 male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40-67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1-12 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Axillas, groin, inframammary, popliteal, and antecubital folds \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Murzaka (2014) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Axillas \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Reyes-Baraona (2014) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Axillas, groin, abdominal folds \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ghorbel (2014) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">49-76 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15 days to 3 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Neck, axillas, groin, inframammary and intergluteal folds, genitals \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Barros (2013) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Neck, axillas, groin, popliteal folds \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nijhawan (2013) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Axillas, shoulders, intergluteal and retroauricular folds \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gaertner (2013) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Several weeks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Groin \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Majima (2013) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">64-65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2-12 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Axillas, groin, popliteal folds \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ohshima (2012) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Neck, axillas, groin, abdominal, inframmamary, and popliteal folds \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ruíz-Villaverde (2011) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 female2 male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">42-78 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Not specified \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Groin, axillas, inframmamary folds \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Jung (2011) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Axillas, groin, abdominal and popliteal folds \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bennàssar (2009) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 female2 male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">54-84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2-12 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Neck, axillas, groin, inframmamary, and popliteal folds \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kim (2008) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 female1 male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25-70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6-12 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Groin, axillas, thighs \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kashima (2007) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 female1 male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">51-62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2-6 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Axillas, groin, popliteal folds \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Muñoz-Pérez (2002) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Axillas, groin, abdominal and antecubital crease \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pock (2001) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 female3 male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">46-71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 weeks to 15 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Axillas, groin, pretibial area, wrists, inframammary fold \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab957410.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Description of Cases of Lichen Planus Pigmentosus Inversus Published in the Literature.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lichen planus pigmentosus inversus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "H.R. Barros" 1 => "J.R. Almeida" 2 => "S.L. Mattos e Dinato" 3 => "A. Sementilli" 4 => "N. Romiti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/abd1806-4841.20132599" "Revista" => array:6 [ "tituloSerie" => "An Bras Dermatol." "fecha" => "2013" "volumen" => "88" "paginaInicial" => "146" "paginaFinal" => "149" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24346904" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lichen planus pigmentosus-inversus: Case report and review of an unusual entity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E. Gaertner" 1 => "W. Elstein" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Dermatol Online J." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 16 | 4 | 20 |
| 2024 October | 206 | 53 | 259 |
| 2024 September | 197 | 66 | 263 |
| 2024 August | 200 | 88 | 288 |
| 2024 July | 177 | 59 | 236 |
| 2024 June | 173 | 54 | 227 |
| 2024 May | 130 | 69 | 199 |
| 2024 April | 148 | 44 | 192 |
| 2024 March | 136 | 60 | 196 |
| 2024 February | 156 | 63 | 219 |
| 2024 January | 106 | 42 | 148 |
| 2023 December | 118 | 31 | 149 |
| 2023 November | 116 | 33 | 149 |
| 2023 October | 118 | 33 | 151 |
| 2023 September | 109 | 30 | 139 |
| 2023 August | 96 | 27 | 123 |
| 2023 July | 96 | 54 | 150 |
| 2023 June | 137 | 43 | 180 |
| 2023 May | 122 | 35 | 157 |
| 2023 April | 72 | 44 | 116 |
| 2023 March | 80 | 50 | 130 |
| 2023 February | 91 | 37 | 128 |
| 2023 January | 61 | 43 | 104 |
| 2022 December | 78 | 52 | 130 |
| 2022 November | 84 | 37 | 121 |
| 2022 October | 65 | 33 | 98 |
| 2022 September | 73 | 48 | 121 |
| 2022 August | 61 | 43 | 104 |
| 2022 July | 64 | 44 | 108 |
| 2022 June | 38 | 36 | 74 |
| 2022 May | 81 | 47 | 128 |
| 2022 April | 88 | 34 | 122 |
| 2022 March | 85 | 41 | 126 |
| 2022 February | 76 | 30 | 106 |
| 2022 January | 88 | 47 | 135 |
| 2021 December | 88 | 38 | 126 |
| 2021 November | 84 | 55 | 139 |
| 2021 October | 105 | 61 | 166 |
| 2021 September | 74 | 45 | 119 |
| 2021 August | 73 | 38 | 111 |
| 2021 July | 67 | 33 | 100 |
| 2021 June | 80 | 44 | 124 |
| 2021 May | 88 | 24 | 112 |
| 2021 April | 138 | 85 | 223 |
| 2021 March | 122 | 33 | 155 |
| 2021 February | 98 | 28 | 126 |
| 2021 January | 66 | 31 | 97 |
| 2020 December | 67 | 21 | 88 |
| 2020 November | 67 | 34 | 101 |
| 2020 October | 68 | 23 | 91 |
| 2020 September | 74 | 21 | 95 |
| 2020 August | 34 | 28 | 62 |
| 2020 July | 60 | 21 | 81 |
| 2020 June | 44 | 23 | 67 |
| 2020 May | 51 | 21 | 72 |
| 2020 April | 61 | 28 | 89 |
| 2020 March | 41 | 27 | 68 |
| 2020 February | 3 | 4 | 7 |
| 2020 January | 4 | 4 | 8 |
| 2019 December | 10 | 7 | 17 |
| 2019 November | 4 | 9 | 13 |
| 2019 October | 1 | 8 | 9 |
| 2019 September | 5 | 7 | 12 |
| 2019 August | 4 | 11 | 15 |
| 2019 July | 4 | 17 | 21 |
| 2019 June | 12 | 25 | 37 |
| 2019 May | 6 | 17 | 23 |
| 2019 April | 14 | 13 | 27 |
| 2019 March | 5 | 10 | 15 |
| 2019 February | 2 | 5 | 7 |
| 2019 January | 7 | 6 | 13 |
| 2018 December | 4 | 5 | 9 |
| 2018 November | 18 | 4 | 22 |
| 2018 October | 19 | 0 | 19 |
| 2018 September | 7 | 0 | 7 |
| 2018 March | 13 | 10 | 23 |
| 2018 February | 46 | 33 | 79 |
| 2018 January | 65 | 32 | 97 |
| 2017 December | 63 | 37 | 100 |
| 2017 November | 60 | 30 | 90 |
| 2017 October | 63 | 33 | 96 |
| 2017 September | 31 | 35 | 66 |
| 2017 August | 33 | 28 | 61 |
| 2017 July | 36 | 40 | 76 |
| 2017 June | 34 | 49 | 83 |
| 2017 May | 47 | 67 | 114 |
| 2017 April | 41 | 53 | 94 |
| 2017 March | 38 | 35 | 73 |
| 2017 February | 67 | 54 | 121 |
| 2017 January | 44 | 24 | 68 |
| 2016 December | 32 | 36 | 68 |
| 2016 November | 34 | 37 | 71 |
| 2016 October | 34 | 28 | 62 |
| 2016 September | 0 | 18 | 18 |
| 2016 August | 0 | 23 | 23 |
| 2016 July | 1 | 3 | 4 |
| 2016 June | 5 | 14 | 19 |
| 2016 May | 0 | 6 | 6 |
| 2016 April | 0 | 10 | 10 |
| 2016 March | 0 | 7 | 7 |
| 2016 February | 0 | 2 | 2 |
| 2016 January | 0 | 5 | 5 |
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