Dermatology Online Journal

Lichen aureus
Carole Hazan MD, Bill Fangman MD, David Cohen MD MPH
Dermatology Online Journal 13 (1): 23

New York University Department of Dermatology

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Clinical synopsis

A 76-year-old man has been followed in the New York University Dermatologic Associates for a history of basal-cell carcinoma. About 4 weeks prior to his scheduled follow-up visit his wife noted the appearance of new lesions on his buttocks. The patient stated that they were asymptomatic. The patient was otherwise well. A biopsy specimen was obtained at the time of presentation.

Erythematous and golden plaques with slight scale were present on the buttocks.

Figure 1	Figure 2

Histopathology reveals a superficial, perivascular infiltrate of lymphocytes that focally extends to the dermoepidermal junction where there is mild interface change. There is fibrosis of the superficial papillary dermis. There are scattered extravasated erythrocytes. A Perls' stain highlights the hemosiderin deposition.

Comment

Lichen aureus was first described by Martin in 1958 [1]. It is a rare and chronic skin disease that is part of the group of pigmented purpuric dermatoses. Lichen aureus often has a predilection for a younger age group. The lesions appear as unilateral, localized and well-circumscribed areas of confluent macules and papules that vary in their color from golden brown to purple with occasional petechiae. The lesions are usually asymptomatic and are located on the lower extremities but may also involve the forearms and trunk. The lesions are slow to evolve and usually persist unchanged for many years. Complete resolution rarely occurs [2].

Treatment of lichen aureus can be a challenge [3]. Very potent topical glucocorticoids, such as clobetasol propionate 0.05 percent have been ineffective in the treatment of lichen aureus [4]. A case responded to treatment with PUVA photochemotherapy [5]. The disease had completely resolved after only eight exposures. A mild relapse occurred subsequently that resolved with local topical glucocorticoid therapy. Resolution of lichen aureus occured with the application of topical pimecrolimus 1 percent cream twice daily in a 10-year-old child [6]. Improvement was noted after only 3 weeks of its application. Clearance of the lesions was noted after 10 weeks, and the application of pimecrolimus was discontinued. A followup 3 weeks later failed to demonstrate recurrence of the lesions. However, the lesions did recur at approximately 8 months followup, and pimecrolimus cream was applied twice daily. The lesions disappeared after a 2-week course, and the patient has remained without evidence of recurrence. Furthermore, no side-effects were noted with this treatment modality. Without treatment lichen aureus is considered a chronic dermatosis.

References

1. Martin RH. Case for diagnosis. Trans Rep St Johns Hosp Dermatol Soc Lond 1958;40:98

2. Price ML, et al. Lichen aureus: a localized persistent for of pigmented purpuric dermatitis. Br J Dermatol 1985;112:307

3. Graham RM, et al. Lichen aureus: a study of 12 cases. Clin Exp Dermatol 1984; 9:393

4. Rudolph RI, et al. Lichen aureus. J Am Acad Dermatol 1983;8:722

5. Ling TC, et al. PUVA therapy in lichen aureus. J Am Acad Dermatol 2001;45:145

6. Bohm M, et al. Resolution of lichen aureus ina 10-year-old child after topical pimecrolimus. Br J Dermatol 2004;151:519

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