INTRODUCTION
Psoriasis is a chronic inflammatory skin condition, affecting approximately three percent of the United States population. While modern therapeutic options for psoriasis have greatly improved symptom management and disease outcomes, many patients suffer from post-inflammatory pigmentary alteration (PIPA) even after their psoriatic disease is controlled.
PIPA includes hypopigmentation and hyperpigmentation and tends to disproportionately affect skin of color patients who can have pigmentary changes that are more visible, socially stigmatizing, and persistent. PIPA can have a profoundly negative impact on psychosocial health and quality of life with some patients regarding PIPA as more distressing than their inflammatory skin condition.1 One study also found that 80 percent of patients felt their PIPA was a neglected aspect of psoriasis treatment, and 73 percent of patients saw PIPA as an unmet treatment need.2
Eruptive lentiginosis (EL) is a rare form of PIPA in which multiple dark brown macules arise within resolving psoriatic plaques. We present a case of a patient with extensive plaque psoriasis who developed eruptive lentiginosis within spontaneously resolved plaques that became more extensive following treatment with ixekizumab. We also review the literature on risk factors, clinical outcomes, and treatments for EL.
Case Report
A 68-year-old male with Fitzpatrick skin type II presented with a 25-year history of chronic plaque psoriasis with psoriatic arthritis. The patient was previously treated with topical betamethasone and a narrowband UVB home unit. He utilized UVB treatment consistently for 3 years, followed by intermittent use for around 15 years. The patient discontinued use of the narrowband UVB home unit 2 years ago due to a lack of response. He had no history of prior treatment with systemic therapy. His past medical history is significant for prothrombin deficiency, childhood measles and mumps infection, and
PIPA includes hypopigmentation and hyperpigmentation and tends to disproportionately affect skin of color patients who can have pigmentary changes that are more visible, socially stigmatizing, and persistent. PIPA can have a profoundly negative impact on psychosocial health and quality of life with some patients regarding PIPA as more distressing than their inflammatory skin condition.1 One study also found that 80 percent of patients felt their PIPA was a neglected aspect of psoriasis treatment, and 73 percent of patients saw PIPA as an unmet treatment need.2
Eruptive lentiginosis (EL) is a rare form of PIPA in which multiple dark brown macules arise within resolving psoriatic plaques. We present a case of a patient with extensive plaque psoriasis who developed eruptive lentiginosis within spontaneously resolved plaques that became more extensive following treatment with ixekizumab. We also review the literature on risk factors, clinical outcomes, and treatments for EL.
Case Report
A 68-year-old male with Fitzpatrick skin type II presented with a 25-year history of chronic plaque psoriasis with psoriatic arthritis. The patient was previously treated with topical betamethasone and a narrowband UVB home unit. He utilized UVB treatment consistently for 3 years, followed by intermittent use for around 15 years. The patient discontinued use of the narrowband UVB home unit 2 years ago due to a lack of response. He had no history of prior treatment with systemic therapy. His past medical history is significant for prothrombin deficiency, childhood measles and mumps infection, and
