Photo Rounds

Brown spots on face

A 52-year-old Ethiopian woman presented to her family physician (FP) with brown spots she’d had on her forehead and cheeks for the past year. The spots were occasionally itchy, and she had similar spots on the back of her hands. She was otherwise in good health.

What’s your diagnosis?


The results of a 4-mm punch biopsy confirmed a diagnosis of actinic lichen planus. As the name implies, this form of lichen planus occurs in areas of sun exposure. Treatment is the same as for other forms of lichen planus, with the addition of avoiding the sun.

The FP counseled the patient about the use of sunscreen and avoiding sun exposure as much as possible. The FP then prescribed a mid-potency topical corticosteroid, 0.1% triamcinolone cream. (A low-potency steroid is unlikely to be beneficial.) In cases like this one, a short course of a mid-potency steroid should be safe on the face without causing atrophy.

At follow-up, there was a significant improvement in the appearance of the patient’s face and hands. The patient was pleased with these results and said she’d been more careful with sun exposure. The FP prescribed 2.5% hydrocortisone cream to be used on the face as needed, in conjunction with the continued use of triamcinolone on the hands as needed.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Kraft RL, Usatine R. Lichen planus. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013: 901-909.

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