Otophyma in a woman: A rare and neglected clinicopathological entity

Abstract

mentation, a comprehensive therapeutic strategy should be considered. The first step is to minimize disease activity based on proper diagnosis and suitable treatment. After disease activity is controlled generation of pigment is halted and unwanted effects such as Koebnerization may be avoided. The second step is then taken to diminish hyperpigmentation. Various interventions are available, and the choice should be made in consideration of the severity and depth of melanin deposition. For LPP, one non-randomized study showed decreased pigmentation after 12–16 weeks of topical tacrolimus (0.03%) in 54% of patients, indicating near half did not respond to mere medical treatment. In our case, the postinflammatory hyperpigmentation was stable following topical and systemic medical treatment, but not improved much, either. Thus, the picosecond laser was introduced as management for refractory post-inflammatory hyperpigmentation. An earlier case report showed improvement of linear LPP of the forehead with topical tacrolimus (0.1%) and low-fluence 1064 nm Q-switched Nd:YAG laser. Theoretically, 1064 nm picosecond Nd:YAG laser should also be effective for dermal pigmentation. A recent retrospective review suggested both 755 nm alexandrite and 1064 nm Nd:YAG picosecond lasers are efficacious for dermal pigmented lesions in Asians. The effect of fractional 1064 nm picosecond laser for mixed or dermal type melasma has also been studied. In conclusion, we presented a case of LPP reports successful response with a combination therapy including topical tacrolimus, systemic hydroxychloroquine and subsequent 1064 nm Nd:YAG picosecond laser for diseaserelated post-inflammatory hyperpigmentation.