What are the other Names for this Condition? (Also known as/Synonyms)

• Lichen Purpuricus
• Localized Variant of Pigmented Purpuric Dermatitis

What is Lichen Aureus? (Definition/Background Information)

• Lichen Aureus is a rare, clinical condition of the skin of unknown cause. This chronic skin disorder is categorized in the group of pigmented purpuric dermatoses
• In this disorder, there is a sudden onset of golden-colored skin lesions consisting of macules and lichenoid papules. The term “aureus” refers to the golden color these lesions exhibit
• The skin discoloration occurs in patches, usually on the lower legs. A skin biopsy may help confirm the diagnosis of Lichen Aureus
• It is difficult to treat Lichen Aureus, which is a progressive skin condition. They may also recur after suitable treatment, and over time the condition can become chronic
• The prognosis of Lichen Aureus is generally good, though it is a chronic recurrent condition. It may lead to cosmetic issues causing a lot of longstanding emotional stress

Who gets Lichen Aureus? (Age and Sex Distribution)

• Lichen Aureus is a rare condition that usually occurs in younger individuals, though older adults may also be affected
• Both males and females are affected; however, the condition is seen at a higher incidence in males
• There is no racial or ethnic predilection for this condition; Lichen Aureus is observed worldwide

What are the Risk Factors for Lichen Aureus? (Predisposing Factors)

• The risk factors of Lichen Aureus include varicose veins, recent trauma, or surgery very near the Lichen Aureus lesion
• Nevertheless, not all cases of Lichen Aureus are associated with either varicose veins or a history of trauma

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Lichen Aureus? (Etiology)

• The exact cause of Lichen Aureus is not well-established or understood
• Some researchers believe that it is an immune-mediated condition
• The condition is not infectious and does not spread from one individual to another

What are the Signs and Symptoms of Lichen Aureus?

The clinical signs and symptoms of Lichen Aureus include the following:

• Localized (confined to a certain area), unilateral (affecting either the right or left side of the body), well-circumscribed areas of golden-brown to purple patches on the skin
• The skin patches are not itchy
• They are usually present on the lower legs.  Rarely, they are found on the forearms and trunk

How is Lichen Aureus Diagnosed?

The diagnosis of Lichen Aureus may involve the following procedures:

• The diagnosis of Lichen Aureus is usually via physical (skin) examination and evaluation of medical history
• Dermoscopy: Dermoscopy is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Skin biopsy: A skin biopsy is performed and sent to a laboratory for a pathological examination, who examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. A skin biopsy is performed to rule out other similar conditions

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Lichen Aureus?

The complications of Lichen Aureus may include the following:

• Development of worsening and recurrent chronic skin lesions, which may be resistant to treatment
• The longstanding lesions can cause emotional stress and psychological trauma in some individuals, leading to depression

How is Lichen Aureus Treated?

The treatment of Lichen Aureus is difficult and the condition is slowly progressive and chronic in nature. The lesions may recur after a period of time, sometimes after the condition gets better. The treatment provided may only help in improving the symptoms.

• The application of topical steroid creams is usually not helpful
• There have been reported cases of treatment with ultraviolet A photochemotherapy
• The presence of chronic skin lesions may cause psychological discomfort; individuals may require reassurance to help with stress and anxiety
• Antibiotic therapy is not helpful in the treatment of this skin condition

Despite therapy, the skin lesions persist for a long period of time, resulting in a chronic skin disorder.

How can Lichen Aureus be Prevented?

There is currently no effective means of preventing Lichen Aureus because the cause of this disorder is unknown.

What is the Prognosis of Lichen Aureus? (Outcomes/Resolutions)

• The skin lesions in Lichen Aureus are not life-threatening
• However, it is chronic in nature, and the characteristic lesions may recur or get worse

Additional and Relevant Useful Information for Lichen Aureus:

When a pathologist examines a biopsy sample specimen of an individual with Lichen Aureus, the following findings may be noted:

• The skin biopsy shows a benign epidermis with a superficial perivascular lymphocytic infiltrate in the dermis. Occasionally, the inflammation extends through the dermal-epidermal junction
• Interface vacuolar alteration is usually identified. The superficial dermis on histopathological sections also shows dilated and engorged capillaries in the papillary dermis, around which, extravasation of erythrocytes (red blood cells) occurs
• These extravasated red blood cells, as they are being removed by the immune system, results in the formation of hemosiderin laden macrophages
• No vasculitis is identified and no granulomas are seen. The superficial papillary dermis shows subtle fibrosis
• The golden-brown appearance of the skin lesions may be due to the presence of hemosiderin within the superficial dermis. A special stain for hemosiderin can demonstrate the presence of hemosiderin within the macrophages in the superficial dermis