Actinic lichen planus (LP) is a rare variant of the already infrequent LP. LP is a chronic inflammatory skin disorder seen in 1-2% population of the world. The classical presentation is in the form of the four P's namely pruritic, purplish, polygonal, papules and plaques. On the contrary in this variant of actinic LP, although the lesions look similar in appearance they are characteristically distributed over the photoexposed areas of the body like the face, extensors of the upper limbs, and dorsum of hands. Koebner's phenomenon which is characteristic of LP is absent. The commonest differentials that leave the clinician in a fix are usually discoid lupus erythematosus, granuloma annulare, and polymorphous light eruptions. A detailed clinical history followed by histopathological examination aids in the final diagnosis in such cases. In scenarios where the patient is not willing for a minor interventional procedure such as a punch biopsy, dermoscopic assessment comes to the rescue. Dermoscopy being an inexpensive, non-invasive, and minimal time-consuming procedure helps in the early diagnosis of a wide range of cutaneous disorders. Fine, reticulate white streaks over the surface of papules or plaques of LP known as "Wickham's striae" act as the diagnosis clincher for most cases of LP. The numerous variants of LP have consistent biopsy findings and the mainstay for treatment remains topical or systemic corticosteroids. We report this case of a 50-year-old female farmer that presented with multiple violaceous plaques on photo-exposed areas of the body owing to its rarity and use of dermoscopy in enabling a prompt diagnosis that helped improve the patient's quality of life.

Background: Melasma refers to acquired hyper-pigmentary condition effecting skin. Owing to its multifactorial causation and chronicity, there is an increased need for new multimodality therapies to treat melasma more effectively and to prevent the side effects seen with the conventional modalities of treatment. Objectives: Compare efficacy of combining oral Tranexamic Acid and Azelaic Acid 15% with that of Oral Tranexamic Acid (TA) and Modified Kligman’s Formula. Also, to record any adverse effects of combining these agents. Methods: Patients having Melasma who will be coming to Dermatology OPD, AVBRH, Sawangi, Wardha, will be enrolled after considering the various inclusion and exclusion criteria. A detailed history will be asked, which will be followed by a cutaneous examination that includes the calculation of MASI (Melasma Area and Severity Index). One Group (A) - participants will receive - Oral 500 mg Tranexamic acid OD plus Modified Kligman’s Formula (fluocinolone acetonide 0.01%, tretinoin 0.05%, and hydroquinone 2%) cream one time at night only. Second Group (B)- participants will receive -  Oral 500 mg Tranexamic Acid OD plus Azelaic Acid 15% gel once daily at night only. Both groups will also receive Broad-spectrum sunscreen SPF-30 daily (3 hourly). Patients will be called for regular follow up at 4 weeks and 8 weeks (for early results). Clinical photos will be clicked at every follow-up visit and MASI score shall be doocumented. Expected Results: To analyze efficacy of combining Oral TA along with Azelaic Acid 15% and if it provides better results, we can avoid the undesirable side effects that are seen on prescribing the Modified Klingman’s Formula, in Melasma patients. Conclusion: This study will help us in analyzing efficacy of combining Oral TA with Azelaic Acid 15%, therefore will provide a newer treatment modality with lesser side effects and maybe better results than the gold standard- Modified Klingman’s Formula.

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