Pityriasis lichenoides

Published on 11/06/2015 by admin

Filed under Pediatrics

Last modified 22/04/2025

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Pityriasis lichenoides acute lesions. Crusted, petechial papules on the trunk of a child.

Pityriasis lichenoides acute lesion. Characteristic red papule with central crust.

Pityriasis lichenoides. Discrete, oval salmon-colored papules with a thin scale.

Both acute and chronic lesions on child with pityraisis lichenoides.

CLINICAL FEATURES

Pityriasis lichenoides has been given multiple names, but it is a single entity with a spectrum of clinical lesions from acute to chronic.

The acute lesions (pityriasis lichenoides et varioliformis acuta (pleva) – Mucha–Habermann) are recurrent crops of red papules 2–4 mm in diameter. The papules have central petechiae and progress to crusting. Lesions of different stages are seen and predominate on the trunk. Individual lesions may last a few weeks. The lesions may heal with central scarring. The acute necrotic lesions may be slightly tender.

The chronic lesions (pityriasis lichenoides chronica (PLC)) are salmon-colored oval papules with central clearing. They are fewer in number than acute lesions and individual lesions may last for months. Pruritus is uncommon. Both acute and chronic lesions may be simultaneously found in the same individual. The disease may last for 2–3 years. A very rare and severe acute febrile ulceronecrotic variant may be seen. The ulcerated plaques may be up as large as 1 cm and occur on the trunk and upper arms. Arthritis may also be present. Lesions heal with scarring.

TREATMENT

Asymptomatic children with mostly chronic lesions may be treated with skin lubrication alone. Erythromycin, 30–50 mg/kg/day for 1–2 months, has been reported to be effective in some children. Natural sunlight may be of benefit. Narrowband ultraviolet B phototherapy is the treatment of choice for widespread symptomatic disease.

The ulceronecrotic form has been treated with systemic steroids, systemic immunosuppressives, anti-tumor necrosis factor or anti-T-cell biologic response modifiers.

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