By Gary M. White, MD
A co-mingling of red papules and crusted lesions is typical.
Pityriasis lichenoides (PL) is a skin condition that manifests in either the acute (pityriasis lichenoides et varioliformis acuta or PLEVA) or the chronic form (pityriasis lichenoides chronica or PLC).
Multiple, disseminated, red, scaly papules and hemorrhagic necrotic lesions are characteristic. They are widespread but are often concentrated on the lower trunk and buttocks. Fever and constitutional symptoms may accompany the outbreaks. The age of onset is from 1 year to old age, although it is most common in the first 3 decades. The disease may last from months to decades, often with lesions coming in crops.
PLEVA usually follows a benign course and treatment is not necessary, especially if the lesions are asymptomatic. Getting some sun may help clear the lesions. For those that need treatment, erythromycin for 2-4 months is often prescribed for children. Alternatively, a tetracycline may be given for older children or adults. Topical steroids have a place, but the diffuse nature of the condition and the lack of tremendous efficacy limits their use. Phototherapy, be it narrow band or broadband UVB or PUVA, is usually quite effective [Am J Clin Dermatol. 2016 Aug 8].
Other reported forms of therapy include methotrexate, cyclosporine and dapsone. For treatment of more severe disease, see Febrile Ulceronecrotic Mucha-Habermann Disease.
Patients with prolonged disease should always be monitored for progression to lymphoma, most commonly CTCL. Indeed, routine biopsy (e.g. every year) is reasonable. Patients at higher risk for progression to lymphoma are those with prolonged doses duration (e.g., > 5 years), changing morphology (e.g. to nodules, hypopigmentation, atrophy or poikiloderma), and localization to sun-protected areas [BJD 2016;175;807].
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