Home            Past Issues            About IP            About IAP           Author Information            Subscription            Advertisement              Search  

   
images

Indian Pediatr 2012;49: 936-937

Pityriasis Lichenoides


Shylaja Someshwar and Satish Udare

Department of Dermatology, MGM Medical College, Navi Mumbai, Maharashtra, India.
Email: [email protected]
n 
 


A 2-year-old male child presented with multiple asymptomatic erythematous scaly papules and plaques with peripheral scales all over the face, scalp, trunk and extremities since 3 weeks (Fig.1). Prior to this, there was a history of fluid filled lesions of 2 weeks duration which left behind Chicken pox like scars following symptomatic treatment. Skin biopsy showed typical features of Pityriasis lichenoides et varioliformis acuta (PLEVA). He was treated with narrow band UVB with good results.

Fig. 1 Erythematous scaly lesions and scars.

Clinical spectrum of Pityriasis lichenoides ranges from acute papular lesions that rapidly evolve into papulovesicles, necrosis and varioliform scarring (PLEVA) to small, scaly, benign-appearing papules (pityriasis lichenoides chronica or PLC) both with a generalized distribution. This affects young adults and occasionally children. Though the etiology of this condition is unclear, infectious/drug related hypersensitivity and premycotic lymphoproliferative disorder are the mainstay theories. The diagnosis is by histopathology. In PLEVA, as there are polymorphic lesions of papules and vesicles appearing in crops which may heal with scars, a differential diagnosis of varicella has to be considered. Hemorrhagic necrosis and a course of waxing and waning are not common in varicella.

As PLC presents as small papules with scaling, pityriasis rosea and psoriasis need to be ruled out. While typical pattern and a self-limiting benign course excludes pityriasis rosea; symmetry, distribution pattern and silvery scales point to the diagnosis of psoriasis. PLC may also have adherent ‘mica like’ scales, which, when detached, reveal a shiny brown surface. If seen, this is a distinctive diagnostic feature. The present case had features of both PLEVA and PLC.

Though the condition is self-limiting, as the course is unpredictable, it warrants therapy. Oral antibiotics, topical corticosteroids and phototherapy have been tried with variable success.

 

Copyright 1999-2012 Indian Pediatrics