Pityriasis lichenoides in childhood: A retrospective review of 124 patients
Pityriasis lichenoides (PL) occurs in all age groups, although predominantly in younger individuals.
We sought to study the clinical features of PL in children followed up at our institution.
The records of 124 children who were given the diagnosis of PL at our institution between 1993 and 2003 were retrospectively reviewed.
PL chronica (PLC) was recorded in 37% of the cases, PL et varioliformis acuta (PLEVA) in 57.3%, and clinical features of both disorders were seen simultaneously in the remaining. The median age of onset was 60 months (range: 6-180 months), although the median age of onset of PLEVA (median: 60 months) was significantly younger than that of PLC (median: 72 months) (P = .03). The age distribution showed peaks at 2 to 3 years (24.8%) and 5 to 7 years (32%). A history of infection or drug intake preceded the skin manifestations in 30% and 11.2% of patients with PLC and PLEVA, respectively. The disease began most commonly during winter (35%) or fall (30%). The median duration was 20 months (range: 3-132 months) in patients with PLC and 18 months (range: 4-108 months) in patients with PLEVA. Involvement was diffuse in 74.2% of the patients, peripheral in 20.2%, and central in the remainder. The disease was recurrent in 77% of the patients (n = 80). Of the patients, 59% had pruritus, whereas 32% reported no symptoms; the remainder had fever, arthralgia, or both. Erythromycin estolate or ethylsuccinate was administered to 79.7% of the affected children; 66.6% of these showed at least a partial response.
The analyzed data were collected retrospectively and biopsies were not performed in all patients.
PL is not an uncommon disease in childhood, with age peaks in the preschool and early school-age years. It is usually recurrent, and shows a seasonal variation with onset most often in the fall or winter. In childhood PL, erythromycin is an effective initial treatment choice.
Available from: Jandrei R Markus
- "Microscopic findings described in PL are controversial. Some studies show a predominance of PLEVA, in 57.3% of patients , others show PLC in 72% . This probably reflects the diverse range of clinical presentations of the disease, which can characteristically exhibit lesions in different stages of evolution. "
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ABSTRACT: Pityriasis lichenoides (PL) is a lymphoproliferative disease of unknown origin; its diagnosis is based on clinical characteristics and confirmed by histology.
To describe clinical and histological features of PL in 29 pediatric patients.
Retrospective descriptive study of children (patients less than 15 years old) diagnosed with PL between 1986 and 2010 at a Reference Service in Pediatric Dermatology from South Brazil.
Twenty-nine PL cases were found by chart review in 24 years. Mean age of diagnosis was 8 years (22 to 178 months) and a mean time of diagnosis was 13.8 months (1 to 120 months). Twenty cases (69%) were male. Seasonal correlation was found with colder months in 62% of cases (p<0.01). Clinical diagnosis was pityriasis lichenoides chronica (PLC) in 25 cases, and pityriasis lichenoides et varioliformis acuta (PLEVA) in four. Itching was the main reported symptom occurring in 13 (45%). Fourteen cases had been histologically evaluated. In six, microscopic findings were consistent with PLC, in four consistent with PLEVA, and four biopsies exhibited mixed characteristics of both forms. Concordance between clinical and histological diagnosis was seen in most cases.
PL occurs in children and young adults, more commonly in males, and during cold months. PLC was the more frequent clinicohistologic form, and necrotic lesions characterized PLEVA. Associating clinical and histological findings is important for differentiating between PLC and PLEVA diagnosis.
Available from: Constança Margarida Sampaio Cruz
- "Although there already is evidence of their immunomodulatory effects, additional clinical and laboratory studies are needed to confirm these properties in this class of antibiotics. However, to date, tetracyclines represent first-line drugs for the treatment of PLEVA, especially in adults . "
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ABSTRACT: A male dark-skinned patient, 33 years old, complaining of a 1-month history of skin lesions in the abdominal region and high fever was admitted to the clinical ward. There were ulcerated and coalescent skin lesions all over the body but sparing the palmar region. The culture of material obtained from the penile lesions was positive for . He was treated with oxacillin and prednisone. The patient persisted with high fever and skin lesions. After histopathological diagnosis of Mucha Habermann's disease, treatment was started with tetracycline with rapid improvement of the lesions. He was reexamined by the dermatologic service with no recurrences during the 12 months of follow-up. At this time, there was a great number of keloid scars from the skin lesions.
Available from: Ana Brinca
- "It is generally accepted that PLEVA and PLC represent two ends of a continuous spectrum, and therefore it is not uncommon to observe both acute and chronic lesions in the same patient, as well as lesions at intermediate stages between PLEVA and PLC . "
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ABSTRACT: We report a case of a 63-year-old man hospitalized for a polymorphous generalized eruption consisting of maculopapules with peripheral scaling, vesicopustules, and ulceronecrotic and crusted lesions measuring 5-20 mm, localized on his trunk and extremities, particularly exuberant in the flexural area. Histopathology showed necrotic keratinocytes with exocytosis of red blood cells and lymphocytes and a dermal perivascular and periadnexal inflammatory infiltrate, composed of CD8+/CD4-/CD30- T cells, indicating the clinical diagnosis of pityriasis lichenoides et varioliformis acuta. He was treated with erythromycin and methylprednisolone reduced gradually over 5 months, with a slow but complete response; the patient was without lesions after 2 years of follow-up. The authors want to remind of this rare entity which may present difficulties in diagnosis and therapy.
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