Anular lichenoid dermatitis of childhood L28.1

Author: Prof. Dr. med. Peter Altmeyer

Last updated on: 29.10.2020

Synonym(s)

ALDY; Annular lichenoid dermatitis of youth; Anular lichenoid dermatitis of childhood; Anular lichenoid dermatosis of childhood; Dermatitis anular lichenoids of childhood

History
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Annessi 2003

Definition
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Etiologically unexplained, chronic, lichenoid dermatitis with truncated, large, reddish or brownish, asymptomatic or slightly itchy patches or tender, barely palpable, scale-free plaques, which are homogeneously or annularly configured and may have central hypopigmentation.

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Occurrence/Epidemiology
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Rarely. There is no epidemiological data available.

Etiopathogenesis
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Probably autoimmunological etiology. Relation to the disease group of lichenoid interface dermatitis ( Lichen planus, Lichen sclerosus et atrophicus, Graft-versus-Host-Disease.

Manifestation
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Mainly occurring in adolescents and children. In adults the clinical picture has not yet been described.

Localization
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Occurring exclusively on the stem.

Clinical features
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Chronic, low dynamic disease that can be active over a period of several years. No general signs of disease. Clinical leading symptom is usually large, roundish or oval, red or brownish, homogeneously filled or anular, spots or barely palpable plaques, which do not show any epidermal involvement (scaling or crust formation). The centre of the anular foci is often hypopigmented, whereas the rim is hyperpigmented.

Histology
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Mild or severe (psoriasiform) acanthosis. Prominent, lichenoid interface dermatitis, which can be detected mainly at the tips of the reticules, but also in the form of a band. Immunohistologically, CD8/TIA-1 and CD4-positive T-lymphocytes are particularly impressive. CD8/TIA-1-positive cells are mainly found intraepithelially.

Diagnosis
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Asymptomatic bland clinic; age of the patients; histological pattern.

Differential diagnosis
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Mycosis fungoides: Rarely found at the preferred age of childhood anular lichenoid dermatosis. Histologically, MF shows an inverse pattern of CD4-positive T-lymphocytes intraepithelially to the lichenoid dermatosis.

Erythema anulare centrifugum: Dynamic course, clearly palpable anular plaques (consistency of a wet wool thread). Histologically a lichenoid pattern is missing.

Tinea corporis: Dynamic course, always epidermal component with scaling, blister or pustular formation. Fungal detection is successful in non-pretreated flocks.

Erythema chronicum migrans: Dynamic course, detection of Borrelia bacteria! Histology: No interface dermatitis.

Erythema anulare rheumaticum: Volatile skin component in rheumatic fever (general symptoms are always present). Clinically there are borderline, polycyclic, reddish-brownish, non-pruritic erythema.

Therapy
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Local therapy with glucocorticoids. The disease proves to be very steroid-sensitive. Recurrence after discontinuation of steroidal therapy is probable.

Progression/forecast
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After years self-limiting.

Literature
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Annessi G et al (2003) Annular lichenoid dermatitis of youth. J Am Acad Dermatol 49: 1029-1036
Kleikamp S et al (2010) Anular lichenoid dermatosis of childhood - another case in a 12-year-old girl. JDDG 6: 653-656