Dermatitis exudative discoid lichenoid L98.8

Author: Prof. Dr. med. Peter Altmeyer

Last updated on: 29.10.2020

Synonym(s)

Dermatosis exudative discoid lichenoid; Dermatosis exudative discoid lichenoid chronic; Exudative discoid and lichenoid chronic dermatosis; Exudative discoid lichenoid chronic dermatosis; Exudative discoid lichenoid dermatitis; Oid-Oid-Disease; Sulzberger-Garbe disease; Sulzberger-Garbe Syndrome

History
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Sulzberger and Garbe, 1937

Definition
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Very rare dermatosis of unexplained genesis, controversial in its autonomy, characterized by the coexistence of eczematous, lichenoid and urticarial foci with distinct itching.

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Dermatology

Dermatitis herpetiformis

Rare, non-zoeliac, gluten-sensitive, chronic autoimmune disease (autoantigen is epidermal transglutaminase)...

Manifestation
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Mainly middle-aged men, mostly Jews.

Localization
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Chest, trunk, face; typical is the affection of penis and scrotum.

Clinical features
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Unbearably severe pruritus. Rapid succession or simultaneous appearance of exudative, reddened, infiltrated, nummular plaques, reminiscent of nummular dermatitis, lichenified papules or small urticarial papules. The skin lesions are extremely resistant to treatment.

Laboratory
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Often eosinophilia.

Histology
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Perivascular infiltrates from lymphocytes, granulocytes, eosinophils, plasma cells. Swelling of the vascular endothelia (unspecific image).

Differential diagnosis
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Nummular dermatitis; Scattering contact dermatitis; dermatitis herpetiformis; Lichen planus; Mycosis fungoides; Drug exanthema; Seborrheic dermatitis; Pityriasis rosea;

External therapy
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Medium strength glucocorticoid creams such as 0.1% betamethasone lotio R030, 0.1% triamcinolone cream R259, 0.25% prednicarbate cream (e.g. Dermatop), 0.1% methylprednisolone cream (e.g. Advantan). Caring greasing external products (e.g. Ungt. emulsif. aq., Linola Fett, Eucerin cum aq.) as well as oil baths such as Balneum Hermal plus, oil bath Cordes, Linola Fett oil bath, Eucerin Omega fatty acids oil bath, Polidocanol shower oil.

Internal therapy
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Therapy of the 1st choice are glucocorticoids, perorally, in medium dosage, initial 60-80 mg/day prednisolone equivalent, slow release to low maintenance dose over several weeks. After discontinuation the skin symptoms flare up again. The glucocorticoids can only be completely eliminated after months or years.

Cases with healing under exclusive azathioprine therapy (e.g. Imurek) are described. An attempt at therapy with antihistamines such as desloratadine (e.g. Aerius) 1-2 tbl/day or levocetirizine (e.g. Xusal) 1-2 tbl/day is possible.

Progression/forecast
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Spontaneous healing after months to years of progress.

Literature
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Jansen T et al (1992) Sulzberger-Garbe exudative discoid and lichenoid chronic dermatosis ("Oid-Oid disease")--reality or fiction? dermatologist 43: 426-
Savill T (1891) On an epidemic skin disease. Br Med J (London) 2: 1197-1202
Stevens DM et al (1984) On the concept of distinctive exudative discoid and lichenoid chronic dermatosis (Sulzberger's scar). At J Dermatopathol 6: 387-395
Sulzberger MB, Garbe W (1937) Nine cases of a distinctive exudative discoid and lichenoid chronic dermatosis. Arch Dermatol (Chicago) 36: 247-278