Pityriasis lichenoides (overview) L41.1

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 07.07.2022

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Synonym(s)

guttate parapsoriasis; Parapsoriasis en gouttes

History
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Juliusberg, 1899

Definition
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Erythematosquamous, acute or chronic, self-limiting skin disease of unexplained etiology and pathogenesis, which was classified in the group of parapsoriasis diseases, i.e. psoriasis-like diseases, by the work of Brocq (1902). (Note: this classification can no longer be maintained.) The different clinical manifestations of pityriasis lichenoides are considered to be variants of the same clinical picture with different acuity.

Classification
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Clinically, an acute and a chronic form are distinguished. Furthermore, there are variants whose nosological assignment is questionable so far. Pityriasis lichenoides chronica can either arise from the acute variant or develop de novo.

Other forms:

Occurrence/Epidemiology
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S.under the respective variants

Manifestation
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Both forms of the disease have a peak of manifestation both in childhood (2-7 years) and in adulthood (mttler age around 40 years).

Tables
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DD of Pityriasis lichenoides

Clinical picture

Clinical criteria

Diagnostics

PLEVA

Arthropod reaction

Irregularly distributed urticarial papules; severe itching; acute, usually overnight

Histology

Varicella

Diseases in contact persons; polymorphous exanthema (starry sky); oral mucosa and capillitium may be affected

VZV-IgM

small vessel vasculitis

Acute onset, usually after infection; always hemorrhagic exanthema; little scaling; no blisters

Diagnostic histology, immunohistology

Gianotti-Crosti syndrome

Acral localized papules

Histology if necessary

Lymphomatoids Papulose

Usually only isolated papules; no vesicles; largely asymptomatic course; occurs predominantly in adults

Typical histology (CD30-positive T-cell pattern)

PLC

Psoriasis vulgaris (guttata type)

Uniform exanthema; psoriasis phenomena are triggerable; family history

Exclusion of infection

Parapsoriasis en plaques, small heart type

Quiet, less symptomatic clinical picture; no scaling; cigarette-paper wrinkling of the skin (pseudoatrophy)

Histology

pityriasis rosea

Uniform exanthema; primary medallion; duration only 6-8 weeks

Exclusion of microspores

urticaria pigmentosa

Disseminated appearance; no scaling; Darier sign is positive; itching in warm showers

Histology is diagnostic

lichen planus

small papular exanthema; distinct itching; waxy shiny papules; flexural accentuation

Histology is diagnostic

Syphilis

Rather discreet exanthema; no itching; palms and soles of the feet may be affected

Syphilisserology is positive

Note(s)
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The term "parapsoriasis", introduced by Brocq in 1902, referred to diseases clinically similar to psoriasis, including pityriasis lichenoides (parapsoriasis guttata) (see also remarks on"erythrosquamous edema").

The term "parapsoriasis" (parapsoriasis en petites plaques; parapsoriasis en grandes plaques; parapsoriasis variegata) is still used today to refer to clinical pictures which, despite their psoriasis-like clinic, are to be assigned to cutaneous T-cell lymphomas. The term "parapsoriasis", as a superordinate generic term, has today only a historical meaning.

Literature
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  1. Brocq LAJ (1902) Les parapsoriasis. Ann Dermatol Syph (Paris) 3: 313-315, 433-468
  2. Koh WL et al (2013) Pityriasis lichenoides in an Asian population. Int J Dermatol 52:1495-1499
  3. Park JM et al (2013) Is narrowband ultraviolet B monotherapy effective in the treatment of pityriasis lichenoides? Int J Dermatol 52:1013-1018

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 07.07.2022