Case report : Pityriasis Lichenoides Chronica : A Rare Case Report

Date : Monday/ June14th 2021

Moderator : Dr. dr. Satya Widya Yenny Sp.KK(K) FINSDV FAADV
Counsellor : dr. Rina Gustia Sp.KK(K) FINSDV FAADV
dr. Mutia Sari Sp.DV
Counsultant : dr. Ennesta Asri Sp.KK(K) FINSDV
dr. Tutty Ariani Sp.DV
Opponents : dr. Marina Saribulan H, dr. Andriani Fuji Lestari

Yosep Prabowo
Resident of Dermato-Venereology, Department of Dermato-Venereology, Dr. M.
Djamil General Hospital/ Faculty of Medicine, Andalas University, Padang
Pityriasis Lichenoides Chronica : A Rare Case Report

ABSTRACK
Background: Pityriasis lichenoides is an uncommon, acquired, idiopathic
papulosquamous disorder of unknown etiology. It is often classified into the acute form,
pityriasis lichenoides et varioliformis acuta (PLEVA), and the chronic form, pityriasis
lichenoides chronica (PLC). PLC is a rare disease that represents a diagnostic and
therapeutic challenge so we will describe a case of PLC, discuss its clinical presentation,
diagnosis, treatment and present a review of the literature.
Case: A case of pityriasis lichenoides chronica in 16 years-old male was reported. There
were reddish brown patches that did not feel itchy or painful on back, both of arms and
both of leg which gradually increased and spread since 3 month ago. Dermatologic state:
erythema papule, erythema plaque, hyperpigmented macules, scales. Dermoscopy reveals
a yellowish structureless areas and the presence of scales. Histopathology showed
interface dermatitis reaction with focus of basal epidermal degeneration, hyperkeratosis,
parakeratoses, irregular acanthosis in epidermis and mild lymphocyte perivascular
infiltrate in dermis. Patient were treated with topical corticosteroid and erytromicin oral.
Discussion: Combination of clinical correlation and histopathological examination is
needed to establish diagnosis PLC. It does not have spesific treatment, but it respond well
to corticosteroids, antibiotics, immunosupressants and phototerapy with UVB narrowband.
This is the fifth case of PLC in our dermatovenereology department since 5 years ago.
Eventhough rare, this disease can proceed to malignancy and can cause morbidity so
important to monitor patients for risk of developing malignant transformation.
Keywords: PLC, PLEVA, Histopathology features

ABSTRAK
Latar belakang: Pityriasis lichenoides adalah kelainan papuloskuamosa idiopatik yang
didapat, jarang, dengan etiologi yang tidak diketahui. Diklasifikasikan ke dalam bentuk
akut, pityriasis lichenoides et varioliformis acuta (PLEVA), dan bentuk kronis, pityriasis
lichenoides chronica (PLC). PLC adalah penyakit langka sehingga merupakan tantangan
dalam diagnostik dan terapeutik sehingga kami akan menjelaskan kasus PLC, diantaranya
presentasi klinis, diagnosis, pengobatan berdasarkan tinjauan literatur.
Laporan kasus: Dilaporkan kasus pityriasis lichenoides chronica pada laki-laki 16 tahun.
Terdapat bercak kemerahan kecokelatan yang tidak terasa gatal atau nyeri pada punggung,
kedua lengan dan kedua tungkai yang berangsur-angsur bertambah dan menyebar sejak 3
bulan yang lalu. Status dermatologis: papula eritema, plak eritema, makula
hiperpigmentasi, skuama. Dermoskopi menunjukkan area kekuningan tanpa struktur dan
adanya skuama. Histopatologi menunjukkan reaksi interface dermatitis dengan fokus
degenerasi epidermis basal, hiperkeratosis, parakeratosis, akantosis ireguler pada
epidermis dan infiltrat perivaskular limfosit ringan di dermis. Pasien diterapi dengan
kortikosteroid topikal dan eritromisin oral.

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Diskusi: Kombinasi korelasi klinis dan pemeriksaan histopatologi diperlukan untuk
menegakkan diagnosis PLC. Penyakit ini tidak memiliki pengobatan khusus, tetapi
merespon dengan baik terhadap kortikosteroid, antibiotik, imunosupresan dan fototerapi
NB UVB. Ini adalah kasus kelima dari PLC di departemen dermatovenereologi kami sejak
5 tahun yang lalu. Meskipun jarang, penyakit ini dapat berkembang menjadi keganasan
dan dapat menyebabkan morbiditas sehingga penting untuk memantau pasien terhadap
risiko transformasi keganasan.
Kata kunci: PLC, PLEVA, Gambaran Histopatologi

INTRODUCTION
Pityriasis lichenoides (PL) is an uncommon papulosquamous disorder of
unknown etiology. Diagnosis, classification, and treatment of PL are challenging.
Pityriasis lichenoides is now considered a lymphocytic vasculitis and removed
from the parapsoriasis group of disorders. But lack of any definite etiology and
absence of vessel wall damage makes it difficult to include the condition under any
nosological classification. In many cases of PLEVA and PLC, the diagnosis is
made after clinicopathologic correlation. Owing to overlapping clinical and
histopathological features, classification is controversial; therefore, it is often
considered as a spectrum with two polar ends: pityriasis lichenoides chronica
(PLC) and pityriasis lichenoides et varioliformis acuta (PLEVA). PLEVA tends to
be more acute and presents with macules, papules, or papulovesicles that may
evolve through stages of crusting, necrosis, and varioliform scarring. Systemic
manifestations such as fever and lymphadenopathy may be present. In contrast,
PLC manifests as red-brown scaly papules that often leave hypo or hyperpigmented
macules upon regression. The highly variable presentation of this condition often
poses a diagnostic challenge. The time course of PLEVA tends to be limited,
although some cases evolve into PLC. PLC may become worse and remit for years.
Psoriasis guttate and pityriasis rosea are differential diagnoses of pityriasis
lichenoides because they include erythropapulosquamous disease with similar
lesions, almost the same predilection and affect mainly children and young
adults.1,2
The etiology of PL is uncertain. Although some believe that it is an
inflammatory condition triggered by an infectious etiology, others argue that it is a
T-cell lymphoproliferative disorder. PL affects mostly children and young adults,
although it has been reported in all age groups. There is no racial or geographic
predisposition. Lesions may self-involute and resolve completely over weeks, or
new lesions occasionally may appear in crops, waxing and waning spontaneously
for months to years thereafter.3,4
2
 Although PL is a self-limiting skin condition, treatment is frequently desired
due to symptomatic and cosmetic disturbances, especially when the rash is
widespread; however, treatment of PL is not straightforward, as its course is
unpredictable. Various treatment options exist for PL, including topical
corticosteroids and immunomodulators, phototherapy, oral antibiotics, and
systemic immunosuppressants, although there are no established treatment
guidelines. Although the symptoms may wax and wane over several years, it
generally follows a benign course. Nevertheless, rare cases of PL evolving into
malignancy have been reported, causing concern for physicians and affected
individuals.5

CASE REPORT
Patient Identity
Name : An. GM
Age : 16 years old
Sex : male
Status : Single
Occupation : Student
Religion : Moeslem
Address : Lubuk Buaya Padang, West Sumatera
Phone : 08136307852x

Case report
A 16-years old man came to Dermato-Venereology Department of Dr. M. Djamil,
Padang on April 9th, 2021 with:

Chief complaint: (Autoanamnesis)

There are reddish brown patches that not feel itchy and not painful on the back,
arms and legs that have been increasing gradually since 3 weeks ago.
Present ilness history:
 Initially 3 months ago, a reddish patch appeared that did not itch and did not feel
pain in the thigh but at that time the patient did not treat it.
 Then, ± 2 months ago, the reddish spots gradually increased and spread to both
legs. The red patches are not itchy and painless. Then the patient went to a
general practitioner and was given liquid powder and pills but the patient did not
3
 know the name of the pill. A few weeks after using the drug, lesions not
improvement.
 ± 3 weeks ago, the reddish spot on both legs increased and the same redness
appeared on both arms which gradually increased. some reddish patches also
appear on the back. Then the patient went to a dermatologist and was given
topical medication and pills but the patient did not know the name of the
medicine. After using the drug, the lesions were slightly reduced and the redness
was still present on both legs, arms and back. Then the patient was referred to
the department of dermatology and venereology, dr. M. Djamil Padang Hospital.
 There was no history of fever, cough, rhinorhea before.
 There was no previous history of bubbles filled with clear or cloudy fluid
before.
 There was no history of small reddish patches with thick, dandruff, rough white
scales especially on the elbows or knees before.
 There was no history of lesions on thrunk which are round or oval with more
reddish edges than the center that initiates other patches.
 There was no history new medication or new topical treatment.
 There was no history consumed agent biologic treatment.
 There was no history of blood transfusion, drug abuse before.
 History of reduce in body weight drastically was denied.

Previous illness history:

 History of reddish spot that not feel itchy or pain was denied

Family illness history:

 History of reddish spot that not feel itchy or pain and rough scales in family
member was denied.
 There was no history patient's parents immune depression disease before
Physical examination:

- Consciousness: Compos mentis cooperative

- General state : General appearance : moderate illness
o Height : 160 cm
o Weight : 56 kg
o Nutritional status : 21,875(normoweigth)
- Vital sign :
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 o Blood pressure : 120/70 mmHg
o Pulse rate : 80 x/min
o Breath rate : 20 x/min
o Temperature : 36,5 °C
- Head : within normal limit
- Eye : conjunctiva anemic (-), hiperemic (-), icteric (-)
- ENT : within normal limit
- Heart : within normal limit
- Lungs : within normal limit
- Abdomen : within normal limit
- Extremity : edema (-), acral perfusion: back within 1 second
- Lymph nodes : regional lymph node didn’t enlarged

Dermatologic state:
- Location
- Distribusion
- Shape/arrangement
- Border
- Size
- Efflorescence
: Both of arms, both of legs, back
: regional
: unspecified/ unspecified
: undefined
: lenticular-nummular
:erythema papule, erythema plaque, hyperpigmented
macules, hyperpigmented plaque,scales

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Patient 9th April 2021

6
7
Resume :
Anamnesis:
 A 16 years old man came to Dermato-Venereology Department of dr. M.
Djamil, Padang on April 9th, 2021 with chief complaint: There were
reddish brown patches that did not feel itchy or painful on back, both of arms
and both of leg which gradually increased and spread since 3 month ago. No
history fever, papules, vesicle, rough scale. No history consumed new
medication or applies new topical treatment.
Physical examination
 Generalized state : within normal limit. From dermatologic state location at
back, both of arms, both of legs, distribution is regional, the shape is
unspecific, arrangement unspecific, border are defined, size lenticular-
nummulare, efflorescence erythema papule, hyperpigmented macules,
hyperpigmented plaque,scales.

Working Diagnosis :
Suspek Pityriasis Lichenoides Chronica

Differensial Diagnosis :
Suspect Pityriasis Lichenoides et Varioliformis Acuta (PLEVA)
Suspect Psoriasis Guttate
Suspect Pityriasis Rosea

Suggestion
 Dermoscopy
 Blood examination
 Pro Biopsy and histopathological examination

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Dermoscopy

Dermoscopy : showed yellowish structureless areas (red circle) and presence scales
(black arrow)

Laboratory findings:
Hb : 13 gr/dl (12-14%)
Leucocyte : 6.260/mm3 (5.000-10.000)
Ht : 43% (40-48)
Trombosit : 288.000/mm3 (150.000-400.000)
PT : 10,9” (9,4-12,6)
APTT : 28,9’’ (22,8-30,2)
SGOT : 15 (<38 U/L)
SGPT : 9 (<41 U/L)
Ureum : 24 mg/dl (10-50)
Creatinin : 0,7 mg/dl (0,8-1,3)
Random blood glucose: 92 mg/dL (<200)

9
 Histopathological examination result
Macroscopic :
a piece of dense chewy brownish white tissue size 1x1x1/2 cm

Microscopic :
It looks like pieces of skin tissue with an interface dermatitis reaction. Skin tissue
with stratified squamous epidermis with hyperplasia, irregular acanthosis,
hyperkeratosis and parakeratosis. In the basal layer of the epidermis, the
perivascular papillae of the dermis contain lymphocytic cells. There are also parts
that have degenerated basal cells and clusters of erythrocytes on the outside of the
vascular.
This feature can be found in pityriasis lichenoides chronic.

Magnifying 200x. Skin tissue appears to have interface dermatitis (red circle). A
lymphocyte infiltration was also seen in the papillary dermis and upper dermis (orange
arrow).

10
Magnifying 200x. Skin tissue with stratified squamous epidermis with hyperplasia (black
arrow), irregular acanthosis, hyperkeratosis (red arrow) and parakeratosis (yellow arrow).

Magnifying 200x. There are also parts that have degenerated basal cells (red arrow) and
clusters of erythrocytes on the outside of the vascular (yellow arrow)

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 Diagnosis
Pityriasis lichenoides Chronica

Treatment:
General treatment:
 Explain to the patient about the disease such as the cause, treatment plan and
follow-up. This disease can heal spontaneously or persist for years and this
healing process only occurs after going through a period of remission and
exacerbation for a long time.
 Explain to the patient for regular follow-up because of the possibility of
malignant transformation in this disease.

Specific treatment :

Topical : - Desoxymethasone 0,25% cr twice a day

Systemic : - Erytromicin tablets 4x500 mg po

Prognosis :
- Quo ad vitam : dubia ad bonam
- Quo ad sanationam : dubia ad bonam
- Quo ad cosmeticum : dubia ad bonam
- Quo ad functionam : dubia ad bonam

Follow up Monday, 26th April 2021

S : - There was no new reddish spot

- Some old lesion or reddish spot become hyperpigmentation
O : Location : Back, both of arms, both of legs
Efflorescence: erythema papule, hyperpigmentations macules, papules and plaque
A : Pityriasis Lichenoides Chronica.
P : Erithromycin tab 4x500 mg po
Dexosimethasone cr 0,25% twice daily on the reddish spot

Follow up Monday, May 5th 2021

S : - There was no new lesion

O : Location : back, both of arms, both of legs
Efflorescence: hyperpigmentations macules, hyperpigmentation papules
A : Pityriasis Lichenoides Chronica.

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P : Erithromycin 4x500 mg po
Dexosimethasone cr 0,25% twice daily on the reddish spot

Photo patient follow up (26th April 2021)

13
14
Photo patient follow up (May 5th 2021)

15
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DISCUSSION
Pityriasis lichenoides (PL) is an uncommon skin disease with few studies on
its clinical and histological presentation. PL affects children and young adults,
peaking in the third decade of life. Men are three times more affected than women,
whereas PLC is six times more common than PLEVA. Study by Anthony et al in
India in 2019 reported that there were only 5 cases of PLC during a year in South
India consisting of 4 males and 1 female. Another study conducted by Van et al in
Vietnam in 2020 reported that there were 15 patients with PLEVA over a 5-year
period. In Indonesia, the incidence or prevalence of PLC has not been found and
case reports and literature knowledge are still few. 5,6,7 In our case, the patient is a
16-year-old boy and this is the fifth case ever reported at RSUP. DR. M. Djamil
since 5 years.
The cause of pityriasis lichenoides is unknown, but there are 3 popular
theories regarding its pathogenesis: a hypersensitivity response due to an infectious
agent, an inflammatory response to a T-cell dyscrasia, or an immune complex–
mediated hypersensitivity vasculitis. The theory of an infectious cause has been
proposed due to reports of disease clustering in families and communities. Elevated
titers of certain pathogens and clearing of the disease after pathogen-specific
treatment also have been reported. Possible triggers cited in the literature include
the epstein-Barr virus, toxoplasma gondii, parvovirus B19, adenovirus, human
immunodeficiency virus, freeze-dried live attenuated measles vaccine,
staphylococcus aureus, and group A β-hemolytic streptococci. Some reported cases
of pityriasis lichenoides have demonstrated T-cell clonality. Weinberg et al found a
significantly higher number of clonal T cells in PLEVA than in PLC (P=.008) and
hypothesized that PLEVA is actually a benign clonal T-cell disorder arising from a
specific subset of T cells in PLC. Malignant transformation of pityriasis lichenoides
has been reported but is rare. At this time, screening for pathogens is not advised
unless the patient has specific symptoms of infection. 8,9,10 In our case, the cause of
PL is not known with certainty. In the anamnesis of this patient there were no
complaints such as fever, weakness and a decrease in the immune system which
indicated the possibility of a bacterial or viral infection. The patient also did not use
the pill, the topical medication that was first applied. The patient also did not use
biologic drugs and on physical examination, there were no enlarged lymph nodes

18
and other signs of malignancy. Therefore, in our patient, the etiology is not known
with certainty and further investigation is necessary.
Pityriasis lichenoides is a spectrum of disease on which PLEVA (acute PL)
and PLC (chronic PL) exist on opposing ends although overlap occurs. The
condition tends to follow a chronic relapsing and remitting course. Clinically,
PLEVA is characterized by the acute onset of pruritic and at times painful,
symptomatic papulovesicles with necrotic, ulcerative or hemorrhagic changes. In its
early presentations, the condition may be confused with varicella. Patients with
PLEVA, however, lack the typical fever and mucous membrane involvement seen
in varicella,
and the course of PLEVA is considerably more prolonged. PLC lesions are
described as erythematous to reddish-brown papules with overlying central scale,
classically micaceous that often leave hypo or hyperpigmented macules upon
regression. The lesion in PLC is also initially an erythematous papule that develops
a reddishbrown hue and a centrally adherent micaceous scale that can easily be
detached to reveal a shiny, pinkish brown surface. Pityriasis lichenoides chronica
usually occurs on the trunk and proximal parts of the extremities, but acral and
segmental distributions have also been described, the lesions being usually
asymptomatic. Lesion onset is more gradual than in PLEVA, with lesions
spontaneously resolving within weeks to months. 1,4,11 Our patient complaint about
reddish brown patch on back, both of arms and both of leg which gradually
developed and spread since 3 month ago. The lesion aymptomatic. There were no
previous history of vesicles, pustules or ulcer.
The etiology of pityriasis lichenoides chronica (PLC) has not yet been fully
elucidated. Diagnosis is often difficult, and in most cases clinical data are not
sufficient, so it is confirmed on the basis of histopathological results. Notably, the
histopathology of these entities can overlap. Examination reveals focal
parakeratosis, mild to moderate acanthosis, a variably intense lichenoid tissue
reaction with dyskeratotic keratinocytes, and erythrocyte extravasation. PLEVA
showed intense perivascular infiltrate, vessel wall infiltration by mononuclear cells,
endothelial swelling and extravasation of RBCs. However, there was lack of vessel
wall damage and no fibrinoid deposition was seen in the vessel walls indicating
PLEVA is not a true vasculitis. On the other hand, all the cases of PLC showed
subtle histopathological changes in the form of mild basal cell vacuolation and a

19
mild perivascular infiltrate. No other blood vessel changes of lymphocytic
vasculitis as seen in PLEVA were seen in PLC. 1,12,13 In our patient, histology
showed presence of interface dermatitis. Epidermal layer hyperplasia, irregular
acanthosis, hyperkeratosis and parakeratosis occur. In the basal layer of the
epidermis, the perivascular papillae of the dermis contain lymphocytes. There is
also a degenerated area of basal cells and clusters of erythrocytes on the outside of
blood vessels. There was no invasion of lymphocytes and fibrinoid deposits on the
vessel wall and endothelial swelling were not found.
In this case, differentially diagnosed for the patient was psoriasis guttate.
Guttate psoriasis might present as either the initial manifestation of psoriasis in
individuals previously unaffected by psoriasis or as an acute exacerbation in
individuals with pre-existing chronic plaque psoriasis. Affected patients are much
more likely to have a family history of psoriasis, and might report experiencing a
stressful life event in close association with the guttate eruption Guttate psoriasis
typically presents as an acute bilateral, symmetric eruption consisting of multiple,
welldemarcated, salmon-pink to erythematous, round to oval papules ranging in
size from 1 mm to 10 mm in diameter. A fine silvery scale is often present on more
established lesions. The distribution is primarily on the trunk and proximal
extremities. The palms, soles, and face are usually spared. Pityriasis lichenoides
differs from guttate psoriasis in that the eruptions are more often polymorphic (as
lesions are present in various stages of evolution) and the papules are generally
smaller than those observed in guttate psoriasis. Diffused dotted vessels, we can
find from dermoscopic psoriasis guttate. From histopathological examination we
can find epidermal hyperplasia, rete ridge elongation, dermal capillary dilatation
and edema, thin or absent granular layer, neutrophils on mounds of
parakeratosis.14,15, 16
Other differential diagnoses fot this patient are pityriasis rosea. In
approximately 20-50% of cases, the red patches of pityriasis rosea are preceded by
the appearance of symptoms similar to viral infections such as upper respiratory
tract disorders or gastrointestinal disturbances such as headache, discomfort in the
digestive tract, fever, malaise, and arthralgia. The most common primary lesion
called herald patch is the appearance of a solitary lesion in the form of
erythematous macules or erythematous papules on the thrunk or neck, which
gradually enlarge over a few days with a diameter of 2-10 cm, salmon pink, oval in

20
shape with thin scales. The location is also often found on the trunk, upper arms
and upper thighs. There are no laboratory tests that help in making the diagnosis.
The results of a skin lesion biopsy that only showed nonspecific inflammation and
other findings were mild acanthosis, focal parakeratosis. Extravasation of
erythrocytes into the epidermis, spongiosis can be found in acute cases.17
Based on table 1 , the first line treatment of PLC are topical corticosteroid,
antibiotics and phototerapy. Systemic antibiotics such as tetracyclines,
erythromycin and azithromycin, are used primarily for their antiinflammatory
rather than antibiotics effects.1

Table 1. Treatment of Pityriasis Lichenoides.1

Currently, there is no specific treatment for pityriasis lichenoides. First-
line therapy for all forms of PL includes topical corticosteroids, calcineurin
inhibitors, topical coal tar preparations, tetracycline, erythromycin, azithromycin,
and phototherapy. Tetracycline, erythromycin, and azithromycin are often
employed for their anti-inflammatory effects, with erythromycin preferred for use
in pediatric populations. Erythromycin has also been demonstrated as effective in
reducing relapses. Treatment for 2–3 months is recommended, followed by a slow
taper. Narrowband UVB (nbUVB) phototherapy has also been postulated as an
effective management strategy in PL. With its low side effect profile, nbUVB
phototherapy has proven beneficial to many patients. However, due to the long-
term risks of phototherapy in children, there have been questions surrounding the
use of nbUVB in pediatric population. Methotrexate, systemic corticosteroids,
IVIg, and cyclosporine have been demonstrated to be effective in cases of severe
and resistant PL, though these are rarely used in children.1,5

21
 In this case, treatment start with macrolides antibiotic therapy (oral
erythromicin 500 mg, fourth times daily) and topical steroid (desoximethanone
ointment 0,25%). Currently, antibiotics appear to be a safe choice as the first-line
therapy in pediatric patients but continues to show inconsistent results. Antibiotics
such as tetracycline, erythromycin and minocycline have been used because
infectious agents are possible trigger of PL and because of their anti-inflammatory
properties. Since tetracyclines are contraindicated in children, erythromycin is
usually employed in this population. Topical corticosteroids (TCS) are often
employed as the first-line therapy in clinical practice to alleviate inflammation and
reduce the duration of the disease.18 At follow up 1 months later, the red spots are
reduced and there are no new red spots. Old red patches turn into hyperpigmented
macules.
Most cases of PL in children follow a benign selflimited course, but
relapses are common, and symptoms can come and go for several months to years.
There is no literature that mentions the exact rate of recurrence and transforming
malignancy in pityriasis lichenoides chronica. Studies have reported a disease
duration ranging from 6 weeks to 31 months. Tomasini et al reported a patient with
a history of PL since age 11 years who subsequently developed MF, although large
studies with long-term follow-up have not shown any progression to lymphomatoid
papulosis or other cutaneous lymphomas. Although some studies have found a
monoclonal lymphocytic infiltrate on T-cell gene rearrangement studies, its
significance is not fully known. It has been suggested that since progression to
lymphoma is rare and many cases spontaneously regress, a vigorous host immune
reaction may eventually control and eliminate the T-cell clone seen in some
cases.1,3, 18, 19, 20

CONCLUSION

Pityriasis lichenoides in the pediatric age group begins around 8 years of

age and is more frequent in males. Various diagnostic modalities are helpful for
the diagnosis although it should be confirmed by histopathological examination of
biopsy specimen because it is the gold standard for final diagnosis. Erythromycin
and topical steroid was effective in this patient. Regular follow up is recommended
for the patient because the possibility of malignant transformation.

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23
 PLEVA
Clinical Acute-to-subacute eruption of multiple, small,
red papules that rapidly develop into
presentation
polymorphic lesions (vesicles, pustules,
ulcers) with periods of varying remission.
Resolve with leaving varioliform (small-pox
like) scars, or hyper/hypo pigmentation
Predilection thrunk, ektremities, flexural areas
Dermoscopy whitish-yellow structurless rim white scale,
whitish crust in the centre, focal bluish-grayish
areas, red dots and hemorrhage within the
central crust plug
Histopathology epidermal necrosis, hyperkeratosis, irregular
achantosis, exocytosis, spongiosis, basal cell
vacuolation, and perivascular infiltrate, vessel
wall infiltration, endothelial swelling and
extravasation of red blood cell.
Treatment Topical corticosteroids, Antibiotics oral
PLC
Gradually developing, very small, red to
brown, flattened macules and papules with
centrally adherent, mica-like, shiny scales.
Usually resolve with postinflammatory
hypopigmentation.
thrunk, proximal ektremities
yellowish structureless areas and presence Dotted vessels, rough white
scales. scales.
Interface dermatitis, epidermal atrophy,
hyperkeratosis, parakeratosis, irregular
achantosis, exocytosis, spongiosis, basal
cell vacuolation, and perivascular infiltrate
Topical corticosteroids, Antibiotics
oral,phototerapy as a first line
Psoriasis Gutata
The lesions are erythematous
plaques with a diameter of
0.5-1 cm, multiple, scattered,
discrete, accompanied by
silvery white scales such as
mica.
thrunk, proximal ektremities
hyperkeratosis and
parakeratosis with Munro's
abscess. infiltration
inflammatory cells on upper
dermis.
Topical corticosteroid, emolien
Pityriasis rosea
Prodormal. The most common
primary lesion called herald
patch is the appearance of a
solitary lesion in the form of
erythematous macules or
erythematous papules, thiniy
scales
Thrunk, upper arms, upper tigh
Irregular linear vessels, blood
spot, brown globules, and
brown structureless.
acanthosis, focal
parakeratosis. Extravasation of
erythrocytes into the
epidermis, spongiosis can be
found in acute cases
Simptomatic, topical
corticosteroid, antihistamin,
erythromicin, acyclovir
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