Advertisement

Pityriasis lichenoides in childhood: A retrospective review of 124 patients

Published:October 18, 2006DOI:https://doi.org/10.1016/j.jaad.2006.08.023

      Background

      Pityriasis lichenoides (PL) occurs in all age groups, although predominantly in younger individuals.

      Objective

      We sought to study the clinical features of PL in children followed up at our institution.

      Methods

      The records of 124 children who were given the diagnosis of PL at our institution between 1993 and 2003 were retrospectively reviewed.

      Results

      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.

      Limitations

      The analyzed data were collected retrospectively and biopsies were not performed in all patients.

      Conclusions

      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.

      Abbreviations used:

      LyP (lymphomatoid papulosis), PL (pityriasis lichenoides), PLC (pityriasis lichenoides chronica), PLEVA (pityriasis lichenoides et varioliformis acuta)
      To read this article in full you will need to make a payment
      AAD Member Login
      AAD Members, full access to the journal is a member benefit. Use your society credentials to access all journal content and features
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Clayton R.
        • Haffenden G.
        • Du Vivier A.
        • Burton J.
        • Mowbray J.
        Pityriasis lichenoides–an immune complex disease.
        Br J Dermatol. 1977; 97: 629-634
        • Clayton R.
        • Haffenden G.
        An immunofluorescence study of pityriasis lichenoides.
        Br J Dermatol. 1978; 99: 491-493
        • Magro C.
        • Crowson A.N.
        • Kovatich A.
        • Burns F.
        Pityriasis lichenoides: a clonal T-cell lymphoproliferative disorder.
        Hum Pathol. 2002; 33: 788-795
        • Weinberg J.M.
        • Kristal L.
        • Chooback L.
        • Honig P.J.
        • Kramer E.M.
        • Lessin S.R.
        The clonal nature of pityriasis lichenoides.
        Arch Dermatol. 2002; 138: 1063-1067
        • Piamphongsant T.
        Tetracycline for the treatment of pityriasis lichenoides.
        Br J Dermatol. 1974; 91: 319-322
        • Zlatkov N.B.
        • Andreev V.C.
        Toxoplasmosis and pityriasis lichenoides.
        Br J Dermatol. 1972; 87: 114-116
        • Fortson J.S.
        • Schroeter A.L.
        • Esterly N.B.
        Cutaneous T-cell lymphoma (parapsoriasis en plaque): an association with pityriasis lichenoides et varioliformis acuta (Mucha-Haberman disease) in young children.
        Arch Dermatol. 1990; 126: 1449-1453
        • Thomson K.F.
        • Whittaker S.J.
        • Russell-Jones R.
        • Charles-Holmes R.
        Childhood cutaneous T-cell lymphoma in association with pityriasis lichenoides chronica.
        Br J Dermatol. 1999; 141: 1146-1148
        • Rogers M.
        Pityriasis lichenoides and lymphomatoid papulosis.
        Semin Dermatol. 1992; 11: 73-79
        • Gelmetti C.
        • Rigoni C.
        • Alessi E.
        • Ermacora E.
        • Berti E.
        • Caputo R.
        Pityriasis lichenoides in children: a long-term follow-up of eighty-nine cases.
        J Am Acad Dermatol. 1990; 23: 473-478
        • Romani J.
        • Puig L.
        • Fernandez-Figueras M.T.
        • Moragas J.M.
        Pityriasis lichenoides in children: clinicopathologic review of 22 cases.
        Pediatr Dermatol. 1998; 15: 1-6
        • Clayton R.
        • Warin A.
        Pityriasis lichenoides presenting as hypopigmentation.
        Br J Dermatol. 1979; 100: 297-302
        • Cornelison R.L.
        • Knox J.M.
        • Everett M.A.
        Methotrexate for the treatment of Mucha-Haberman disease.
        Arch Dermatol. 1972; 106: 507-508
        • Truhan A.
        • Hebert A.A.
        • Esterly N.B.
        Pityriasis lichenoides in children: therapeutic response to erythromycin.
        J Am Acad Dermatol. 1986; 15: 66-70
        • Rasmussen J.E.
        Mucha-Habermann's disease.
        Arch Dermatol. 1979; 115: 676-677
        • Siew N.T.
        UV-B phototherapy for pityriasis lichenoides.
        Australas J Dermatol. 1985; 26: 9-13
        • Tomasini D.
        • Zampatti C.
        • Palmedo G.
        • Bonfacini V.
        • Sangalli G.
        • Kutzner H.
        Cytotoxic mycosis fungoides evolving from pityriasis lichenoides in a 17-year-old girl.
        Dermatology. 2002; 205: 176-179
        • Panhans A.
        • Bodemer C.
        • Macinthyre E.
        • Fraitag S.
        • Paul C.
        • de Prost Y.
        Pityriasis lichenoides of childhood with atypical CD30-positive cells and clonal T-cell receptor gene rearrangements.
        J Am Acad Dermatol. 1996; 35: 489-490
        • Varga F.J.
        • Vonderheid E.C.
        • Olbricht S.M.
        • Kadin M.E.
        Immunohistochemical distinction of lymphomatoid papulosis and pityriasis et varioliformis acuta.
        Am J Pathol. 1990; 136: 979-987
        • Kadin M.E.
        T cell clonality in pityriasis lichenoides. Evidence for a premalignant or reactive immune disorder?.
        Arch Dermatol. 2002; 138: 1089-1090
        • Tomasini D.
        • Tomasini C.F.
        • Cerri A.
        • Sangalli G.
        • Palmedo G.
        • Hantschke M.
        • et al.
        Pityriasis lichenoides: a cytotoxic T-cell-mediated skin disorders; evidence of human parvovirus B19 DNA in nine cases.
        J Cutan Pathol. 2004; 31: 531-538