Pityriasis lichenoides (overview) L41.1

Author: Prof. Dr. med. Peter Altmeyer

All authors of this article

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.

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Dermatology

Parapsoriasis (overview)

Term introduced by Brocq in 1902 as a temporary measure for various rare, chronic, unclassifiable, erythema...

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.

Pityriasis lichenoides et varioliformis acuta (PLEVA)
Pityriasis lichenoides chronica (PLC)

Other forms:

Pityriasis lichenoides et varioliformis acuta with vasculitis (with evidence of leukocytoclastic vasculitis).
Pseudolymphomatous pityriasis lichenoides et varioliformis acuta (with clinical relationship to lymphomatoid papulosis).

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