Abstract
About 20 years after its first description, Annular Lichenoid Dermatitis of Youth (ALDY) is recognized as a distinctive lichenoid dermatosis with specific clinical and histological features. The disease occurs mostly in young persons all over the world, runs a chronic course, and has an obscure etiopathogenesis. Clinically, lesions consist of persistent, asymptomatic erythematous macules and round-oval annular patches with a red-violaceous non-scaling border and central hypopigmentation, mostly localized on the groin and flanks. Histology shows a peculiar lichenoid dermatitis characterized by irregular epidermal hyperplasia with an alternation of thinned and quadrangular rete ridges and a dense band-like lichenoid infiltrate of lymphocytes in the papillary dermis. Typically, there is infiltration of lymphocytes into the lower epidermal layers with massive necrosis/apoptosis of keratinocytes, which is limited to the tips of rete ridges. Dermal lymphocytes are usually CD3+, CD4+, while most of the intraepidermal T cells are CD8+. Analysis of TCR-γ-chain gene rearrangement displayed polyclonality in all cases examined. Differential diagnosis mainly includes morphea, mycosis fungoides, annular erythemas and inflammatory lesions of vitiligo. Topical corticosteroids and topical tacrolimus represent the most effective drugs for ALDY treatment.
Highlights
In 2003, Annessi and colleagues described 23 Italian children and adolescents with red-violaceous annular patches that were mostly localized on the groin and flanks and showed a peculiar histologic lichenoid dermatitis with massive necrosis/apoptosis of the keratinocytes at the tips of the rete ridges
Thereisisasupra-papillary adense dense lichenoid infiltrate of by lymphocytes toofthe tips of rete ridges, which acquire a quadrangular shape as a consequence of massive necrosis/apoptosis of keratinocytes
May be distinguished from mycosis fungoides by an infiltration of lymphocytes within the epidermis restricted to the tips of rete ridges, the finding of entire rete ridges transformed into clusters of necrotic/apoptotic keratinocytes, the lack of alignment of lymphocytes in the basal layer of the epidermis along a wide front of the lesion and the absence of atypical lymphocytes, and eosinophils or plasma cells in the dermal infiltrate
Summary
In 2003, Annessi and colleagues described 23 Italian children and adolescents with red-violaceous annular patches that were mostly localized on the groin and flanks and showed a peculiar histologic lichenoid dermatitis with massive necrosis/apoptosis of the keratinocytes at the tips of the rete ridges. On the basis of these clinical, histological and epidemiological features, they proposed naming the disease Annular Lichenoid Dermatitis of Youth (ALDY) [1]. Dermatopathology 2022, 9 infection, and serum antibodies against cytomegalovirus, Epstein–Barr virus, parvovirus B19, Coxsackie/Echovirus and respiratory syncytial virus were negative or within normal limits in all patients [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21]. Standard patch testsagainst were performed in manyEpstein–Barr cases, alwaysvirus, with parvovirus negative results serum antibodies cytomegalovirus, B19,.
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