Diagnosis Of Pityriasis Lichenoides Research Articles

Pityriasis lichenoides et varioliformis acuta (PLEVA)

We report a case of a 3-year-old male child presenting with a polymorphous generalized eruption consisting of crusted maculopapular lesions all over body except for face and mucus membrane. Histopathology showed interface dermatitis along with perivascular infiltrates chiefly comprising of lymphocytes and extravasated red blood cells, indicating the diagnosis of pityriasis lichenoides et varioliformis acuta. He was treated with dapsone and eryhthromycin with success.

Mystifying lesions in syphilis-HIV co-infection

Case report We report the case of a 22 years old male patient, who presented with a vesicular eruption, bacterial over infected, with a group pattern distribution throughout the entire skin, evolving for approximately three months. The patient was previously treated for this condition with systemic antibiotics, which he could not mention, being diagnosed with superficial folliculitis. However, no improvement was noticed. He denied unprotected sexual intercourse. The patient was clinically examined and we performed routine tests, immunologic assays, bacteriological swab and skin biopsy. General examination showed generalized, painless micropoly-lymphadenopathy and continuous muscle pain in the lower legs. Dermatological assessment of lesions revealed a disseminated eruption on the entire skin, including the face and penis sheath, consisting of erythematous plaques with the surface covered by crusts and vesicles arranged in groups, with various sizes (diameter 13 cm) and clearly defined edges. The presumptive diagnosis was secondary syphilis, and in order to rule out the differential diagnosis of pityriasis lichenoides et varioliformis acuta, eosinophilic folliculitis and systemic lupus erythematosus we performed a series of tests including immunologic assays, viral markers for HCV, serology for syphilis, bacteriological swab from the lesions and a skin biopsy. The results were positive for syphilis and Staphylococcus aureus was isolated from the lesions. Histopathological appearance of psoriasiform and lichenoid dermatitis with plasma cells was interpreted in the context of secondary syphilis, confirming our diagnosis. The patient eventually admitted having multiple unprotected sexual contacts. We tested for HIV Ag/Ac (1 + 2), which was positive.

Assessment of the ‘no eosinophils' rule: are eosinophils truly absent in pityriasis lichenoides, connective tissue disease, and graft‐vs.‐host disease?

Eosinophils are often present in the inflammatory infiltrate of an interface dermatitis, but the diagnostic specificity of eosinophils in interface dermatitis has not been formally evaluated. We retrospectively identified 97 examples of interface dermatitis with clinically confirmed diagnoses, including lupus erythematosus (LE), lichen planus, pityriasis lichenoides (PL), graft-vs.-host disease (GVHD), dermatomyositis (DM) and drug reaction. Diagnoses were clinically confirmed by at least two dermatologists. Slides were reviewed in a blinded fashion by at least two dermatopathologists. The average eosinophil count per 10 ×200 (×20 objective) fields was lowest for PL (0.2), DM (0.3), GVHD (0.4), and LE (0.5) [defined as Group 1] and was higher for lichen planus, drug reactions, erythema multiforme (major and minor) and viral exanthems [defined as Group 2]. Distinction between Group 1 and Group 2 was maximized using an eosinophil count cutoff of 1.1. In conclusion, eosinophils are usually rare to absent in PL, DM, most forms of LE and GVHD. While final interpretation requires a composite assessment of all features, our results suggest that the presence of even a single eosinophil within nine or ten ×20 fields argues against a diagnosis of PL, DM or LE.

Pityriasis Lichenoides Chronica Associated with Herpes Simplex Virus Type 2

Introduction. Pityriasis lichenoides is a rare, acquired spectrum of skin conditions of an unknown etiology. Case Report. A 28-year-old man presented with recurrent outbreaks of herpes simplex virus associated with the onset of red-to-brown maculopapules located predominantly in trunk in each recurrence. Positive serologies to herpes simplex virus type 2 were detected. Histopathological examination of one of the lesions was consistent with a diagnosis of pityriasis lichenoides chronica. Discussion. Pityriasis lichenoides is a rare cutaneous entity of an unknown cause which includes different clinical presentations. A number of infectious agents have been implicated based on the clustering of multiple outbreaks and elevated serum titers to specific pathogens (human immunodeficiency virus, cytomegalovirus, Epstein-Barr virus, Toxoplasma gondii, and herpes simplex virus). In our patient, resolution of cutaneous lesions coincided with the administration of antiviral drugs and clinical improvement in each genital herpes recurrence. In conclusion, we report a case in which cutaneous lesions of pityriasis lichenoides chronica and a herpes simplex virus-type 2-mediated disease have evolved concomitantly.

Pityriasis lichenoides chronica: stratification by molecular and phenotypic profile

Pityriasis lichenoides (PL) has traditionally been classified as a benign papulosquamous disease. However, there is an increasing literature precedent that suggests that PL should instead be considered a form of cutaneous lymphoid dyscrasia. We prospectively encountered 46 patients with a diagnosis of PL and used immunohistochemical and multiplex polymerase chain reaction fragment size analysis to assess for phenotypic abnormalities and for T-cell clonal restriction, respectively. We categorized them into 2 groups based on the molecular profile, namely, those cases that showed a monoclonal and/or a restricted oligoclonal profile versus those cases that were polyclonal. Half of all the cases studied showed a monoclonal and/or an oligoclonal restricted T-cell repertoire. From a clinical perspective, 2 cases in this group manifested skin lesions compatible with mycosis fungoides (MF). All of the other cases demonstrated a persistent but nonprogressive clinical course characterized by periods of regression and recurrence. In any case in which there were multiple biopsies, the same T-cell dominant clonotypes, be it in the context of representing a true monoclonal and/or oligoclonal pattern, were implicated over time and at different biopsy sites, including 2 cases in which there was a subsequent evolution to MF. Substantial losses of CD7 and CD62L were seen in both monoclonal/oligoclonal and polyclonal cases of PL, although both values of percentage reduction were greater in the monoclonal/oligoclonal cases. A dominance of CD8 lymphocytes was seen in more than half of all the cases of PL and held to be reactive in nature, potentially directed against clonally restricted CD4 cells. CD4/CD25+ (Foxp3+) T cells averaged 24% in the polyclonal cases; it was 12% in the monoclonal variants of PL. We conclude that PL is a form of indolent cutaneous T-cell dyscrasia. The limited propensity for progression to MF may reflect internal countercheck mechanisms of controlling clonally restricted CD4+ T-cell proliferations via CD8 and CD4/CD25+ regulatory T cells.

Pityriasis lichenoides in childhood: A retrospective review of 124 patients

Pityriasis lichenoides (PL) occurs in all age groups, although predominantly in younger individuals. We sought to study the clinical features of PL in children followed up at our institution. The records of 124 children who were given the diagnosis of PL at our institution between 1993 and 2003 were retrospectively reviewed. 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. The analyzed data were collected retrospectively and biopsies were not performed in all patients. 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.

Histopathologic Diagnosis of Pityriasis Lichenoides et Varioliformis Acuta and Its Clinical Correlation

To assess the specificity of the histopathologic features in the diagnosis of pityriasis lichenoides et varioliformis acuta (PLEVA), we reviewed the clinical manifestations and courses of 42 patients for whom this diagnosis was suggested in the pathology report. The histologic diagnosis of PLEVA was clinically substantiated in 16 of these 42 cases. Of the 26 cases in which PLEVA was erroneously diagnosed histologically, the correct clinical diagnosis was suggested before biopsies were done in 21 instances. In the five remaining cases, both the prebiopsy clinical diagnosis and the pathologic diagnosis proved to be incorrect. Pityriasis rosea, insect bites, and eczematous dermatitis accounted for the majority of the cases that histologically mimicked PLEVA. The constellation of histologic findings described in PLEVA (presence of intraepidermal lymphocytes and erythrocytes, dermal hemorrhage, and so-called lymphocytic vasculitis) is not specific and may be seen in a variety of dermatologic disorders.