Lichen Spinulosus Research Articles

Vellus hair follicle diseases

Abstract Human hair follicles are composed of vellus hair follicles (vHFs), sebaceous hair follicles, and terminal hair follicles (tHFs), which share histoanatomy, but differ in biophysiology, therefore are distinctive in clinical morbidities. vHFs are much less studied, and many issues remain to be clarified, such as the expression and regulation of androgen receptors, hair follicle stem cells, immune privilege, and microbiome. Hirsutism is an example of an endocrine disorder with the pathogenesis incompletely understood, especially in idiopathic hirsutism. Interactions between androgens and other hormones deserve special attention. Treatment is unstandardized, whereas combination of antiandrogens and laser shows promise. Keratosis pilaris, a keratinization disorder, lacks clarity in etiopathogenesis, impacting esthetics and therapeutic efficacy. Among the inflammatory disorders, perioral/periorbital dermatitis arises from vHFs irritation, categorized into papular, eczematous, and granulomatous forms. This necessitates varied differential diagnoses and therapeutic approaches. Follicular eczema, a variant of atopic dermatitis in children, is also associated with xerotic dermatitis and allergic contact dermatitis in adults. Bacterial infections rarely target vHFs, in contrast to tHFs. Trichodysplasia spinulosa (TdS) links to TdS-associated polyomavirus infection localized to the inner root sheath cells of vHFs, underdiagnosed in immunocompromised patients. The varying manifestation and pathogenic significance of Malassezia furfur in Malassezia (pityrosporum) folliculitis, pityriasis versicolor, and seborrheic dermatitis remain debated. Proliferative/neoplastic entities of vHFs include vellus hair cyst, pilomatrixoma, trichoepithelioma, and trichostasis spinulosa. Follicular spiny hyperkeratosis, lichen spinulosus, and lichen scrofulosorum are reactive conditions of vHFs. Recognizing vHF-associated diseases helps us to better understand the human hair follicles and to enhance daily dermatological practices.

Diagnostic dilemma: Multiple Autoimmune Syndrome versus incomplete Graham-Little-Piccardi-Lassueur Syndrome overlap mixed connective tissue disease

Objectives. We present a very rare case of incomplete Graham-Little-Piccardi-Lassueur syndrome (GLPLS) overlap with Mixed Connective Tissue Disease (MCTD) versus Multiple Autoimmune Syndrome (MAS). Case Presentation. A 53- year-old female with a long history of more than two years of patchy hair loss on scalp like “footprints in the snow”, partial loss of eyebrows' hair, face erythema, scaly atrophied red/brown patches on face, grouped follicular papules 2-3 mm in diameter with a pointed or hair-like horny spine extending approximately 1-2 mm around the tip of the follicle on lumbar area. The histopathological results from biopsies of scalp and lumbar areas confirmed the clinical diagnosis of cicatricial alopecia induced by lichen plan pilaris (LPP) and also presence of lichen spinulosus (LS) on lumbar area. The description provided by pathologist is however borderline regarding so called interface dermatosis like chronic cutaneous lupus erythematous (CCLE) or Pseudopelade of Brocq (PPB) as the end stage of CCLE or LPP. Blood tests showed both Antinuclear antibodies and U1-nRNP in high titers and the absence of anti-Sm, anti SS-A, anti SS-B and anti-dsDNA antibodies, and also peculiar antibody patterns of MCTD. Outcome. After thorough investigation, MCTD was proven by antibodies results. After one year of treatment a lot of clinical features dramatically responded under therapy. Conclusions. Clinical manifestations in the pathology with strictly cutaneous or systemic localization in conjunction or overlap with other autoimmune diseases (grouped in the MAS) represent a rare diagnostic in daily practice.

Lichen Spinulosus: Successfully Treated with Individualised Homoeopathic Treatment – A Case Report

AbstractLichen spinulosus (LS) is a rare skin disorder that belongs to the family of Follicular Keratotic disorder, primarily seen in children. Its prevalence is more in boys, rarely in adults. The aetiology of this condition is still indefinite, but genetic predominance was noted. The skin lesions are follicular hyperkeratotic papules grouped into large patches, mainly on the neck and buttocks, abdomen and the extensor surface of arms and legs. The individual lesions are flat to conical projections, 1 to 3 mm in diameter, which bears a hair-like horny spine, protruding approximately 1 to 2 mm above the surface, which are the characteristics of this disease. This case of an 8-year-old boy was reported in the outpatient department of our institute and diagnosed as LS. This case report aims to show the importance of individualised prescription based on the totality of symptoms (TOS) in homoeopathic treatment; even the name of the disease is not mentioned in the homoeopathic literature. From the constructed TOS and constitution of the patient, Calcarea Phosphoricum 200C medicine was prescribed, which improved this condition successfully without using any topicals.

An uncommon case of lichen spinulosus induced by dupilumab in a patient treated for bronchial asthma

An uncommon case of lichen spinulosus induced by dupilumab in a patient treated for bronchial asthma

Clinico-dermatoscopic and Histopathological Evaluation of a Case of Generalized Lichen Nitidus

Lichen nitidus (LN) is a rare asymptomatic skin disease composed of numerous tiny, shiny, flat papules mainly over the chest, forehead, neck, forearm, and glans penis. They are of two types based on distribution, localized which is more common compared to generalized. Dermoscopy helps in differentiating LN from other similar dermatoses such as lichen planus, keratosis pilaris, follicular eczema, lichen spinulosus, which is non-invasive. We describe a 15-year-old female with generalized lichen nitidus with palms, soles, and nail involvement with dermoscopic features and histopathological correlation.

Clinico-histopathological correlation of follicular skin lesions

Introduction: Follicular skin lesions are common skin problems which are caused by inflammation and infection of the hair follicles. The objective of the study was to know the incidence of the follicular skin lesions among patients attending Dermatology department and correlate them clinically and histopathologically. Materials and Methods: This study was conducted January 2019 to June 2019. One hundred patients with follicular skin lesions were included in the study. Detailed history, clinical examination and skin biopsy for histopathology was done. In all cases clinical diagnosis was confirmed by histopathology. Results: Phrynoderma was found to be most common (42 cases) followed by Keratosis pilaris (24 cases), pityriasis rubra pilaris (8 cases), Kyrle’s (6 cases), Darier’s disease (5 cases), follicular lichen planus (4 cases), perforating folliculitis (4 cases), lichen spinulosus (2 cases), follicular psoriasis (1 case), lichen scrofulosorum (1 case). Three cases were found to be non -specific on histopathology. Phrynoderma was most common (42%) follicular skin lesion among children. Keratosis Pilaris was common in adult females whereas Darier’s disease and Kyrle’s disease in adult males. Atopy was most commonly associated with keratosis pilaris. Conclusions: The present study emphasizes the various follicular skin lesions in this geographical location. Both clinical examination and histopathology helps in differentiating different follicular skin lesions. Keywords: Follicular, Keratosis pilaris, Phrynoderma.

An Uncommon Case of Lichen Spinulosus in an Adult Patient Clinically Mmimicking Folliculotropic Mycosis Fungoides

Lichen spinulosus (LS) is an uncommon skin condition mostly in children and adolescents but uncommon in adults. It presents as a group of hypopigmented or skin-colored follicular papules and keratotic spines with a sandpaper-like appearance. There is a lymphohistiocytic infiltrate in the dermis centered around hair follicles. We present a rare case of LS in a 52-year-old woman with a rough, bumpy, itchy rash affecting the trunk and extremities. Her rash consisted of clusters of hyperkeratotic follicular-based spiny papules. Histologic sections demonstrated several dilated hair follicles filled with keratotic plugs surrounded by a dense perifollicular lymphohistiocytic infiltrate, particularly at the level of the infundibula, that extended into the follicular epithelium.

Lip swelling and constipation: Pretest probability of cutaneous signs for crohn's disease in the absence of typical gastrointestinal symptoms

We describe a female child in the first decade patient admitted to a children's hospital for lip swelling and constipation who was ultimately diagnosed with Crohn's disease. Her lip swelling resolved after the initial immunosuppression for her Crohn's disease. In this article, we discuss the pretest probability of cutaneous findings associated with inflammatory bowel disease in predicting a diagnosis of Crohn's disease in the absence of intestinal symptoms. Cutaneous findings including linear immunoglobulin A bullous dermatosis, pyoderma gangrenosum, lichen spinulosus, and epidermolysis bullosa acquisita are discussed.

Successful treatment of lichen spinulosus with topical adapalene

A 69-year-old Japanese man presented with a 2-month history of multiple brown lesions on his trunk and limbs. Physical examination showed brownish, 2-4 mm follicular hyperkeratotic papules on the trunk and limbs (figure 1A). Some lesions were surrounded by a reddish halo. Routine laboratory tests (including HIV serology) were normal, except for a decreased red-blood cell count and increased serum glucose. None of his family members had similar lesions. Histological examination of lesional skin revealed [...]

Multiple minute digitate hyperkeratosis: A proposed algorithm for the digitate keratoses

Multiple minute digitate hyperkeratosis (MMDH) is a rare disorder of keratinization with many different names. We present a case of MMDH and review the literature. We propose and discuss the classification the digitate keratoses, which include MMDH, lichen spinulosus, phrynoderma, spiny keratoderma, arsenical keratosis, multiple filiform verrucae, postirradiation digitate keratosis, trichodysplasia spinulosa, and hyperkeratotic spicules. We present a table of suggested and synonymous terms and propose a diagnostic algorithm for these digitate keratoses. A literature search using PubMed and MEDLINE was performed. This included the search terms "MMDH," "familial disseminated filiform hyperkeratosis," "punctate porokeratotic keratoderma," "disseminated spiked keratosis," "minute aggregate keratosis," "digitate keratosis," "conical keratosis," "hyperkeratotic spicules," and "music box spine dermatosis." Acase of MMDH in an 89-year-old woman is described. The digitate keratoses are presented alongside their synonymous terms and are divided into those that are generalized or localized using an algorithm. Separate disease entities are likely to arise within the digitate keratoses with increased reporting of immunohistochemical keratin analysis and molecular genetic studies. We report a new case of MMDH and provide a clinical approach to diagnosis of the digitate keratoses.

Successful Treatment of Lichen Spinulosus with Topical Tacalcitol Cream

Lichen spinulosus (LS) is a rare idiopathic cutaneous eruption characterized by follicular keratotic spiny papules that are grouped in large patches. Here, we report two cases of LS in the submental area, an uncommon site, which were treated effectively and safely with topical tacalcitol cream.

Lichen Spinulosus in an Alcoholic Patient

© 2009 The Authors. doi: 10.2340/00015555-0600 Journal Compilation © 2009 Acta Dermato-Venereologica. ISSN 0001-5555 Sir, Lichen spinulosus (LS) is a rare and benign disorder, characterized by the development of patches of small follicular papules with a central horny spine (1). Diseases such as keratosis pilaris and pityriasis rubra pilaris occasionally present with lesions that resemble LS (1–3). Idiopathic LS lesions usually occur on the trunk or extremities, mainly in children and adolescents (3). Although the hands, feet and face are usually spared in classically described LS (4), the generalized form of this condition has been reported in patients infected with human immunodeficiency virus (HIV) (2, 5). We report here a case of LS occurring on the face and the nuchal region in association with alcoholism.

A Case of Lichen Spinulosus with an Histologic Finding of Follicular Mucinosis

A Case of Lichen Spinulosus with an Histologic Finding of Follicular Mucinosis

きょく状苔せん 自験２例および本邦報告例の検討

症例1: 67歳の男性。小児期より特に誘因なく顔面·躯幹·上肢などに,棘状に突出する丘疹が出現していたが放置していた。自覚症状のない粟粒大の毛孔一致性丘疹が上記部位に多発集簇し,大小の局面を形成。一部では角化性の棘状突起を伴っていた。病理組織学的には開大した毛嚢に一致して柱状に突出した角質塊がみられ,毛包周囲にはリンパ球浸潤を伴い,原発性棘状苔癬と診断した。治療としてサリチル酸ワセリン外用を行ったが無効であった。症例2: 82歳の女性,下腿伸側を中心に,軽度のそう痒を伴う粟粒大の毛孔一致性丘疹が多発集簇し,おろし金様の局面を形成。丘疹の頂点には角化性の棘状突起物を伴っていた。皮脂欠乏性湿疹を合併しており,一部では苔癬化局面も認められた。病理組織学的には開大した毛嚢に一致して柱状に突出した角質塊がみられ,毛包周囲にはリンパ球浸潤を伴っていた。続発性棘状苔癬と診断し,治療としてヘパリン類似物質,吉草酸酢酸プレドニゾロン,10%サリチル酸ワセリンの外用を行ったところ皮疹は約1ヵ月で軽快した。本症の本邦報告例56例を集計し,考察を加えた。

Lichen spinulosus: Clinicopathologic review of thirty-five cases

Lichen spinulosus is a rare, idiopathic dermatosis characterized by follicular keratotic papules that are grouped into large patches. In this report the clinical and histologic data of 35 patients with lichen spinulosus are presented. The patients consisted of 14 males and 21 females, and their average age was 17.8 +/- 9.5 years. The average age at onset of disease was 16.2 +/- 10.1 years. Affected areas were symmetrically distributed and involved the extensor surfaces of the arms and legs, back, chest, face, and neck. Lesions were characterized by round or oval, 2 to 6 cm plaques composed of grouped punctate, "thorny," 1 to 3 mm, follicular keratotic papules. Microscopic examination revealed keratotic plugging of the follicular infundibulum and a perivascular and perifollicular mononuclear infiltrate. Although the cause is not yet known, lichen spinulosus probably represents a follicular reaction pattern of more than one origin.

ULERYTHEMA OPHRYOGENES; REVIEW AND REPORT OF A CASE. DISCUSSION OF RELATIONSHIP TO CERTAIN OTHER SKIN DISORDERS AND ASSOCIATION WITH INTERNAL ABNORMALITIES.

This child has ulerythema ophryogenes which began to be manifest at birth by absence of eyebrow hair and the presence of erythema in the supraorbital areas. While there was an appearance of a few normal eyebrow hairs later, atrophy and sclerosis have been slowly progressive. This patient exemplifies the association of various other ectodermal defects: dentigenous cyst, red keratosis pilaris of Bazin, typical keratosis pilaris of the extremities, and an area of the chin simulating lichen spinulosus. In addition, the child exhibits atopy, an emotional disturbance, large venous lakes in the midportion of the parietal bones, and probably a deficient absorption of vitamin A. There was no improvement in the skin disease when the serum vitamin A levels were kept elevated for six months by means of intramuscular injections of vitamin A.

TURKEY

<h3>Vitamin Therapy in Dermatology.</h3> —In<i>Hastane</i>, the Istanbul periodical for specialists in Turkish hospitals, dermatologist Dr. Kemal Turgut of the Istanbul venereal disease department has published the results of his 10 year experimentation on vitamins as an adjunct to external application of medicaments. In patients who had lichen ruber planus and similar diseases the skin manifestations soon disappeared when vitamin A by mouth was added to external applications of medicaments. Fifteen patients who had lichen ruber planus were given a daily dose of 150,000 units of "prepalin," a vitamin A preparation. The patients recovered within one to two months. A 5-year-old boy who had generalized lichen spinulosus was given a daily dose of 100,000 units of vitamin A supplemented by a generous serving of red carrots for three months. The patient fully recovered after four months' therapy, and since then two years have passed without a relapse. A patient who

Follicular lichen planus (lichen planopilaris).

IN THIS study we have directed our effort toward clarification of a syndrome most appropriately termed follicular lichen planus, which has been the subject of considerable discussion since the turn of the century. The British and American authors who kept the discussion alive have progressively contributed to the better understanding of the disease. In the following brief historical review, we will evaluate the accumulated material which helped crystallize our concept of the disease. The disorder was labeled lichen planopilaris by Pringle1in 1895. At a meeting of the Dermatological Section of the Royal Society of Medicine on April 15, 1915, Little2presented a patient showing cicatricial alopecia of the scalp, together with a follicular eruption on the body, indistinguishable clinically from lichen spinulosus. The relation of the follicular lesions of the scalp to the follicular lesions of the body was debated, and Little expressed the opinion of the

Studies of Sweating: I. Preliminary Report with Particular Emphasis on a Sweat Retention Syndrome

A good deal of attention has been devoted to skin diseases associated with plugging of the orifices of the sebaceous glands. Acnes, comedones, miia, some furuncles, folliculitides, lichen spinulosus, and keratosis pilaris are common examples of affections in which keratotic plugs in the openings of the piosebaceous apparatus have been recognized as an intimate part of the pathogenetic happenings. In contrast, but little attention has been accorded the role of plugging of the sweat gland orifices as an important part of the pathology of certain cutaneous diseases. Recent findings have made us feel that sweat glandobstruction deserved further consideration and more intensive study. The principal stimulus to the present studies was given by recent observations in the tropics (1, 2, 3). These observations confirmed those of S. Pollitzer (4) in that it could be shown that horny plugs in the openings of the sweat ducts occurred in prickly heat, and played a substantial part in the pathogenesis of this disease. It was further shown that the outfiowing of sweat was very much reduced or absent in and around the affected zones; and that this reduced or absent sweating could persist for some time after the acute clinical manifestations of ordinary miiaria were no longer in evidence. It was also demonstrated that the syndrome described by Allen and O'Brien (5) as tropical anidrotic asthenia and by Wolkin, Goodman and Kelley (6) as thermogenic anidrosis was associated with horny plugging of the openings of the sweat pores with an inhibition of outpouring of sweat; and with histologic and clinical cutaneous pictures (e.g. papulation, vesicle formation on exposure to elevated environmental temperatures) quite analagous to those found in the end stages of ordinary prickly heat. In the most recent studies from Guam (1, 2, 3) it was emphasized that prickly heat and tropical anidrotic asthenia might well be related to one and the same fundamental mechanism, namely occlusion of the sweat ducts, and consequent local cutaneous effects. It was inferred that when extensive areas were involved, the plugging of the pores, and the consequent failure to pour out (and evaporate) sensible perspiration when needed, could lead to profound disturbances of the heat-regulating mechanisms and systemic aberrations of great significance.

BLOOD VITAMIN A AND CUTANEOUS DISEASES

The skin contains no appreciable vitamin A, 1 in spite of the fact that the latter has an important influence on cutaneous structure and growth. Indeed, all epidermal parts are affected by indirect means through the metabolism of vitamin A. Just how this action is accomplished is not known, but some evidence points to active participation of the liver in the process. The procedure is probably a complex one with at least several repercussions. This surmise is strengthened by the various resulting forms that a single organ such as the skin may show from vitamin A deficiency and dysmetabolism. Thus it has been fairly satisfactorily demonstrated that vitamin A metabolism in some way or another is associated with such diverse morphologic forms as Darier's 2 and Devergie's 3 diseases as well as xeroderma and certain forms of lichen spinulosus. Balbi 4 found that generalized cutaneous eruptions