A Case of a 9 year old Male with Pityriasis Lichenoides Chronica

Authors: Katrina Marie Macandog Salvosa, MD, Maria Rosa Noliza F. Encarnacion, MD, Milali T. Torres, MD, FPDS, Elizabeth Prieto, MD, FPDS

Abstract

Introduction: Pityriasis Lichenoides Chronica (PLC) is a chronic, non-communicable, skin disease that affects all racial and ethnic groups in all geographic regions. It is more common in children and young adults with a male predominance of 1.5:1 to 3:1. It is characterized by recurrent crops of erythematous papules that develop crusts, vesicles, pustules, or erosions before spontaneously regressing within weeks. PLC tends to concentrate on the trunk and proximal extremities, but any region of the skin and even mucous membranes can be involved. In time, the lesions may become hyperpigmented or hypopigmented especially after sun exposure, which is a hallmark of PLC.

Case Summary: A 9 year old male presents with a 3 month history of recurrent crops of erythematous scaly macules and papules, most of which, evolved to become hypopigmented ill to well-defined macules coalescing into patches, some topped with scales and crusts. No other accompanying symptoms were present. Histopathology results showed multifocal parakeratosis, irregular slight acanthosis and slight basal layer vacuolization, and a mild superficial perivascular and slightly interstitial lymphocytic infiltrate with occasional melanophages, which are consistent with Pityriasis Lichenoides Chronica. The patient was treated with Mometasone Furoate lotion once a day on the face and two times a day on the body  for two weeks then was shifted to Tacrolimus 0.03 % ointment + Vaselina Blanca (1:1) two times a day on affected areas after discontinuation of Mometasone. The patient responded with moderate improvement of pruritus within 1 month, however, with minimal improvement of lesions.

Conclusion: Treatment of Pityriasis Lichenoides Chronica (PLC) is mainly a combination of topical corticosteroids and phototherapy. Systemic antibiotics are primarily used for their anti-inflammatory rather than antibiotic effects. Other effective treatments include Tacrolimus, Prednisone and Methotrexate. For PLC, photodynamic therapy has been used successfully.

The more acute the clinical course and the more severe the individual lesions, the more systemic therapy is indicated.

 

Citation

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Keywords

PLC, Pityriasis Lichenoides Chronica

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