- Keratosis pilaris
- Pityriasis rubra pilaris
- Lichen spinulosus
- Atopic dermatitis
This patient was diagnosed with lichen spinulosus, a rare and benign cutaneous disorder characterized by sudden onset of localized circumscribed plaques comprised of follicular hyperkeratotic papules. It most frequently occurs in children and adolescents; however, young adults can also be affected.
Learnings/What to Look for
- Etiology and pathogenesis are not known, although atopic, infectious, and genetic factors have been proposed as causes
- Patients often have a history of atopy
- Although usually localized to certain sites of predilection, a more severe generalized variant of lichen spinulosus also exists. It occurs in association with nodulocystic acne and pityriasis rubra pilaris as part of type VI (HIV-associated) pityriasis rubra pilaris
- Rare associations include Crohn’s disease, Hodgkin’s disease, seborrheic dermatitis, syphilis, id reactions to fungal infections, and heavy metal ingestions
- Note that these associations are 1) not causal relationships and 2) may be the consequence of ascertainment bias
Pearls for Urgent Care Management
- Lichen spinulosus has a variable course. Most cases tend to resolve spontaneously at puberty, although persistent cases have also been described
- While no treatment is required, effective therapeutic options include topical keratolytic agents and topical retinoids
Acknowledgment: Images and case presented by VisualDx (www.VisualDx.com/JUCM).