Pityriasis lichenoides is an erythematosquamous skin disease that can be acute or chronic. It is an autoimmune disease with an unknown cause. The symptomatic treatment of the skin papules is carried out using anti-inflammatory local treatment.
What is pityriasis lichenoides?
The specialist literature also refers to skin diseases as dermatoses. These diseases usually manifest themselves not only on the skin, but also in their appendages. These include the hair, nails, sebaceous glands and sweat glands. There are different subcategories under dermatoses. One of them is that of erythematous-squamous skin diseases. See definitionexplorer for Hepatic Encephalopathy Definitions.
Pityriasis lichenoides is an erythematous-squamous skin disease first described in 1899. Juliusberg is considered to be the first to describe it. Brocq described the disease as one of several parapsoriatic diseases three years after it was first described. The speculation on several psoriasis-like diseases cannot be maintained due to recent research results.
In the meantime, medicine assumes clinically different manifestations of pityriasis lichenoides, which are to be understood as variants of one and the same disease. Four forms have been clinically distinguished so far, which are characterized by different degrees of acuteness. The acute form of the disease is also known as Mucha-Habermann disease.
Pityriasis lichenoides is a rather rare disease. In most cases, male adolescents or adult men are affected by the dermatosis. The cause of the skin disease has not yet been clarified. Speculations about causal factors have also been few and far between, which probably has something to do with the rare occurrence of the dermatosis.
It is probably an autoimmune disease. During the course of the disease, T-cells of the immune system cause inflammation in the skin area. The immunological cells thus mistakenly recognize the body’s own tissue as a foreign substance or pathogen that needs to be combated. The primary cause of such misprogramming of the immune system could be a virus.
In addition, vaccines and environmental factors such as periods of stress are discussed as primary causes of pityriasis lichenoides. So far, it remains unclear why males suffer more from the disease. For the causal connection, gender seems to play at least hardly any role.
Symptoms, Ailments & Signs
An acute is distinguished from a chronic form of pityriasis lichenoides. In principle, both forms can also occur side by side in the same patient. The acute form (pityriasis lichenoides et varioliformis acuta or PLEVA) is the rarer variant and is manifested by single or multiple papules that begin to necrotize hemorrhagically.
Pain or an uncomfortable feeling of tension accompany the tissue-destroying necrosis. Exanthema is characteristic of the chronic form of the disease (pityriasis lichenoides chronica or PLC). This is a rash that is uniform over a large area. In the context of chronic lichenoid pityriasis, these rashes usually remain for several months and are accompanied by the formation of round or oval, sharply demarcated papules.
Most patients experience only minor itching. In many cases, their skin is covered by a parakeratotic cover of scales. Parakeratosis is a keratinization disorder of the squamous epithelium that leaves nuclei of the epithelial cells in the top cell layer.
Diagnosis & course of disease
The diagnosis of pityriasis lichenoides is based on the clinical symptoms. In addition to histopathology, progress monitoring is indicated for precise diagnosis and determination of the form of the disease. In terms of differential diagnosis, the chronic form of pityriasis lichenoides must be differentiated from guttate psoriasis and syphilis II.
In the acute form there is a certain resemblance to chickenpox as well as drug eruptions and allergic vasculitis. Because the disease often first appears in early childhood, patients are most often misdiagnosed with chickenpox when they have their first acute attack. The prognosis for those affected is rather favorable. Although the acute form is clinically more severe, it usually goes into remission on its own and resolves completely.
In the case of pityriasis lichenoides et varioliformis acuta, those affected suffer from various skin complaints. These complaints have a very negative effect on the quality of life of those affected and can limit it considerably. In most cases, this also leads to severe psychological problems and inferiority complexes or reduced self-esteem.
Children may also be bullied or teased. The skin itself is covered with papules and pustules and can also be itchy in some cases. Children in particular scratch their skin very often, which can lead to scars or even bleeding. Most patients with pityriasis lichenoides et varioliformis acuta also suffer from a general feeling of illness and also from exhaustion and fatigue.
Pityriasis lichenoides et varioliformis acuta is treated with the help of medication and various creams or ointments. There are no complications. However, it cannot be universally predicted whether the symptoms will disappear completely as a result of the treatment. However, the life expectancy of the patient is not affected by pityriasis lichenoides et varioliformis acuta.
When should you go to the doctor?
If unusual skin changes occur that do not go away on their own within a few days, medical attention is required. At the latest when symptoms such as itching or inflammation appear, a doctor must be consulted about pityriasis lichenoides. The diagnosis allows for immediate treatment with medication, which should resolve the bran worm sore within a few days to weeks. People suffering from chronic skin diseases or an autoimmune disorder are particularly at risk. Patients with skin fungi such as Malassezia furfur also belong to the risk groups and should have the symptoms mentioned promptly clarified.
Anyone who is in a warm, humid climate, sweats heavily or has underlying diseases such as diabetes mellitus must also inform their family doctor. Other contact points are the dermatologist or a specialist in internal medicine. The treatment usually takes place on an outpatient basis. In the case of severe pityriasis lichenoides, inpatient therapy in a specialist clinic may be necessary. The patient may also need therapeutic support, as the illness can cause great emotional distress.
Treatment & Therapy
A causal treatment option does not yet exist for patients with pityriasis lichenoides. Since the primary cause of the disease has not yet been clarified, causal treatment approaches cannot be developed. For this reason, the chronic form of dermatosis in particular is considered an incurable disease. Symptomatic treatment options are available.
The treatment approaches used to date range from exposure to UV rays to conservative drug therapies. For example, the PUVA method uses UV. This is the combination of psoralens with long-wave UV radiation, which is used as therapy in dermatology for various indications.
Among the drug therapy routes, taking antibiotics has proven to be effective for patients with pityriasis lichenoides. The same applies to the supply of steroids. Systemic glucocorticoids are the most common therapy method. Another treatment option is anti-inflammatory local therapy for individual papules.
In the acute form of the disease, the lesions disappear on their own in most cases. Depending on the individual course, this regression can take some time. Remissions are also common in the chronic form. With this variant, however, the symptoms only disappear for a certain period of time and then reappear.
Outlook & Forecast
As a rule, the further course of pityriasis lichenoides depends very much on the exact cause and also on the severity of the disease, so that a general prediction cannot usually be made. However, an early diagnosis by a doctor has a very positive effect on the further course of this disease and can also prevent the occurrence of further complications or symptoms.
If pityriasis lichenoides is not treated at all, the symptoms will not go away on their own and in many cases can also get worse. Therefore, treatment should always be sought for this disease. As a rule, various creams or ointments are used to alleviate the symptoms. The regular application of these medications can limit the symptoms permanently and sustainably, so that they do not recur.
However, the healing time can vary greatly and also depends heavily on how well the medication works for the patient. The affected person should avoid scratching the affected areas in any case, so that there is no bleeding or scarring. Likewise, a high standard of hygiene can alleviate the symptoms and also prevent the recurrence of the disease.
There are hardly any preventive steps for pityriasis lichenoides. As long as the primary cause of the disease has not been clarified, no promising preventive measures can be developed. Since extreme stressful situations appear to be a causal factor, the use of stress management strategies may play a role in prevention. Nevertheless, this is not a safe avoidance strategy.
In most cases, those affected with pityriasis lichenoides have only very few and only limited follow-up measures available. As a rule, a doctor should be contacted at an early stage so that further complications and other symptoms do not arise. Early diagnosis usually has a very positive effect on the further course of the disease and can prevent the symptoms from worsening.
Therefore, the patient should consult a doctor at the very first symptoms and signs of the disease. Most of those affected with pityriasis lichenoides are therefore dependent on taking various medications. It is always important to ensure the correct dosage with regular intake in order to properly alleviate the symptoms.
If antibiotics are taken, they should not be taken together with alcohol. Furthermore, those affected by pityriasis lichenoides should protect their skin particularly well against light and not be in the sun unprotected. Regular check-ups by a doctor help to identify and treat damage early on.
You can do that yourself
This rather rare disease often affects men. Since the cause of the disease has not yet been determined, the disease can only be treated symptomatically. Here, the treating dermatologist will suggest suitable therapies.
It is possible, however, that pityriasis lichenoides is an autoimmune disease, the course of which worsens depending on stress and environmental influences. Therefore, a healthy lifestyle that includes several components is advisable. On the one hand, patients should not ingest any additional toxins, since they are also transported through the skin, which can aggravate the disease. You should therefore not smoke, consume only moderate to no alcohol and avoid stress.
Sport is important because on the one hand it stimulates the metabolism and on the other hand it supports the immune system in the fight against pityriasis lichenoides. In addition, it ensures better body awareness, which is particularly beneficial for patients who suffer from visually disfiguring blisters. A careful diet with vitamin-rich, fresh foods and little fat and sugar is also part of a healthy lifestyle. Patients are advised to drink plenty of water to flush out any toxins.
Draining and detoxifying measures can also strengthen the immune system. For this purpose, visits to the sauna are combined with naturopathic or homeopathic remedies. Naturopathic doctors and naturopaths will be happy to advise you.