Pityriasis Lichenoides in Childhood: Review of Clinical Presentation and Treatment Options

Abstract

Pityriasis lichenoides (PL) is a skin condition of unclear etiology that occurs not uncommonly in childhood. It is often classified into the acute form, pityriasis lichenoides et varioliformis acuta (PLEVA), and the chronic form, pityriasis lichenoides chronica (PLC). We performed a comprehensive review of the English-language literature using the PubMed database of all cases of childhood PL reported from 1962 to 2014 and summarized the epidemiology, clinical features, treatment options, and prognosis of this condition in children. The proposed etiologies are discussed, including its association with infectious agents, medications, and immunizations and evidence for PL as a lymphoproliferative disorder. We found an average age of PL onset of 6.5 years, with a slight (61%) male predominance. We also found that PLEVA and PLC tend to occur with equal frequency and that, in many cases, there is clinical and histopathologic overlap between the two phenotypes. When systemic therapy is indicated, we propose that oral erythromycin and narrowband ultraviolet B phototherapy should be first-line treatment options for children with PL since they have been shown to be effective and well tolerated. In most cases, PL follows a benign course with no greater risk of cutaneous T-cell lymphoma, although given the rare case reports of transformation, long-term follow-up of these patients is recommended.

Use of Phototherapy in Children

“…Phototherapy has been used as second‐line therapy in PLC once conventional treatment has failed . Although we had small patient numbers, NBUVB was found to be effective and all patients improved.…”

A systematic review of treatments for pityriasis lichenoides

“…In paediatric patients, NB UVB phototherapy is usually used for a short period of time, mitigating the potential carcinogenic risk of UVB exposure. However, in chronic relapsing cases, in which a long course of phototherapy is required, other modalities should be preferred as first‐line therapy . Only some studies compared treatment responses of patients with PL in a long‐term follow‐up to assess how are durable the results after the cessation of treatment.…”

“…However, in chronic relapsing cases, in which a long course of phototherapy is required, other modalities should be preferred as first-line therapy. 50 Only some studies compared treatment responses of patients with PL in a long-term follow-up to assess how are durable the results after the cessation of treatment. Zang et al 51 reviewed treatment responses of 75 children with PL (50 PLC and 25 PLEVA) and conducted a long-term follow-up via telephone interviews but did not report relapse rates for each treatment.…”

A case of pityriasis lichenoides et varioliformis acuta pemphigoides successfully treated with methotrexate and corticosteroids

“…PLEVA presents as skin eruption of erythematous macules, papules, or papulovesicles that tend to be brownish-red and evolve through stages of crusting, necrosis, and varicella-like scarring (Geller, Antonov, Lauren, Morel, & Garzon, 2015). Children and adolescents are more frequently affected, and a male predominance exists (Geller et al, 2015;Ersoy-Evans, & Greco, 2007).…”