The Pityriasis lichenoides III,update
 

 

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THE PITYRIASIS LICHENOIDES III, AN UPDATE,  a link between PLEVA and PLC with lymphoma...

LA PITIRIASIS LIQUENOIDE III, ACTUALIZACION, un eslabon entre la PLEVA y PLC con el linfoma... !!!

Data-Medicos 
Dermagic/Express No. 5-(121) 
30 Abril 2.004 / 30 April 2.004 
 

EDITORIAL ESPANOL
=================

Hola amigos DERMAGICOS, hoy 3 años y medio despues de mi ultima publicacion sobre el tema PITIRIASIS LIQUENOIDE, hice una nueva revision sobre el mismo tratando de encontrar nuevas publicaciones y brindar nuevas luces en el tratamiento de esta enfermedad dermatologica que puede afectar tanto a adultos como a niños.

He recibido llamadas telefonicas de varios paises (FRANCIA, ESTADOS UNIDOS, ALEMANIA), de familiares de pacientes a quienes se les ha diagnosticado PITIRIASIS LIQUENOIDE en sus formas, aguda (PLEVA) o cronica (PLC), y tengo algunos pacientes con esta enfermedad.

La razon final que me llevo a esta revision, fue aclarar esa duda que tenemos todos los dermatologos sobre el hecho de que esta enfermedad puede evolucionar hacia el linfoma... y segun estas ultimas publicaciones es una REALIDAD.

Las tendencias cambian en la medida que evolucionan las tecnicas de diagnostico y hoy en dia con la experiencia vivida en esta enfermedad, tenemos que considerar SERIAMENTE en todo paciente que tenga PITIRIASIS LIQUENOIDE, la remota probabilidad que evolucione hacia un linfoma.

En pocas palabras ya se ha demostrado cientificamente que existe un eslabon entre la PITIRIASIS LIQUENOIDE y el LINFOMA, y estas referencias bibliograficas asi lo demuestran.

Tres revisiones en 4 años ha hecho el DERMAGIC sobre este tema, mas de 150 referencias, leanlas con mucha atencion porque alli encontraran la gran REALIDAD que rodea a la PITIRIASIS LIQUENOIDE y sus posibles tratamientos y evolucion.

En mi humilde opinion lo mejor para tratar esta enfermedad: ERITROMICINA, FOTOTERAPIA, Y MINI DOSIS DE ESTEROIDES.

Dedicado con mucho cariño a todos esos pacientes quienes me han llamado desesperados buscando luces sobre esta enfermedad,

Atentamente

Dr. Jose Lapenta R.
 

EDITORIAL ENGLISH
=================

Hello DERMAGIC friends , today, 3 and a half years after my last publication on the topic PITYRIASIS LICHENOIDES, I made a new review on the same one trying to find new publications and to offer new lights in the treatment of this dermatologic illness that can affect as much to adults as to children.

I have received telephone calls of several countries (FRANCE, UNITED STATES, GERMANY), of family of patient to who have been diagnosed Pityriasis Liquenoides in their forms, acute (PLEVA) or chronic (PLC), and I have some patients with this illness.

The final reason that I take myself to this review, was to clarify that doubt that we have all the dermatologist on the fact that this illness can evolve toward the lymphoma... and according to these publications it is a REALITY.

The tendencies change in the measure that the techniques evolve of I diagnose, and today in day with the experience lived in this illness, we have to consider SERIOUSLY in all patient that has PITYRIASIS LICHENOIDES, the remote probability that evolves toward a lymphoma.

In few words, it has already been demonstrated scientifically that a link exists among the PYTIRIASIS LICHENOIDES and the LYMPHOMA, and these bibliographical references demonstrate it.

Three reviews in 4 years have made THE DERMAGIC on this topic, but of 150 references, read them with a lot of attention because you will found the great REALITY that surrounds the PITYRIASIS LICHENOIDES and their possible treatments and evolution.

In my humble opinion the best thing to treat this illness: ERYTHROMYCIN, PHOTOTHERAPY, AND SEMIPULSE DOSE OF STEROIDS.

Dedicated with a lot of affection to all those patients who have called me desperate looking for lights on this illness ...

Sincerely

Dr. José Lapenta R.
======================================================
                                        HOT LINKS

The Pityriasis Lichenoides I.  (1.999)

The pityriasis Lichenoides II, a paraneoplastic Syndrome.      (2.000)

======================================================
REFERENCIAS BIBLIOGRAFICAS / BIBLIOGRAPHICAL REFERENCES
======================================================

1.) [Photochemotherapy for pityriasis lichenoides: 3 cases]
2.) Febrile ulceronecrotic Mucha-Habermann disease with extensive skin necrosis in
intertriginous areas.
3.) Febrile ulceronecrotic Mucha-Habermann's disease managed with methylprednisolone
semipulse and subsequent methotrexate therapies.
4.) Febrile ulceronecrotic Mucha-Habermann disease: a case report and a review of the
literature.
5.) Refractory pityriasis lichenoides chronica successfully treated with topical tacrolimus.
6.) Pityriasis lichenoides et varioliformis acuta.
7.)Febrile ulceronecrotic pityriasis lichenoides et varioliformis acuta with atypical cells.
8.) Phototherapy in pediatric patients.
9.) A case of febrile ulceronecrotic Mucha-Habermann disease requiring debridement of
necrotic skin and epidermal autograft.
10.) Absence of Epstein-Barr virus and human herpesvirus-6 in pityriasis lichenoides and
plaque parapsoriasis.
11.) Pityriasis lichenoides et varioliformis acuta in pregnancy. Does it affect pregnancy
outcome?
12.) Cytotoxic mycosis fungoides evolving from pityriasis lichenoides chronica in a
seventeen-year-old girl. Report of a case.
13.) Bexarotene is a new treatment option for lymphomatoid papulosis.
14.) Pityriasis lichenoides et varioliformis acuta in pregnancy. Does it affect pregnancy
outcome?
15.) The value of molecular analysis by PCR in the diagnosis of cutaneous lymphocytic
infiltrates.
16.) Pityriasis lichenoides: a clonal T-cell lymphoproliferative disorder.
17.) Medium-dose ultraviolet A1 therapy for pityriasis lichenoides et varioliformis acuta and
pityriasis lichenoides chronica.
18.) T-cell clonality in pityriasis lichenoides: evidence for a premalignant or reactive immune
disorder?
19.) The clonal nature of pityriasis lichenoides.
20.) A Clone Is a Clone Is a Clone?
21.) Differentiation and Clonality of Lesional Lymphocytes in Pityriasis Lichenoides
Chronica
22.) Is PLC a Clonal T-Cell Lymphoproliferative Disorder?
23.) Cutaneous T-cell lymphoma (parapsoriasis en plaque). An association with pityriasis
lichenoides et varioliformis acuta in young children
24.) T-Cell Clonality in Pityriasis Lichenoides et Varioliformis Acuta
A Heteroduplex Analysis of 20 Cases
25.) Phototherapy of pityriasis lichenoides
26.) Acral pityriasis lichenoides.
27.) Pityriasis lichenoides in a girl with the granulomatous form of common variable
immunodeficiency.
28.) Pityriasis lichenoides et varioliformis acuta in pregnancy.
29.) Detection of cytomegalovirus infection in a patient with febrile ulceronecrotic Mucha-
Habermann's disease.
30.) Expression of cutaneous lymphocyte-associated antigen and TIA-1 by lymphocytes in
pityriasis lichenoides et varioliformis acuta and lymphomatoid papulosis:
immunohistochemical study.
31.) Medullary CD30+ T cell lymphoma with eosinophilia and hyper-IgE supervening
during the relentless course of pityriasis lichenoides.
32.) Pityriasis lichenoides-like mycosis fungoides in children.
33.) Childhood cutaneous T-cell lymphoma in association with pityriasis lichenoides
chronica.
34.) Pityriasis lichenoides-like exanthem and primary infection by Epstein-Barr virus.
35.) Pityriasis lichenoides chronica with acral distribution mimicking palmoplantar syphilid.
36.) Pityriasis lichenoides and acquired toxoplasmosis.
37.) Paraneoplastic pityriasis lichenoides chronica.
38.) Cutaneous T-cell lymphoma presenting with 'segmental pityriasis lichenoides chronica'.
39.) Mucha-Habermann disease-like eruptions due to Tegafur.
40.) [Ulcers of the tongue, pityriasis lichenoides and primary parvovirus B19 infection]
41.) Infectious causes of pityriasis lichenoides: A case of fulminant infectious mononucleosis
42.) Pityriasis lichenoides in children: a long-term follow-up of eighty- nine cases.
====================================================
====================================================
1.) [Photochemotherapy for pityriasis lichenoides: 3 cases]
====================================================
Ann Dermatol Venereol. 2004 Feb;131(2):201-3.
[Article in French]

Panse I, Bourrat E, Rybojad M, Morel P.

Service de Dermatologie, Hopital Saint-Louis, 1, avenue Claude Vellefaux, 75010 Paris.
[email protected]

BACKGROUND: Pityriasis lichenoides is a rare cutaneous disorder of unknown origin that
mainly affects children and young people. The disease consists of two variants: pityriasis
lichenoides et varioliformis acuta, characterized by papular lesions evolving into necrosis
and pityriasis lichenoides chronica characterized by scaly papules that may last from several
months to several years. Various types of therapy have been proposed for pityriasis
lichenoides, to our knockledge, photochemotherapy has never been used. We report the
first 3 cases of pityriasis lichenoides treated by photochemotherapy. CASE REPORTS:
Three patients, 6, 15 and 18 years old, presented respectively with a 1 month, 2 years and
3 months history of numerous, papular and necrotic lesions or squally papular lesions.
Clinical appearance and histopathologic examination of biopsy were consistent with
pityriasis lichenoides et varioliformis acuta (patients 1 and 3) and with pityriasis lichenoides
chronica (patient 2). They had received different treatments without significant effect: topical
corticosteroids, antibiotic, UVB therapy and dapsone. Acitretin associated with PUVA
were dramatically effective within few weeks. DISCUSSION: Pityriasis lichenoides can be
a severe scarring disease with significant social, psychological and physical consequences.
In our opinion, photochemotherapy, which has never been used in pityriasis lichenoides, is
effective. Therapeutic modalities have to be define.

====================================================
2.) Febrile ulceronecrotic Mucha-Habermann disease with extensive skin necrosis in
intertriginous areas.
====================================================

Eur J Dermatol. 2003 Sep-Oct;13(5):493-6.

Yang CC, Lee JY, Chen W.

Department of Dermatology, College of Medicine, National Cheng Kung University, 138
Sheng-Li Road, Tainan, Taiwan.

Febrile ulceronecrotic Mucha-Habermann disease (FUMHD) is a severe variant of
pityriasis lichenoides et varioliformis acuta characterized by high fever and papulonecrotic
skin lesions. Here we report a case of a 14-year-old boy with typical features of FUMHD
and unusual manifestation of extensive skin necrosis in intertriginous regions including
axillae, neck, inguinal and antecubital areas. Systemic administration of corticosteroid and
erythromycin led to rapid healing of ulcerations without residual scar formation. Review of
the literature showed male-predominance and favorable outcome in pediatric cases of
FUMHD.


====================================================
3.) Febrile ulceronecrotic Mucha-Habermann's disease managed with methylprednisolone
semipulse and subsequent methotrexate therapies.
====================================================
J Am Acad Dermatol. 2003 Dec;49(6):1142-8.

Ito N, Ohshima A, Hashizume H, Takigawa M, Tokura Y.

Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu,
Japan.

Febrile ulceronecrotic Mucha-Habermann's disease is an unusual severe form of pityriasis
lichenoides et varioliformis acuta characterized by abrupt onset of ulceronecrotic eruption
associated with a high fever and systemic symptoms. To our knowledge, 19 cases of this
disease have been reported in the literature, and 4 of them were fatal. We report the case
of a 12-year-old boy with this disorder who had abdominal pain, hypoproteinemia, and
anemia. Although these associated symptoms are considered life-threatening factors
according to reported cases, our patient was successfully treated with methylprednisolone
semipulse and subsequent methotrexate therapies. From a review of the literature and the
present case, we propose that when patients have these systemic symptoms, therapeutic
choices include methotrexate, high-dose corticosteroids, and 4,4-diamino-diphenyl-sulfone,
which may depress early development of this disease.

====================================================
4.) Febrile ulceronecrotic Mucha-Habermann disease: a case report and a review of the
literature.
====================================================
J Clin Pathol. 2003 Oct;56(10):795-7. Related Articles, Links

Miyamoto T, Takayama N, Kitada S, Hagari Y, Mihara M.

Department of Dermatology, Tsuyama Central Hospital, 1756 Kawasaki, Tsuyama 708-
0841, Japan. [email protected]

This report describes the case of a 76 year old man who suffered from febrile
ulceronecrotic Mucha-Habermann disease (FUMHD). Despite this patient's typical clinical
and histological findings, the fulminating course led to death. Polymerase chain reaction (
PCR) analysis of the skin lesions showed that the infiltrating cells were monoclonal in origin
and were from an aberrant clone. FUMHD is a very rare, febrile variant type of pityriasis
lichenoides et varioliformis acuta, and is characterised by necrotic cutaneous ulcerations
associated with high fever and systemic manifestations. Including this present case, only 18
cases of FUMHD have been reported. FUMHD can occur in both adults and children,
although there are several differences between the manifestations of the disease in the two
groups. One major difference is prognosis: all cases resulting in fatality are of the adult type,
whereas no fatal cases have been reported among children. The aberrant clone detected by
PCR may be responsible for host responses, resulting in the severe symptoms observed in
this disorder.

====================================================
5.) Refractory pityriasis lichenoides chronica successfully treated with topical tacrolimus.
====================================================
Clin Exp Dermatol. 2003 Jul;28(4):456-8.

Mallipeddi R, Evans AV.

Publication Types:
Case Reports
Letter
====================================================
====================================================
6.) Pityriasis lichenoides et varioliformis acuta.
====================================================
Indian Pediatr. 2003 Mar;40(3):266-7.

Gulati R, Bagga G.

Department of Skin STD and Leprosy, Mahatama Gandhi National Institute of Medical
Sciences, Sitapura Insitutional Area, Jaipur, India. [email protected]

Publication Types:
Case Reports
====================================================
====================================================
7.)Febrile ulceronecrotic pityriasis lichenoides et varioliformis acuta with atypical cells.
====================================================
Int J Dermatol. 2003 Jan;42(1):26-8. Related Articles, Links

Rivera R, Ortiz P, Rodriguez-Peralto JL, Vanaclocha F, Iglesias L.

Publication Types:
Case Reports
Letter
Review
Review, Multicase
====================================================

====================================================
8.) Phototherapy in pediatric patients.
====================================================
Pediatr Dermatol. 2003 Jan-Feb;20(1):71-7.

Pasic A, Ceovic R, Lipozencic J, Husar K, Susic SM, Skerlev M, Hrsan D.

Department of Dermatology and Venerology, Zagreb University Hospital Center, Zagreb,
Croatia. [email protected]

The treatment of children with psoriasis, atopic dermatitis (AD), pityriasis lichenoides, and
scleroderma poses a therapeutic problem because all therapeutic options are associated
with numerous side effects. Therefore ultraviolet A and B (UVA and UVB) phototherapy is
presented as a possible alternative to some of these therapies, primarily topical and
systemic corticosteroids, in children. Our results in treating children with phototherapy and
psoralen plus UVA (PUVA) bath phototherapy over the past 5 years are reported. UVB
therapy (TL01) was used in 20 psoriatic children (6 boys, 14 girls; ages 6-14 years) during
the stage of disease exacerbation and in 9 children (3 boys, 6 girls; ages 8-16 years) with
pityriasis lichenoides. Combined UVA/UVB phototherapy was applied in 21 AD children
(7 boys, 14 girls; ages 4-15 years). Photochemotherapy with local application of a PUVA
bath was used in six children (2 boys, 4 girls; ages 9-16 years) with circumscribed
scleroderma and in one girl with systemic scleroderma. All children received short courses
of phototherapy with either no maintenance or short maintenance. All three therapeutic
protocols resulted in a certain degree of improvement in most of the study patients. None of
the patients exhibited any early phototherapy side effects. We conclude that phototherapy
and PUVA bath are valuable and safe therapeutic options for selected children who do not
respond to other treatments.

====================================================
9.) A case of febrile ulceronecrotic Mucha-Habermann disease requiring debridement of
necrotic skin and epidermal autograft.
====================================================
Br J Dermatol. 2002 Dec;147(6):1249-53.

Yanaba K, Ito M, Sasaki H, Inoue M, Nobeyama Y, Yonemoto H, Ishiji T, Tanaka H,
Kamide R, Niimura M.

Department of Dermatology, The Jikei University School of Medicine, 25-8 Nishishimbashi
3-chome, Minato-ku, Tokyo 105-8461, Japan. [email protected]

We report a case of febrile ulceronecrotic Mucha-Habermann disease (FUMHD) in a 21-
year-old man. This disease is a severe form of pityriasis lichenoides et varioliformis acuta (
PLEVA) and is characterized by the sudden onset of diffuse ulcerations associated with
high fever and systemic symptoms. It is sometimes lethal especially in elderly patients. In the
present case, intense generalized maculopapular erythematous plaques with central necrosis
developed progressively in association with a high fever. Initial treatment with systemic
betamethasone had been unsuccessful and the skin lesions, which covered about 50% of
the body surface, became severely ulcerated. Although the development of new lesions had
ceased spontaneously, widespread ulceration of the skin remained. Debridement of the
necrotic skin and skin grafting using cultured epidermal autografts and meshed allografts of
cadaver skin led to prompt reepithelization.


====================================================
10.) Absence of Epstein-Barr virus and human herpesvirus-6 in pityriasis lichenoides and
plaque parapsoriasis.
====================================================
Eur Acad Dermatol Venereol. 2002 Sep;16(5):536-7.

Erkek E, Sahin S, Atakan N, Kocagoz T, Olut AI.

Publication Types:
Letter
====================================================
====================================================
11.) Pityriasis lichenoides et varioliformis acuta in pregnancy. Does it affect pregnancy
outcome?
====================================================
Saudi Med J. 2002 Aug;23(8):1014-5.


Pityriasis lichenoides et varioliformis acuta in pregnancy. Does it affect pregnancy outcome?

Shelleh HH.

Department of Dermatology, Najran General Hospital, Najran, Kingdom of Saudi Arabia.

====================================================
====================================================
12.) Cytotoxic mycosis fungoides evolving from pityriasis lichenoides chronica in a
seventeen-year-old girl. Report of a case.
====================================================
Dermatology. 2002;205(2):176-9.

Tomasini D, Zampatti C, Palmedo G, Bonfacini V, Sangalli G, Kutzner H.

Department of Dermatology, Hospital of Busto Arsizio, Italy. [email protected]

Pityriasis lichenoides chronica and its acute form, pityriasis lichenoides et varioliformis
acuta, are skin diseases of unknown origin, that probably represent a hypersensitivity
reaction to an infective agent. Pityriasis lichenoides is often a benign disorder but, because
of the presence of a clonal T cell population detected both in the chronic and acute forms,
some authors have suggested that it may belong to the group of primary cutaneous T cell
lymphomas. Although various studies have clearly documented no significant association
between pityriasis lichenoides and malignant lymphomas, cases of long-standing pityriasis
lichenoides evolving into mycosis fungoides have been described. Herein we report the
case of a girl suffering from pityriasis lichenoides since the age of 11 years, subsequently
developing a CD45RO+, CD8+, TIA-1+ mycosis fungoides. Copyright 2002 S. Karger
AG, Basel

====================================================
13.) Bexarotene is a new treatment option for lymphomatoid papulosis.
====================================================
Dermatology. 2003;206(2):142-7.

Krathen RA, Ward S, Duvic M.

Division of Internal Medicine, Department of Dermatology, The University of Texas MD
Anderson Cancer Center, Houston, Tex 77030-3597, USA.

BACKGROUND: Lymphomatoid papulosis (LyP) is a clonal T cell proliferation with large
cell histology, a chronic course, and an increased risk of lymphoma. Bexarotene (Targretin)
is an RXR-selective retinoid (rexinoid) approved for the cutaneous manifestations of
cutaneous T cell lymphoma. OBJECTIVE: To determine whether bexarotene is effective in
treating LyP. METHODS: Ten patients with chronic and symptomatic LyP were
prospectively treated with oral (n = 3) or topical gel (n = 7) formulations of bexarotene.
RESULTS: A favorable response to bexarotene treatment with decreased numbers or
duration of lesions was seen in all with objective responses in 8 patients.
CONCLUSIONS: Bexarotene may be an effective palliative treatment for LyP, warranting
further controlled studies.

====================================================
14.) Pityriasis lichenoides et varioliformis acuta in pregnancy. Does it affect pregnancy
outcome?
====================================================
Saudi Med J. 2002 Aug;23(8):1014-5.

Shelleh HH.

Department of Dermatology, Najran General Hospital, Najran, Kingdom of Saudi Arabia.
====================================================

====================================================
15.) The value of molecular analysis by PCR in the diagnosis of cutaneous lymphocytic
infiltrates.
====================================================
J Cutan Pathol. 2002 Sep;29(8):447-52.

Comment in:
J Cutan Pathol. 2003 Sep;30(8):521; author reply 521.

Holm N, Flaig MJ, Yazdi AS, Sander CA.

Department of Dermatology, Ludwig-Maximilians-University Munich, Munich, Germany.

The diagnosis and classification of cutaneous lymphomas remain a challenge for the clinician
and dermatopathologist. This diagnostic dilemma is mainly encountered in the distinction
between an early malignant lymphoma and a benign reactive lymphocytic infiltrate (
pseudolymphoma). Until the beginning of the 1980s, our diagnostic tools were limited to the
clinical presentation, course, and histopathology in diagnosis and classification of
lymphocytic infiltrates. Advances in immunology and, in particular, in molecular genetics
with the introduction of the Southern blot technique and the polymerase chain reaction (
PCR) have revolutionized the diagnosis of lymphocytic infiltrates by determination of
clonality. In some series, more than 90% of cutaneous T-cell lymphomas have a clonal
rearrangement of the T-cell receptor gamma-chain gene, as opposed to very low
percentages of rearrangement in T-cell pseudolymphomas. However, the presence of
clonality does not necessarily imply malignancy. Cases of pseudolymphomas, lichen planus
and pityriasis lichenoides et varioliformis acuta were reported with clonal lymphocytic
proliferations. Therefore, care should be exercised in the evaluation of the results of
molecular analysis, and these should always be correlated with the clinical, histological and
immunophenotypic picture to arrive at the correct diagnosis. It may be expected that the
molecular methods for diagnosis of lymphocytic infiltrates will be improved and refined in
future, and that sensitivity and specificity will increase.

====================================================
16.) Pityriasis lichenoides: a clonal T-cell lymphoproliferative disorder.
====================================================
Hum Pathol. 2002 Aug;33(8):788-95

Magro C, Crowson AN, Kovatich A, Burns F.

Department of Pathology Ohio State University Medical Center, Columbus, OH 43210,
USA.

Pityriasis lichenoides (PL) is a papulosquamous disorder often considered a form of
reactive dermatosis and classified with small plaque parapsoriasis (digitate dermatosis).
However, some patients with PL have developed large plaque parapsoriasis (LPP) and
mycosis fungoides (MF), and lymphoid atypia and T-cell clonality have been reported in
lesions of PL. We set out to explore the possibility that PL is a form of T-cell dyscrasia.
Cases were selected by natural language search from an outpatient dermatopathology
database; 35 cases were reviewed and clinicians and patients were contacted. Hematoxylin
and eosin-stained sections were examined and immunophenotyping was carried out on
paraffin-embedded, formalin-fixed tissue using antibodies to CD2, CD3, CD4, CD5, CD7,
CD8, CD20, CD30, and CD56. In paraffin-embedded tissue, T-cell receptor (TCR)-
gamma chain rearrangement was sought through polymerase chain reaction single stranded
conformational polymorphism analysis. There were 14 males and 21 females with a mean
age of 40 years held clinically to have PL chronica (PLC) (28 cases) and/or PL et
varioliformis acuta (PLEVA) (7 cases). Five patients developed large atrophic
poikilodermatous and/or annular plaques compatible with MF and/or LPP in a background
of typical PLC. All biopsies showed tropism of lymphocytes to an epidermis manifesting
psoriasiform hyperplasia, dyskeratosis, parakeratosis, and intraepithelial collections of
Langerhans' cells and lymphocytes mimicking Pautrier's microabascesses. Epidermal
atrophy, dermal fibroplasia, poikilodermatous alterations, and a dominance of
intraepidermal cerebriform cells were seen only in patients with chronic persistent disease (i
.e., PLC) and in some cases corresponded with clinical progression to MF. All cases had a
T cell-dominant infiltrate, with a CD7 deletion in 21 of 32 biopsies examined; the CD7-
negative cells were typically the largest and most atypical forms, often in a cohesive array
within the upper layers of the epidermis. In 17 biopsies in which a CD4 stain was
satisfactory for evaluation, 50% or more of the intraepidermal population was CD4 positive
in 8 biopsies, whereas in 11 biopsies 50% or more of the dermal infiltrate was CD4
positive. The CD4-positive cells frequently had a cerebriform nuclear morphology and
were CD7 negative. Most cases had an admixture of CD8-positive lymphocytes in excess
of 40% or more of the intraepidermal and/or dermal infiltrate; it was the dominant
intraepidermal infiltrate in 10 cases. The CD8-positive cells, typically small, round, and
CD7 positive, showed a directed pattern of migration into acrosyringia and suprapapillary
plates, with satellitosis around CD4-positive/CD8-negative/CD7-negative atypical
lymphocytes. CD56 positivity was seen among the intraepidermal lymphoid cells and
roughly paralleled the CD8 profile. In general, CD8-positive lymphocytes dominated in
cases of PLEVA, whereas CD4-positive lymphocytes were very conspicuous and
composed the dominant intraepidermal populace only in those biopsies of progressive PL/
PLC. Clonality was shown in 25 of 27 biopsies in which amplifiable DNA was obtained.
Intraepithelial atypical lymphocytes, phenotypic abnormalities, and TCR-gamma
rearrangements suggest that PLC and PLEVA are a form of T-cell dyscrasia. Lesions may
follow a recalcitrant course characteristic of MF and premycotic disorders such as LPP.
The aberrant phenotype cell is similar to that defining MF: a CD4-positive T lymphocyte
with a CD5 and CD7 deletion. Directed epidermal migration seen in biopsies procured
from incipient lesions along with occasional temporal association to viral or drug exposure
suggests that an abnormal immune response to an antigenic trigger may be the inciting event.

====================================================
17.) Medium-dose ultraviolet A1 therapy for pityriasis lichenoides et varioliformis acuta and
pityriasis lichenoides chronica.
====================================================
J Am Acad Dermatol. 2002 Sep;47(3):410-4.

Pinton PC, Capezzera R, Zane C, De Panfilis G.

Department of Dermatology, Azienda Spedali Civili di Brescia, Brescia, Italy.

BACKGROUND: Ultraviolet A1 (340-400 nm) was found to be effective in the treatment
of cutaneous T-cell-mediated diseases. OBJECTIVE: The purpose of the present study
was to assess the efficacy of UVA1 phototherapy for pityriasis lichenoides et varioliformis
acuta (PLEVA) and pityriasis lichenoides chronica (PLC). METHODS: Eight patients (3
with PLEVA and 5 with PLC) received 60 J/cm(2) UVA1 daily until remission. Four
patients also had lesions inaccessible to UVA1 that were used as control lesions.
Immunocytologic studies of skin infiltrates and circulating T cells were done. RESULTS:
Six patients showed complete clinical and histologic recovery. Two patients with PLC had
a partial improvement. Unirradiated control lesions never improved. Serious short-term
adverse effects were not encountered. No effects on circulating lymphocytes were
reported. CONCLUSION: UVA1 therapy is an effective and well-tolerated treatment for
PLEVA and PLC. The therapeutic activity seems to be related to direct effects on
cutaneous inflammatory infiltrates because the lesions in nonexposed cutaneous areas did
not respond

====================================================
18.) T-cell clonality in pityriasis lichenoides: evidence for a premalignant or reactive immune
disorder?
====================================================
Arch Dermatol. 2002 Aug;138(8):1089-90.


Comment on:
Arch Dermatol. 2002 Aug;138(8):1063-7.


Kadin ME.

Publication Types:
Comment
Editorial
====================================================
====================================================
19.) The clonal nature of pityriasis lichenoides.
====================================================
Arch Dermatol. 2002 Aug;138(8):1063-7.

Comment in:
Arch Dermatol. 2002 Aug;138(8):1089-90.

Weinberg JM, Kristal L, Chooback L, Honig PJ, Kramer EM, Lessin SR.

Department of Dermatology, University of Pennsylvania, Philadelphia, USA. jwein@bway
.net

BACKGROUND: Pityriasis lichenoides et varioliformis acuta (PLEVA) and pityriasis
lichenoides chronica (PLC) are benign lymphocytic infiltrates of the skin that classically
present as either a recurrent papulonecrotic eruption (PLEVA) or a persistent, scaling,
papular eruption (PLC). Observations of both types of lesions present on individual patients
have led to speculation that both entities are related. Previous studies evaluating the DNA
of biopsy specimens from patients with PLEVA and PLC revealed clonal T-cell receptor
beta gene rearrangements. OBJECTIVE: To analyze and compare the T-cell populations
between lesions of PLEVA and PLC. DESIGN: Retrospective and prospective analysis of
patient tissue samples, classified by histologic analysis. Extracted DNA from 13 skin biopsy
specimens with the diagnosis of PLC and 14 skin biopsy specimens with the diagnosis of
PLEVA was analyzed by polymerase chain reaction/denaturing gradient gel electrophoresis
(PCR/DGGE). SETTING: Molecular diagnostic laboratory at an academic medical center.
PATIENTS: Twenty-seven tissue samples were obtained from patients with a histologic
diagnosis of PLEVA or PLC. These samples were analyzed by PCR/DGGE. MAIN
OUTCOME MEASURE: The presence or absence of T-cell receptor gene
rearrangements on PCR/DGGE analysis corresponding to a clonal population of T cells.
RESULTS: Of 14 PLEVA specimens, 8 (57%) demonstrated monoclonal T-cell receptor
gene rearrangements; 1 (8%) of 13 PLC specimens showed a gene rearrangement (P =.
008, Fisher exact test). CONCLUSIONS: Our results demonstrate the polyclonal nature
of the lymphocytic infiltrate found in almost all of the PLC specimens, which contrasts with
the monoclonal nature found in most of the PLEVA specimens. These differences may
represent different stages of the clinical evolution of a single entity that results from varying
host immune responses to pathogenic factors. Specifically, we propose that PLEVA is a
benign clonal T-cell disorder in which the clone arises from a subset of T cells in lesions of
PLC. The host immune response to this clone determines the clinical and histologic findings
in PLEVA.

====================================================
20.) A Clone Is a Clone Is a Clone?
====================================================
— Bruce R. Smoller, MD

Published in Journal Watch Dermatology September 9, 2002

Source

Weinberg JM et al. The clonal nature of pityriasis lichenoides. Arch Dermatol 2002 Aug;
138:1063-7.

The clinical significance of a clonal proliferation of T lymphocytes in the skin has gradually
become less certain. At first, the laboratory data were promising: Clonality was identified in
many cases of cutaneous T-cell lymphoma, suggesting that this finding could aid in early
diagnosis. In recent years, however, the specificity of this finding has been called into
question. Investigators found clonal populations of T cells in such wide-ranging conditions
as lymphomatoid papulosis, pityriasis lichenoides, and lichen planus. In this study, the
authors compared the T-cell populations in 13 biopsy samples from patients with
histologically diagnosed pityriasis lichenoides chronica (PLC) and 14 samples from patients
with histologically diagnosed pityriasis lichenoides et varioliformis acuta (PLEVA).
Monoclonal T-cell populations were found in 8 (57%) PLEVA cases and 1 (8%) PLC
case. Interestingly, the single PLC case with a monoclonal T-cell infiltrate was first
diagnosed as PLEVA on clinical examination. The authors conclude that PLEVA
represents a benign monoclonal proliferation that arises from a subset of the polyclonal T
lymphocytes in PLC lesions.

Comment: The authors' conclusion does not implicate PLC or PLEVA in the evolution of
T-cell malignancy. Instead, the authors display a rare and admirable ability to analyze
laboratory results in the context of an entire clinicopathologic setting. PLEVA rarely (if
ever) progresses to overt lymphoma. Therefore, a finding of clonal proliferation does not
necessarily imply such a progression. The hypothesis that PLEVA represents a preferential
monoclonal evolution from polyclonal PLC is intriguing and requires additional follow-up.
Stay tuned!

====================================================
21.) Differentiation and Clonality of Lesional Lymphocytes in Pityriasis Lichenoides
Chronica
====================================================
Sherry Shieh, MD; Debra L. Mikkola, MS; Gary S. Wood, MD

Arch Dermatol. 2001;137:305-308.

Background Pityriasis lichenoides chronica (PLC) and pityriasis lichenoides et varioliformis
acuta (PLEVA) are benign T-cell diseases that share several overlapping clinicopathologic
features, leading many to believe that they exist as a spectrum rather than as single entities.
Previous molecular studies have shown that PLEVA is a clonal lymphoproliferative
disorder. To further characterize the immunohistologic features of PLC and to determine
whether PLC demonstrates clonality, we studied 6 cases of PLC using a frozen section–
immunoperoxidase technique and polymerase chain reaction/denaturing gradient gel
electrophoresis.

Observations All 6 cases showed a mild to moderate superficial and deep perivascular
infiltrate composed predominantly of CD4+ T cells, admixed with Langerhans cells and
macrophages; most were associated with an HLA-DR+ epidermis. Three of 6 cases
involved monoclonal T-cell receptor gamma (TCR) gene rearrangements detected by V1-
8/J1-2 and V9/J1-2 primers.

Conclusions Our findings enhance existing data showing that PLC shares many
immunohistologic features with PLEVA and indicating that PLC is frequently a clonal T-cell
disease. This provides further evidence that PLC and PLEVA are interrelated processes
within the larger group of T-cell lymphoproliferative disorders.


From the Departments of Internal Medicine (Dr Shieh) and Dermatology (Ms Mikkola),
Case Western Reserve University, University Hospitals of Cleveland, and the Louis Stokes
Cleveland Veterans Affairs Medical Center, Cleveland, Ohio; and the Department of
Medicine (Dermatology), University of Wisconsin and Middleton Veterans Affairs Medical
Center (Dr Wood), Madison.

====================================================
22.) Is PLC a Clonal T-Cell Lymphoproliferative Disorder?
====================================================
Summary and Comment

— BR Smoller

Published in Journal Watch Dermatology May 3, 2001

Source

Shieh S et al. Differentiation and clonality of lesional lymphocytes in pityriasis lichenoides
chronica. Arch Dermatol 2001 Mar; 137:305-

The nature of pityriasis lichenoides chronica (PLC) and its relationship to pityriasis
lichenoides et varioliformis acuta (PLEVA) and mycosis fungoides (MF) remain enigmatic.
Recently, evidence of clonal proliferation has been reported in cases of PLEVA,
strengthening the evidence that these entities may be part of a spectrum of
lymphoproliferative disorders. The present study evaluated biopsies from 6 patients with
PLC for the presence of clonal T-cell gene rearrangements. In addition, the researchers
performed immunophenotyping of the infiltrating lymphocytes.
All patients demonstrated a classic combination of clinical and histologic features of the
disease. A clonal rearrangement was detected in 3 of the 6 cases. All cases demonstrated a
predominance of CD4+ infiltrates. The authors suggest that these findings provide
additional evidence that PLC, PLEVA, and MF are related.

Comment: The data are very convincing, but caution is nonetheless essential in interpreting
the findings. While clonality has been associated with lymphomas and may portend an
aggressive clinical course, evidence is mounting that not all clonal processes result in
adverse outcomes. The/significance of clonality within cutaneous T-cell infiltrates remains to
be seen. Long-term follow-up studieswith large numbers of patients will be necessary
before anydefinitive statements can be made.

====================================================
23.) Cutaneous T-cell lymphoma (parapsoriasis en plaque). An association with pityriasis
lichenoides et varioliformis acuta in young children
====================================================
Arch Dermatol, Nov 1990; 126: 1449 - 1453.
J. S. Fortson, A. L. Schroeter and N. B. Esterly

Department of Dermatology, Wright State University School of Medicine, Dayton, Ohio
45401-0927.

Pityriasis lichenoides et varioliformis acuta (PLEVA) and pityriasis lichenoides chronica (
PLC) are related benign disorders without recognized association with cutaneous T-cell
lymphoma (CTCL). We report the cases of two children with documented PLEVA
evolving into CTCL over several years. One child had the clinical lesions of PLC but the
dermatopathologic findings of PLEVA at age 2 years. At age 12 years, he had skin
changes of poikiloderma atrophicans vasculare and dermatopathologic findings consistent
with parapsoriasis en plaque. The second child presented at age 7 years with scaling
dermatitis and dermatopathologic findings of PLEVA. At age 12 years, the histologic
diagnosis was parapsoriasis. Monoclonal antibody studies performed on biopsy specimens
from both patients revealed 70% to 100% cells staining with CD5, 80% to 90% staining
with CD4, 30% to 50% staining with CD8, and an increase in CD1-staining cells in the
papillary dermis, indicating a predominantly helper T-cell infiltrate. We believe that PLC
and PLEVA may be part of the spectrum of CTCL. Furthermore, CTCL may be more
common in young children than once thought.

====================================================
24.) T-Cell Clonality in Pityriasis Lichenoides et Varioliformis Acuta
A Heteroduplex Analysis of 20 Cases
====================================================
Olivier Dereure, MD; Edi Levi, MD, PhD; Marshall E. Kadin, MD

Arch Dermatol. 2000;136:1483-1486.

Background Cutaneous lesions of pityriasis lichenoides et varioliformis acuta (PLEVA), a
T cell–mediated cutaneous inflammatory condition, are clinically similar to lymphomatoid
papulosis (LyP), leading some authors to hypothesize that they are part of the same
spectrum of lymphoproliferative disorders, although reports of the development of
cutaneous lymphoma in patients with PLEVA are not as frequent as they are for patients
with LyP. Furthermore, unlike in cases of LyP, no systematic search for a dominant T-cell
clone has been carried out in cases of PLEVA, whereas clones have been detected in a
few cases of PLEVA using mainly Southern blot analysis.

Objective To investigate T-cell clonality in a series of archival PLEVA lesions.

Tissues Archival paraffin-embedded biopsy specimens from 20 clinically and pathologically
typical cases of PLEVA were selected.

Main Outcome Measure Identification of a dominant T-cell clone by polymerase chain
reaction and heteroduplex analysis targeted on the TCR gene. Peripheral blood
mononuclear cells (PBMCs) and Jurkat cells were used as negative and positive controls.
Serial dilutions of Jurkat T-cell lymphoma DNA in PBMC DNA were used to assess the
sensitivity of the method.

Results Analysis of 13 (65%) of 20 PLEVA biopsy specimens revealed the presence of a
dominant T-cell clone. Positive and negative controls confirmed the specificity of the
procedure. The sensitivity was determined to be between 1% and 5% of the total T-cell
infiltrate.

Conclusions This study provides further evidence for the presence of a dominant T-cell
clone in skin lesions of some patients with PLEVA and supports the hypothesis that
PLEVA is part of the spectrum of clonal–T-cell cutaneous lymphoproliferative disorders.

From the Department of Pathology, Beth Israel Deaconess Medical Center, Harvard
Medical School, Boston, Mass.

====================================================
25.) Phototherapy of pityriasis lichenoides
====================================================
Arch Dermatol, May 1983; 119: 378 - 380.

M. J. LeVine

Eleven patients with chronic pityriasis lichenoides chronica were treated with topically
applied bland emollient cream and minimally erthemogenic doses of UV radiation from
fluorescent sunlamps. The conditions of all patients cleared completely in an average of 29
treatments, requiring an average UV dose of 388 millijoules/sq cm at clearance.
Phototherapy provides a convenient effective outpatient therapy for pityriasis lichenoides
chronica.

====================================================
26.) Acral pityriasis lichenoides.
====================================================
Australas J Dermatol. 2002 Feb;43(1):68-71.

Kossard S.

Skin and Cancer Foundation Australia, Sydney, New South Wales, Australia.
[email protected]

Two patients presented with acrally located papulosquamous lesions that were polymorphic
and had an identical morphology to those of pityriasis lichenoides. The lesions remained
localized to the feet and ankles for years. Multiple skin biopsies had the histopathological
features of pityriasis lichenoides. In one biopsy syringotropic lymphocytes and early
syringolymphoid hyperplasia were observed. This rare variant of pityriasis lichenoides may
be under-recognized and misdiagnosed as it resembles a variety of papulosquamous
disorders particularly psoriasis.

====================================================
27.) Pityriasis lichenoides in a girl with the granulomatous form of common variable
immunodeficiency.
====================================================
Pediatr Dermatol. 2002 Jan-Feb;19(1):56-9. Related Articles, Links

Pasic S, Pavlovic M, Vojvodic D, Abinun M.

Pediatric Immunology, Mother and Child Health Institute, Belgrade, Yugoslavia.

Pityriasis lichenoides (PL) is a cutaneous disease of unknown origin. In our 8-year-old
female patient with the granulomatous form of common variable immunodeficiency (CVID),
PL occurred together with massive splenomegaly and intra-abdominal lymphadenopathy.
Prednisone was efficient for treatment of her splenomegaly and autoimmune cytopenias.
However, PL was resistant to both topical and systemic steroid treatment. Healing of PL
was achieved with the use of a super-potent topical steroid, clobetasol propionate. A
defect of T-cell function in CVID may contribute to development of PL. In the
granulomatous form of CVID, sarcoid-like granulomas are the most commonly reported
cutaneous lesions. PL has not been previously reported.

====================================================
28.) Pityriasis lichenoides et varioliformis acuta in pregnancy.
====================================================
Saudi Med J. 2001 Dec;22(12):1127-9.

Eskandar MA.

Department of Obstetrics and Gynecology, King Khalid University, College of Medicine,
PO Box 641, Abha, Kingdom of Saudi Arabia. [email protected]

Pityriasis lichenoides et varioliformis acuta is an uncommon disease, especially during
pregnancy. In review of the obstetric literature, there was no report of pityriasis lichenoides
et varioliformis acuta during pregnancy. A 25-year-old female was seen at 24 weeks of
gestation for consultation about a cutaneous disease. She was admitted at 30 weeks of
gestation because of threatened premature labor, and some active cutaneous papules
presented themselves at that time. After the treatment, cutaneous papules remitted. But at
35 weeks of gestation, she had spontaneous labor. Both the mother and infant were doing
well at 5 months postpartum. If pityriasis lichenoides et varioliformis acuta exists in the
vagina or cervical bone of the uterus, it is due to infections from lymphatic vasculitis and
necrosis. It may cause threatened premature labor and premature rupture of the membrane.

====================================================
29.) Detection of cytomegalovirus infection in a patient with febrile ulceronecrotic Mucha-
Habermann's disease.
====================================================
Int J Dermatol. 2001 Nov;40(11):694-8.

Tsai KS, Hsieh HJ, Chow KC, Lin TY, Chiang SF, Huang HH.

Departments of Dermatology, Medical Research and Pathology, China Medical College
Hospital and China Medical College, Taichung, Taiwan.

BACKGROUND: Febrile ulceronecrotic Mucha-Habermann's disease (FUMHD) is a
severe and very rare variant of pityriasis lichenoides et varilioformis acuta, which is
characterized by large coalescing, and ulceronecrotic maculopapules or plaques.
Morphological changes of the skin accompanied by persistent high fever and several
constitutional symptoms have suggested virus infection in patients with FUMHD. However,
the available information of viral origin is limited. In this study we investigated the
relationship of cytomegalovirus (CMV), Epstein-Barr virus (EBV), human herpesvirus 8 (
HHV8), type I human T-cell lymphotropic virus (HTLV-I), and parvovirus B19 (PVB19)
with FUMHD in a Taiwanese patient. METHODS: The existence of CMV, EBV, HHV8,
HTLV-I, and PVB19 was determined by polymerase chain reaction (PCR). The presence
of CMV in the endothelial cells was characterized by in situ hybridization (ISH) and
immunohistochemistry (IHC). RESULTS: Serologic immunoglobulin to CMV and IHC
identification of CMV late gene in the biopsy specimen indicated that the patient was
infected with CMV. Detection of CMV was confirmed by PCR and ISH.
CONCLUSIONS: These results indicate that FUMHD is associated with dermal CMV
manifestation. Nonetheless, the induction mechanism of FUMHD with CMV infection has
yet to be determined.

====================================================
30.) Expression of cutaneous lymphocyte-associated antigen and TIA-1 by lymphocytes in
pityriasis lichenoides et varioliformis acuta and lymphomatoid papulosis:
immunohistochemical study.
====================================================
J Cutan Pathol. 2001 Oct;28(9):453-9.

Jang KA, Choi JC, Choi JH.

Department of Dermatology, Seoul Paik Hospital, Inje-Univeristy, Seoul, Korea.

BACKGROUND: Pityriasis lichenoides et varioliformis acuta (PLEVA) and lymphomatoid
papulosis (LyP) are benign self-healing cutaneous eruptions that may be clinically and
histologically similar. The purposes of this study were to evaluate immunohistological
characteristics of PLEVA and LyP and to investigate whether Epstein-Barr virus (EBV)
may be present in PLEVA and LyP. METHODS: We performed an immunohistochemical
staining in 12 cases of PLEVA and 8 cases of LyP using nine antibodies for CD3, CD4,
CD8, CD30, CD45RO, CD56, CD79, cutaneous lymphocyte-associated antigen (CLA),
and TIA-1. In situ hybridization was performed using fluorescein-conjugated
oligonucleotide probes for EBV early regions (EBER). RESULTS: In PLEVA,
immunohistochemical studies revealed that infiltrated lymphocytes consisted of mainly CD3
-positive (5+), CD8-positive (4+ to 5+), CLA-positive (4+ to 5+) T cells and partly CD79
positive (+ to 2+) B cells. CD4-positive T cells were less than 25%. In LyP,
immunohistochemical studies revealed that infiltrated lymphocytes consisted of partly CD3
-positive (5+), CD8-positive (2+ to 3+), CLA-positive (3+ to 4+) T cells and partly CD
79-positive (2+ to 3+) B cells. CD4-positive T cells were less than 10%. CD8 and CLA
were more strongly expressed in PLEVA than in LyP. CD30 was strongly expressed in
LyP but not expressed in PLEVA. CD79 was more expressed in LyP than in PLEVA.
TIA-1 was not expressed in any cases. In situ hybridization using antisense EBER probe
showed negative reaction in all cases. CONCLUSIONS: Immunohistochemical stains for
CD8, CD30, CD79 and CLA may be valuable tools in the differential diagnosis between
PLEVA and LyP. TIA-1 was negative in LyP, which means cytotoxic cells may not be
implicated in the pathogenesis of LyP. It was a contradictory result to the previous results.
The absence of EBV in PLEVA and LyP suggests that this virus may not be operative in
the pathogenesis of these diseases. These results suggest that LyP and PLEVA are
separate disorders, thus accounting for their variable prognosis.

====================================================
31.) Medullary CD30+ T cell lymphoma with eosinophilia and hyper-IgE supervening
during the relentless course of pityriasis lichenoides.
====================================================
Dermatology. 2000;200(2):170-2.

Hermanns-Le T, Pierard GE.

Department of Dermatopathology, University of Liege, Belgium.

We report a case of extensive pityriasis lichenoides exhibiting a relentless course. PUVA
therapy and oral retinoids cleared temporarily the lesions but did not really halt the course
of the disease. Eosinophilia and hyper-IgE occurred after 50 years of evolution. An
aggressive medullary CD30+ T cell lymphoma without skin involvement was then
diagnosed when pityriasis lichenoides became more extensive and necrotic. The disease
was rapidly fatal.

====================================================
32.) Pityriasis lichenoides-like mycosis fungoides in children.
====================================================
Br J Dermatol. 2000 Feb;142(2):347-52.

Ko JW, Seong JY, Suh KS, Kim ST.

Department of Dermatology, Kosin Medical Center, Pusan, South Korea.

We report three children with clinical features of pityriasis lichenoides (scaly red to brown
papules and macules) in whom there were histopathological findings of mycosis fungoides
(disproportionate epidermotropism, Pautrier's microabscesses, and wiry and coarse
collagen bundles). Immunohistochemical staining revealed a prevalence of T lymphocytes in
the infiltrate. T-cell receptor gene rearrangement analysis in lesional skin demonstrated
rearrangement of the gamma chain in all cases. Human T-cell lymphotropic virus type 1
serology was negative in the two patients in whom this test was performed. Thus, lesions
resembling pityriasis lichenoides can be an unusual and potentially misleading presentation
of mycosis fungoides.

===================================================
33.) Childhood cutaneous T-cell lymphoma in association with pityriasis lichenoides
chronica.
====================================================
Br J Dermatol. 1999 Dec;141(6):1146-8.

Comment on:
Br J Dermatol. 1997 Dec;137(6):983-7.

Thomson KF, Whittaker SJ, Russell-Jones R, Charles-Holmes R.

Publication Types:
Case Reports
Comment
Letter
====================================================
====================================================
34.) Pityriasis lichenoides-like exanthem and primary infection by Epstein-Barr virus.
====================================================
Int J Dermatol. 2000 Feb;39(2):156-9.

Almagro M, Del Pozo J, Martinez W, Silva JG, Pena C, Yebra-Pimentel MT, Fonseca E.

Departments of Dermatology and Pathology, Hospital Juan Canalejo, La Coruna. Spain.

Publication Types:
Case Reports
====================================================
====================================================
35.) Pityriasis lichenoides chronica with acral distribution mimicking palmoplantar syphilid.
====================================================
Acta Derm Venereol. 1999 May;79(3):239.
Chung HG, Kim SC.

Publication Types:
Case Reports
Letter
====================================================
====================================================
36.) Pityriasis lichenoides and acquired toxoplasmosis.
====================================================
Int J Dermatol. 1999 May;38(5):372-4.

Rongioletti F, Delmonte S, Rebora A.

Department of Dermatology, University of Genoa, Italy.

Publication Types:
Case Reports
====================================================
====================================================
37.) Paraneoplastic pityriasis lichenoides chronica.
====================================================
J Eur Acad Dermatol Venereol. 1999 Mar;12(2):189-90.
Lazarov A, Lalkin A, Cordoba M, Lishner M.

Publication Types:
Case Reports
Letter
====================================================
====================================================
38.) Cutaneous T-cell lymphoma presenting with 'segmental pityriasis lichenoides chronica'.
====================================================
Clin Exp Dermatol. 1998 Sep;23(5):232.

Child FJ, Fraser-Andrews EA, Russell-Jones R.

Publication Types:
Case Reports
Letter
====================================================
====================================================
39.) Mucha-Habermann disease-like eruptions due to Tegafur.
====================================================
J Dermatol. 1999 Mar;26(3):164-7. Related Articles, Links

Kawamura K, Tsuji T, Kuwabara Y.

Department of Dermatology, Nagoya City University Medical School, Japan.

The first case of Mucha-Habermann disease-like drug eruptions due to Tegafur is reported.
A 59-year-old man noticed various skin lesions after he had taken 300 mg of Tegafur daily
for about 200 days. The patient had papulonecrotic eruptions on his trunk and extremities.
The histology from a papular lesion revealed epidermal necrosis surrounded by spongiosis,
perivascular inflammatory infiltrations composed of lymphocytes and erythrocytes, and
endothelial swelling. The etiology of Mucha-Habermann disease is not known, but an
immune mechanism may be supported by our case.

====================================================
40.) [Ulcers of the tongue, pityriasis lichenoides and primary parvovirus B19 infection]
====================================================
Ann Dermatol Venereol. 1996;123(11):735-8.

[Article in French]

Labarthe MP, Salomon D, Saurat JH.

Service de Dermatologie, Hopital Cantonal Universitaire de Geneve, Suisse.

INTRODUCTION: We report a case of parapsoriasis en gouttes (or pityriasis lichenoides)
which presents two peculiarities. First, the patient had lingual ulcerations and second, the
eruption appeared during a seroconversion for Parvovirus B19. OBSERVATION: A 25
old woman presented a first episode of characteristic parapsoriasis en gouttes associated
with purpuric palmoplantar lesions and lingual ulcerations, reaching deep muscular in
histology. DISCUSSION: This observation of parapsoriasis en gouttes, peculiar because of
lingual ulcerations, is mostly interesting because of its association with a primo-infection to
Parvovirus B19. The receptor of the virus is localised on endothelial cells and that could
explain purpuric lesions and ulcerations observed.

====================================================
41.) Infectious causes of pityriasis lichenoides: A case of fulminant infectious mononucleosis
====================================================
(J Am Acad Dermatol 2003;49:S151-3.)

Case Reports
Peter A. Klein, MD, MPA* a
Evan C. Jones, MPHa
Jonathan L. Nelson, MDa
Richard A.F. Clark, MDa

Abstract

Pityriasis lichenoides is a rare cutaneous eruption of unknown cause that spans a spectrum
of clinical severity. Infectious agents have long been suspected as etiologic factors. The
present case is the first to demonstrate a known EBV-mediated process evolving and
resolving in concert with pityriasis lichenoides. Epstein-Barr virus, Toxoplasma gondii, and
HIV are the most frequently reported infectious triggers of pityriasis lichenoides. Pityriasis
lichenoides may arise secondary to EBV-mediated acute infectious mononucleosis.

====================================================
42.) Pityriasis lichenoides in children: a long-term follow-up of eighty- nine cases.
====================================================
(J Am Acad Dermatol 1990 Sep;23(3 Pt 1):473-8)
C Gelmetti
C Rigoni
E Alessi
E Ermacora
E Berti
R Caputo

Abstract

Pityriasis lichenoides is usually classified into an acute and a chronic form. From a review of
89 cases of the disease seen since 1974 it seems that a more realistic classification into
three main groups, according to the distribution of pityriasis lichenoides lesions, could be
made, namely, a diffuse, a central, and a peripheral form, each characterized by a different
clinical course. Conversely, no correlations were detected in our series between the
severity of skin lesions and their distribution or the overall course of the disease. None of
our cases suggests the possible evolution of pityriasis lichenoides into lymphomatoid
papulosis. Although no infectious causative agent has been identified, a viral origin seems
likely in some cases. Most patients responded favorably to UVB irradiation. Our
conclusions are (1) that pityriasis lichenoides is probably a clinical disorder with a diverse
etiology and (2) that its classification by distribution seems more useful than its subdivision
into an acute and a chronic form.


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DATA-MEDICOS/DERMAGIC-EXPRESS No 5-(121)  30/04/2.004 DR. JOSE LAPENTA R. 
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