Lichenoid Eruptions: Can You Match that Rash with the Dx?
Test your visual diagnostic skills with an up-close look at 3 papulosquamous rashes and see if you can make a Dx match.
Let's have a look at some lichenoid rashes that you will likely see in the course of primary care practice.
The 3 patients that follow were all asymptomatic, had medical histories that were non-contributory, and the rash had been present from several weeks to several months. If you're unsure when you see something like this, don't assume it's a steroid-responsive rash and then prescribe steroids just for something to do.
Patient #1. Very sharply demarcated, pinhead-sized round, flesh-colored papules on his feet; linear areas of koebnerization (ie, the rash occurs in areas where the patient scratches or traumatizes the skin).
Patient #1. hundreds of ≤1-mm flat-topped, flesh-colored papules on the dorsum of the foot.
Patient #1. Linear array of papules in an area that was scratched (koebnerization).
Patient #2. Small horny spines that extrude from follicular flesh-colored papules that occur in circular patches.
Patient #2. A well-circumscribed patch that is roughened and has lichenified follicular accentuation.
Patient #2. Follicular accentuation that is rough in texture/ lichenified.
Patient #3. Note a unilateral, linear, papular eruption of minute, confluent, lichenified papules.
Patient #3. Note the linear papular lesion and evidence of mild inflammation.
Can you match the rash to the diagnosis: Keratosis pilaris, lichen sclerosis et atrophicus, lichen nitidus, lichen spinulosis, Bowenoid papulosis, lichen striatus, atypical lichen planus, lichen aureus.
Answers: Patient 1. Lichen nitidus; Patient #2. Lichen spinulosis; Patient #3. Lichen striatus
Lichen nitidus: Benign. Falls into broad category of papulosquamous skin conditions.
Lichen nitidus: Treatment. Mild steroids may be worth a try.
Lichen spinulosis. Papulosquamous disease. Histology: perifollicular hyperkeratosis.
Lichen spinulosis: Treatment.
Lichen spinulosis: Treatment. moisturizing soaps, mild keratolytic agents, topical moisturizers.
Lichen striatus: Papulosquamous disease. Resolution - months to years. Treat with keratolytics and steroids, sometimes in combination.
Lichen striatus: Treatment. Lactic acid lotions, alpha hydroxy acid lotions, urea creams, salicylic acid.
The topic is lichenoid dermatoses. The overview in the slides below lets you test your visual diagnostic skills by looking at 3 different rashes, all asymptomatic, all present for from several weeks to several months, and all in patients with medical histories that were non-contributory.Can you match that rash x3? Â
