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Lichen spinulosus - Skin
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Lichen spinulosus - Skin

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Contributors: Vimal Prajapati MD, Ben Barankin MD, Jeffrey D. Bernhard MD, Sarah Stein MD, Karen Wiss MD, Sheila Galbraith MD, Craig N. Burkhart MD, Dean Morrell MD, Lynn Garfunkel MD, Nancy Esterly MD
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Synopsis

Lichen spinulosus is 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. There is a slight male preponderance. Individuals of any race can be affected. The etiology and pathogenesis is 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. This variant occurs in association with nodulocystic acne and pityriasis rubra pilaris as part of type VI (HIV-associated) pityriasis rubra pilaris. Additional 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.

Lichen spinulosus has a variable course. Most cases tend to resolve spontaneously at puberty; however, persistent cases have also been described. Although no treatment is required, effective therapeutic options include topical keratolytic agents and topical retinoids.

Codes

ICD10CM:
L73.8 – Other specified follicular disorders

SNOMEDCT:
4859009 – Lichen spinulosus

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Differential Diagnosis & Pitfalls

  • Keratosis pilaris – occurs with much greater frequency, has more gradual onset, appears more diffusely (not in circumscribed plaques), preferentially affects the upper aspects of the arms and legs, and often has a seasonal variation (improves in summer, worsens in winter).
  • Pityriasis rubra pilaris, especially type IV (circumscribed juvenile) – more erythematous, primarily affects the elbows and knees, resembles localized psoriasis, and may be associated with palmoplantar keratoderma.
  • Frictional lichenoid eruption – tends to affect children only (especially those in their first decade of life); occurs almost exclusively on the dorsal hands, elbows, and knees; and repetitive exposure to significant frictional force during play (ie, contact with abrasive material such as sand, grass, or carpet) is often elicited from history.
  • Phrynoderma (hypovitaminosis A, or vitamin A deficiency) – rare in developed countries except in the setting of intestinal malabsorption or anorexia nervosa, and associated systemic findings are often present.

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Last Updated: 02/12/2015
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Lichen spinulosus - Skin
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Lichen spinulosus : Abdomen, Extensor distribution, Follicular configuration, Neck, Symmetric extremities, White color, Scaly papules, Knees
Clinical image of Lichen spinulosus
Multiple discrete, follicularly based, scaly papules on the elbows.
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