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Salah EM, Bedair NI, El-Rahim SKA, El-Khalawany MA. Efficacy and safety of excimer light (308 nm) in the treatment of pityriasis lichenoides chronica. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2024; 40:e12964. [PMID: 38616405 DOI: 10.1111/phpp.12964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/14/2024] [Accepted: 04/02/2024] [Indexed: 04/16/2024]
Abstract
INTRODUCTION Pityriasis lichenoides chronica is the chronic end of the spectrum of pityriasis lichenoides which have several forms of papulosuamous conditions. Several treatments obtained complete clearance of the condition including phototherapy and specifically narrow band ultraviolet B. The Excimer light 308 is a monochromatic light that acts within the ultraviolet B wavelength and used as a targeted phototherapy in several skin conditions. METHODS Thirty-four patients with histopathologically diagnosed pityriasis lichenoides chronica underwent treatment with biweekly sessions of excimer light 308 nm. Treatment continued until complete clearance was obtained or to a maximum of 48 sessions (24 weeks). RESULTS Thirty-one patients obtained complete clearance with no recurrence till the end of the study period, two patients had partial response and only one patient showed poor response to treatment. CONCLUSION Excimer light can be a safe and effective treatment of pityriasis lichinoides chronica in different ages and genders.
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Affiliation(s)
- Eman Mohamed Salah
- Department of Dermatology, Andrology, Sexual Medicine and STDs, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Nermeen Ibrahim Bedair
- Department of Dermatology, Andrology, Sexual Medicine and STDs, Faculty of Medicine, Helwan University, Cairo, Egypt
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Agaoglu E, Erdogan HK, Acer E, Saracoglu ZN, Bilgin M. Narrowband ultraviolet B phototherapy for pityriasis lichenoides: A real-life experience. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2023; 39:520-526. [PMID: 37340660 DOI: 10.1111/phpp.12895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 06/22/2023]
Abstract
INTRODUCTION Pityriasis lichenoides (PL) is a papulosquamous disease affecting both children and adults, for which narrowband-UVB (NB-UVB) phototherapy is regarded as a commonly used treatment option. The aim of this study was to investigate the efficacy of NB-UVB phototherapy in the management of PL and to compare response rates in pediatric and adult age groups. MATERIALS AND METHODS This observational, retrospective study included 20 PL patients (12 pityriasis lichenoides chronica; PLC, 8 pityriasis lichenoides et varioliformis acuta; PLEVA) who failed to respond to other treatment modalities. The data for this study were collected retrospectively from patient follow-up forms in the phototherapy unit. RESULTS A complete response (CR) was obtained in all pediatric patients with PL, while 53.8% of adult patients had achieved CR. The mean cumulative dose required to achieve the CR was higher in pediatric patients than adult patients with PL (p < .05). The CR was achieved in 6 (75%) of 8 PLEVA patients, while 8 (66.7%) of 12 PLC patients had reached to CR. The mean number of exposures for patients with PLC to achieve a CR was higher than patients with PLEVA (p < .05). Erythema was the most common adverse effect during phototherapy particularly in 5 (35.7%) of the patients with PL who had achieved CR. CONCLUSIONS NB-UVB is an effective and well-tolerated treatment option for PL especially in diffuse types. A higher response can be obtained in children with higher cumulative dose. Patients with PLC may require more exposures for CR than patients with PLEVA.
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Affiliation(s)
- Esra Agaoglu
- Department of Dermatology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Hilal Kaya Erdogan
- Department of Dermatology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Ersoy Acer
- Department of Dermatology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Zeynep Nurhan Saracoglu
- Department of Dermatology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Muzaffer Bilgin
- Department of Biostatistics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
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Raghavan SS, Wang JY, Gru AA, Marqueling AL, Teng JMC, Brown RA, Novoa RA, Kim Y, Zehnder J, Zhang BM, Rieger KE. Next-generation sequencing confirms T-cell clonality in a subset of pediatric pityriasis lichenoides. J Cutan Pathol 2021; 49:252-260. [PMID: 34614220 DOI: 10.1111/cup.14143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/10/2021] [Accepted: 09/28/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pityriasis lichenoides (PL) is a papulosquamous disease that affects both adults and children. Previous studies have shown a subset of this entity to have clonal T-cell populations via PCR-based assays. In this study, we sought to implement next-generation sequencing (NGS) as a more sensitive and specific test to examine for T-cell clonality within the pediatric population. METHODS We identified 18 biopsy specimens from 12 pediatric patients with clinical and histopathologic findings compatible with PL. Patient demographics, clinical features, management, and histopathologic findings were reviewed. All specimens were analyzed for clonality with NGS of T-cell receptor beta (TRB) and gamma (TRG) genes. RESULTS Of the 12 patients, 9 (75%) had complete resolution of lesions at the time of data collection (mean follow-up 31 months). The remaining three patients significantly improved with methotrexate (with or without acitretin). Interestingly, 7 of 12 patients (58%) and 9 of 17 biopsy specimens (53%) showed evidence of T-cell clonality. Two patients showed matching TRB clones from different anatomic sites. CONCLUSIONS T-cell clonality is a common finding in PL, probably representing a "reactive clonality" rather than a true lymphoproliferative disorder. Clonality alone cannot be used as a means to distinguish PL from lymphomatoid papulosis or cutaneous lymphoma.
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Affiliation(s)
- Shyam S Raghavan
- Department of Pathology, University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - Jennifer Y Wang
- Department of Dermatology, Stanford University Medical Center, Stanford, California, USA
| | - Alejandro A Gru
- Department of Pathology, University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - Ann L Marqueling
- Department of Dermatology, Stanford University Medical Center, Stanford, California, USA
| | - Joyce M C Teng
- Department of Dermatology, Stanford University Medical Center, Stanford, California, USA
| | - Ryanne A Brown
- Department of Dermatology, Stanford University Medical Center, Stanford, California, USA.,Department of Pathology, Stanford University Medical Center, Stanford, California, USA
| | - Roberto A Novoa
- Department of Dermatology, Stanford University Medical Center, Stanford, California, USA.,Department of Pathology, Stanford University Medical Center, Stanford, California, USA
| | - Youn Kim
- Department of Dermatology, Stanford University Medical Center, Stanford, California, USA
| | - James Zehnder
- Department of Pathology, Stanford University Medical Center, Stanford, California, USA
| | - Bing Melody Zhang
- Department of Pathology, Stanford University Medical Center, Stanford, California, USA
| | - Kerri E Rieger
- Department of Dermatology, Stanford University Medical Center, Stanford, California, USA.,Department of Pathology, Stanford University Medical Center, Stanford, California, USA
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Pityriasis Lichenoides: A Large Histopathological Case Series With a Focus on Adnexotropism. Am J Dermatopathol 2020; 42:1-10. [PMID: 31880634 DOI: 10.1097/dad.0000000000001448] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Pityriasis lichenoides (PL) is an infrequent skin disorder. The clinical manifestations are usually specific enough for a reliable diagnosis, although the histopathological assessment of a biopsy is sometimes needed to differentiate between PL and a range of other diseases. The objectives of this study were to review cases of PL managed in our hospital, confirm the classical histopathological features of PL, and identify signs that may be of value in the diagnosis of PL. MATERIALS AND METHODS All cases of PL assessed in our pathology department between January 2007 and December 2017 were retrieved, and all slides were reviewed. Cases were selected only if a diagnosis of PL was initially suggested by a dermatologist and then confirmed by the histopathological assessment. RESULTS Seventy-one cases met the study criteria. The following features were almost always present: vacuolar changes or necrotic keratinocytes (100%), both superficial and deep lymphocytic infiltrates (99%), and the infiltration of lymphocytes into the adnexal epithelium (97%). The inflammatory cells were always small- to medium-sized lymphocytes. There were no eosinophilic infiltrates. Superficial perivascular and/or intraepidermal red blood cells were observed in 83% of cases. DISCUSSION We highlighted the presence of a deep dermal lymphocytic infiltrate, with a "T-shaped" periadnexal arrangement along the full length of the follicular and sudoral epithelia. This might be a feature that enables the differentiation of PL from other diseases. Our findings also prompted a number of physiopathological hypotheses for PL. CONCLUSIONS Our present results confirmed the classical histological aspects of PL and provided some useful new diagnostic features.
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Chen Y, Zhao M, Xiang X, Wang Z, Xu Z, Ma L. Oral erythromycin in pityriasis lichenoides chronica and pityriasis lichenoides et varioliformis acuta. Dermatol Ther 2020; 33:e13311. [PMID: 32174014 DOI: 10.1111/dth.13311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 11/29/2022]
Abstract
Pityriasis lichenoides (PL) is an uncommon cutaneous disorder. Oral erythromycin is proposed to be effective in treating the disease. Here, we reported 16 pediatric patients with PL and systematically reviewed published literatures on erythromycin treatment response in pediatric PL patients, to observe the different treatment response to erythromycin in the pityriasis lichenoides chronica (PLC) and the pityriasis lichenoides et varioliformis acuta (PLEVA) groups. Sixteen patients, 8 with PLC and 8 with PLEVA, were treated with erythromycin. In the PLC group, 25% (n = 2) patients responded to erythromycin, while in the PLEVA group, 87.5% (n = 7) patients responded to erythromycin. The response rate was higher in the PLEVA group than the PLC group (P =.05). No side effect was reported in the 16 patients. A total of 34 children including 16 from our studies were included for further descriptive analysis, in which 12 had PLC and 22 had PLEVA. In the PLC group, 41.7% (n = 5) of patients responded to erythromycin while in the PLEVA group, 90.9 % (n = 20) of patients responded. The response rate was higher in the PLEVA group than the PLC group (P = .004). In conclusion, erythromycin is effective and safe in the treatment of children with PL, and erythromycin was more effective in patients with PLEVA than PLC.
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Affiliation(s)
- Yunliu Chen
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Mutong Zhao
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xin Xiang
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zhaoyang Wang
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zigang Xu
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Lin Ma
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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6
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Jung F, Sibbald C, Bohdanowicz M, Ingram JR, Piguet V. Systematic review of the efficacies and adverse effects of treatments for pityriasis lichenoides. Br J Dermatol 2020; 183:1026-1032. [PMID: 32112390 DOI: 10.1111/bjd.18977] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pityriasis lichenoides (PL) is a papulosquamous dermatosis affecting both children and adults, for which no standard treatment currently exists. OBJECTIVES To characterize different treatment options and develop an evidence-based treatment algorithm for PL. METHODS A systematic search of published literature on PL treatments was performed on 23 December 2017 via the MEDLINE, Embase, CINAHL, CENTRAL, ClinicalTrials.gov and the EU Clinical Trials Register databases. RESULTS Of 1090 abstracts retrieved, 27 full-text articles with 502 participants were included for analysis. Seventeen of the full-text articles were retrospective cohort studies and two were randomized controlled studies. Treatment modalities included in these articles were phototherapy, antibiotics, methotrexate, pyrimethamine and trisulfapyrimidine, corticosteroids and conservative treatment. Of these treatments, phototherapy led to complete remission in the highest proportion of patients, and topical corticosteroids were found to have been trialled in the highest number of patients. CONCLUSIONS The current literature consists almost entirely of uncontrolled studies, and none provides compelling data to support an evidence-based approach to PL treatment. Pityriasis lichenoides chronica and pityriasis lichenoides et varioliformis acuta should be distinguished in response to treatment, and definitions of response to treatment must be standardized. Additional randomized control studies with longer follow-up will help better differentiate between treatment efficacies and adverse effects.
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Affiliation(s)
- F Jung
- Division of Dermatology, Department of Medicine, University of Toronto School of Medicine, Toronto, ON, Canada
| | - C Sibbald
- Division of Dermatology, Department of Medicine, University of Toronto School of Medicine, Toronto, ON, Canada
| | - M Bohdanowicz
- Division of Dermatology, Department of Medicine, University of Toronto School of Medicine, Toronto, ON, Canada
| | - J R Ingram
- Dermatology, Division of Infection & Immunity, Cardiff University, Cardiff, UK
| | - V Piguet
- Division of Dermatology, Department of Medicine, University of Toronto School of Medicine, Toronto, ON, Canada.,Dermatology, Division of Infection & Immunity, Cardiff University, Cardiff, UK.,Division of Dermatology, Women's College Hospital, Toronto, ON, Canada
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7
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Bellinato F, Maurelli M, Gisondi P, Girolomoni G. A systematic review of treatments for pityriasis lichenoides. J Eur Acad Dermatol Venereol 2019; 33:2039-2049. [DOI: 10.1111/jdv.15813] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/08/2019] [Indexed: 11/27/2022]
Affiliation(s)
- F. Bellinato
- Section of Dermatology and Venereology Department of Medicine University of Verona Verona Italy
| | - M. Maurelli
- Section of Dermatology and Venereology Department of Medicine University of Verona Verona Italy
| | - P. Gisondi
- Section of Dermatology and Venereology Department of Medicine University of Verona Verona Italy
| | - G. Girolomoni
- Section of Dermatology and Venereology Department of Medicine University of Verona Verona Italy
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8
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Van TN, Thi TN, Huu DL, Huu ND, Thi ML, Minh TN, Huyen ML, Gandolfi M, Satolli F, Feliciani C, Tirant M, Vojvodic A, Lotti T. Clinical Aspects and Treatment of Pityriasis Lichenoides Et Varioliformis Acuta: A Retrospective Vietnamese Study. Open Access Maced J Med Sci 2019; 7:198-199. [PMID: 30745957 PMCID: PMC6364730 DOI: 10.3889/oamjms.2019.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 01/16/2019] [Accepted: 01/17/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND: Pityriasis lichenoides et varioliformis acuta (PLEVA) is an uncommon condition which presents acutely with papulo-vesicles that may develop necrotic, ulcerative, or hemorrhagic changes. AIM: We studied clinical, and treatment characteristics of PLEVA hospitalised patients at our hospital from September 2009 to December 2014. METHODS: The records of 15 PLEVA patients were retrospectively reviewed. RESULTS: The median age of onset was 21.8 ± 18.81 (from 1 to 68), male to female ratio was 2/1. The common area of onset was trunk (60.0%) and extremities (33.3%). Clinical features were purpuric papules (100%), hemorrhagic crusted papules (46.7%), pustular purpuric papules (40%), and necrotic ulcerating lesions (13.3%). CONCLUSION: All patients were received systemic antibiotics (macrolides: 53.3%, others: 46.7%), 2 patients were added immunosuppressive drugs. A 1-year-old patient died, others had a good response.
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Affiliation(s)
- Thuong Nguyen Van
- National Hospital of Dermatology and Venereology, Hanoi, Vietnam.,Dermatology and Venereology Faculty, Hanoi Medical University, Hanoi, Vietnam
| | - Tuyen Nguyen Thi
- National Hospital of Dermatology and Venereology, Hanoi, Vietnam.,Dermatology and Venereology Faculty, Hanoi Medical University, Hanoi, Vietnam
| | - Doanh Le Huu
- National Hospital of Dermatology and Venereology, Hanoi, Vietnam
| | - Nghi Dinh Huu
- National Hospital of Dermatology and Venereology, Hanoi, Vietnam.,Dermatology and Venereology Faculty, Hanoi Medical University, Hanoi, Vietnam
| | - Mai Le Thi
- National Hospital of Dermatology and Venereology, Hanoi, Vietnam
| | - Thu Nguyen Minh
- National Hospital of Dermatology and Venereology, Hanoi, Vietnam
| | - My Le Huyen
- National Hospital of Dermatology and Venereology, Hanoi, Vietnam
| | | | | | | | - Michael Tirant
- University of Rome G. Marconi, Rome, Italy.,Psoriasis Eczema Clinic, Melbourne, Australia
| | - Aleksandra Vojvodic
- Department of Dermatology and Venereology, Military Medical Academy of Belgrade, Belgrade, Serbia
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Deepthi B, Goyal S, Dhull RS, Rai P, Saha A. Frequent relapses in a child with nephrotic syndrome due to PLEVA. Trop Doct 2018; 48:348-349. [PMID: 30099945 DOI: 10.1177/0049475518788478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A seven-year-old boy with nephrotic syndrome presented with a frequent rash along with relapse of nephrotic syndrome. Clinical and histological features were suggestive of pityriasis lichenoides et varioliformis acuta (PLEVA). Treatment of the condition with doxycycline led to the cure of the lesions as well as the relapses.
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Affiliation(s)
- Bobbity Deepthi
- 1 Senior Resident, Division of Pediatric Nephrology, Department of Pediatrics, Lady Hardinge Medical College and associated Kalawati Saran Children Hospital, New Delhi, India
| | - Samridhi Goyal
- 1 Senior Resident, Division of Pediatric Nephrology, Department of Pediatrics, Lady Hardinge Medical College and associated Kalawati Saran Children Hospital, New Delhi, India
| | - Rachita Singh Dhull
- 2 Assistant Professor of Pediatric Nephrology, Division of Pediatric Nephrology, Department of Pediatrics, Lady Hardinge Medical College and associated Kalawati Saran Children Hospital, New Delhi, India
| | - Preeti Rai
- 3 Associate Professor of Pathology, Department of Pathology, Lady Hardinge Medical College and associated Smt Sucheta Kriplani Hospital, New Delhi, India
| | - Abhijeet Saha
- 4 Professor, Department of Pediatrics, Lady Hardinge Medical College and associated Kalawati Saran Children Hospital, New Delhi, India
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10
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Horie C, Mizukawa Y, Yamazaki Y, Shiohara T. Varicella zoster virus as a possible trigger for the development of pityriasis lichenoides et varioliformis acuta: retrospective analysis of our institutional cases. Clin Exp Dermatol 2018; 43:703-707. [PMID: 29797478 DOI: 10.1111/ced.13549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2017] [Indexed: 11/30/2022]
Abstract
Although numerous infective agents, including varicella zoster virus (VZV), have been described in association with pityriasis lichenoides et varioliformis acuta (PLEVA) and pityriasis lichenoides chronica (PLC), none has been identified consistently in these lesions. We sought to immunohistochemically identify VZV glycoprotein (g)E antigens in the vascular endothelium in PLEVA and PLC lesions, based on our previous observation that gE was detected in the vascular endothelium and eccrine unit up until 2 months and 2.5, respectively, years after herpes zoster (HZ) infection. In five of the six cases of PLEVA, VZV gE was identified in the endothelial cells and eccrine epithelium, as observed in HZ lesions, whereas VZV gE was detected in only one of seven patients with PLC. None of the patients with PLEVA who had VZV gE-positive vascular endothelial cells had experienced previous episodes of HZ. VZV may be one of the aetiological agents for PLEVA while other aetiological factors could exist in PLC.
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Affiliation(s)
- C Horie
- Department of Dermatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Y Mizukawa
- Department of Dermatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Y Yamazaki
- Department of Dermatology, Kyorin University School of Medicine, Tokyo, Japan
| | - T Shiohara
- Department of Dermatology, Kyorin University School of Medicine, Tokyo, Japan
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Zang JB, Coates SJ, Huang J, Vonderheid EC, Cohen BA. Pityriasis lichenoides: Long-term follow-up study. Pediatr Dermatol 2018; 35:213-219. [PMID: 29315771 DOI: 10.1111/pde.13396] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES Pityriasis lichenoides is an uncommon papulosquamous disorder of unknown etiology. The objective of this study was to review the clinical features and treatment responses of individuals with pityriasis lichenoides seen at a tertiary referral center. METHODS Seventy-five patients diagnosed with pityriasis lichenoides between 1997 and 2013 were reviewed, and 46 had long-term follow-up via telephone interviews. RESULTS Fifty (67%) patients were diagnosed with pityriasis lichenoides chronica, 22 (29%) with pityriasis lichenoides et varioliformis acuta, and 3 (4%) with mixed pityriasis lichenoides chronica and pityriasis lichenoides et varioliformis acuta features. Mean ± standard deviation age at onset was 12 ± 13 years (median 8 years). Disease duration was significantly shorter for patients with pityriasis lichenoides et varioliformis acuta (35 ± 35 months) than for those with pityriasis lichenoides chronica (at least 78 ± 48 months). At long-term follow-up, 23 of 28 (82%) patients with pityriasis lichenoides chronica and 3 of 16 (19%) with pityriasis lichenoides et varioliformis acuta had active disease. None progressed to lymphomatoid papulosis or cutaneous T-cell lymphoma. Ten of 23 active pityriasis lichenoides chronica cases had residual pigmentary change independent of race and lasted at least 35 ± 20 months. The most effective treatments were phototherapy (47% response rate), heliotherapy (33%), topical corticosteroids (27%), and antibiotics (25%). CONCLUSION Pityriasis lichenoides is a predominantly pediatric disorder. The time course of pityriasis lichenoides chronica is significantly longer than that of pityriasis lichenoides et varioliformis acuta. Pityriasis lichenoides chronica may persist with pigmentary alterations in the absence of other signs of active inflammation. Treatment response is often limited, particularly for patients with pityriasis lichenoides chronica.
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Affiliation(s)
- Julie B Zang
- Department of Dermatology, Weill Cornell Medicine, New York, NY, USA
| | - Sarah J Coates
- Department of Dermatology, Weill Cornell Medicine, New York, NY, USA
| | - Jing Huang
- Department of Dermatology, Weill Cornell Medicine, New York, NY, USA
| | - Eric C Vonderheid
- Department of Dermatology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Bernard A Cohen
- Department of Dermatology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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12
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Fernández-Guarino M, Aboin-Gonzalez S, Ciudad Blanco C, Velázquez Tarjuelo D, Lázaro Ochayta P. Treatment of adult diffuse pityriasis lichenoides chronica with narrowband ultraviolet B: experience and literature review. Clin Exp Dermatol 2017; 42:303-305. [PMID: 28111789 DOI: 10.1111/ced.13035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2016] [Indexed: 11/30/2022]
Abstract
Pityriasis lichenoides chronica (PLC) is an infrequent dermatosis of unknown aetiology, wholse evolution and response to treatment differs between children and adults. When PLC is recalcitrant or unresponsive to topical treatment, phototherapy is one of the main treatments used. We carried out a prospective study of adult diffuse PLC treated with narrowband ultraviolet B (NB-UVB). We treated eight patients whose disease showed no response to topical therapy, and obtained a complete response rate of 88% in a mean of 23 sessions (cumulative dose 16.99 J/cm2 ). However, the relapse rate was 43% in the first 6 months. Our results are similar to those of other published studies but there is much variability between them in the doses applied and the number of sessions needed. Further studies are necessary to devise a protocol for NB-UVB treatment of PLC.
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Affiliation(s)
- M Fernández-Guarino
- Dermatology Department, Hospital Universitario Sanitas La Zarzuela, Universidad Francisco de Vitoria, Madrid, Spain
| | - S Aboin-Gonzalez
- Dermatology Department, Hospital Universitario Sanitas La Zarzuela, Universidad Francisco de Vitoria, Madrid, Spain
| | - C Ciudad Blanco
- Dermatology Department, Hospital Universitario Sanitas La Zarzuela, Universidad Francisco de Vitoria, Madrid, Spain
| | - D Velázquez Tarjuelo
- Dermatology Department, Hospital Universitario Sanitas La Zarzuela, Universidad Francisco de Vitoria, Madrid, Spain
| | - P Lázaro Ochayta
- Dermatology Department, Hospital Universitario Sanitas La Zarzuela, Universidad Francisco de Vitoria, Madrid, Spain
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13
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Phototherapy for Pityriasis Lichenoides in the Pediatric Population: A Review of the Published Literature. Am J Clin Dermatol 2016; 17:583-591. [PMID: 27502793 DOI: 10.1007/s40257-016-0216-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Pityriasis lichenoides (PL) is a dermatologic disorder that manifests in either the acute (pityriasis lichenoides et varioliformis acuta) or the chronic form (pityriasis lichenoides chronica, also known as parapsoriasis chronica). Traditional first-line therapy consists of corticosteroids or antibiotics; however, these treatments are often accompanied with multiple side effects and may be ineffective. OBJECTIVE The goal of this study was to review the use of phototherapy for treating PL in the pediatric population. MATERIALS AND METHODS We performed a systematic review of the literature in the National Library of Medicine's PubMed database and the SCOPUS database discussing phototherapy for treatment of PL in the pediatric population. The following search terms were used: 'pityriasis lichenoides', 'pityriasis lichenoides chronica', 'pityriasis lichenoides et varioliformis acuta', and 'febrile ulceronecrotic Mucha-Habermann disease'. RESULTS The systematic search and screening of articles resulted in 14 articles including a total of 64 patients with PL treated with phototherapy. Three different modalities were utilized, with five studies using broadband ultraviolet B (BB-UVB) radiation, nine studies utilizing narrowband UVB (NB-UVB), and two studies employing psoralen with ultraviolet A (PUVA) therapy. Overall, the use of BB-UVB had an initial clearance rate of 89.6 % with 23.1 % recurrence, whereas NB-UVB cleared 73 % of the lesions with no recurrence, and PUVA therapy initially cleared 83 % of the lesions with 60 % recurrence. The side-effect profiles were similar and revealed limited toxicity. CONCLUSION Phototherapy shows promising results and a favorable side-effect profile in the treatment of PL. Ultimately, large randomized controlled trials are needed to determine optimal treatments.
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Sibbald C, Pope E. Systematic review of cases of cutaneous T-cell lymphoma transformation in pityriasis lichenoides and small plaque parapsoriasis. Br J Dermatol 2016; 175:807-9. [DOI: 10.1111/bjd.14605] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- C. Sibbald
- Department of Dermatology; University of Toronto; Toronto ON Canada
| | - E. Pope
- Department of Dermatology; University of Toronto; Toronto ON Canada
- Division of Dermatology; The Hospital for Sick Children; Toronto ON Canada
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Castro BACD, Pereira JMM, Meyer RLB, Trindade FM, Pedrosa MS, Piancastelli ACC. Pityriasis lichenoides et varioliformis acuta after influenza vaccine. An Bras Dermatol 2016; 90:181-4. [PMID: 26312710 PMCID: PMC4540544 DOI: 10.1590/abd1806-4841.20153492] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 08/19/2014] [Indexed: 11/21/2022] Open
Abstract
The etiology of pityriasis lichenoides is unknown. One of the accepted theories
admits that PL is an inflammatory response to extrinsic antigens such as infectious
agents, drugs and vaccines. In recent medical literature, only the MMR vaccine
(Measles, Mumps and Rubella) was associated with the occurrence of this disease. We
present a case of a male, 12 year old healthy patient who, five days after Infl uenza
vaccination, developed erythematous papules on the trunk, abdomen and limbs, some
with adherent crusts and associated systemic symptoms. This case report is notable
for describing the first case of pityriasis lichenoides et varioliformis acuta
associated with the vaccine against Influenza.
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Dupin A, Bosset D, Atger L, Chevallier B, Saiag P, Benoist G. Maladie de Mucha-Habermann fébrile et ulcéronécrotique. Arch Pediatr 2016; 23:82-5. [DOI: 10.1016/j.arcped.2015.09.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 06/23/2015] [Accepted: 09/29/2015] [Indexed: 10/22/2022]
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18
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Geller L, Antonov NK, Lauren CT, Morel KD, Garzon MC. Pityriasis Lichenoides in Childhood: Review of Clinical Presentation and Treatment Options. Pediatr Dermatol 2015; 32:579-92. [PMID: 25816855 DOI: 10.1111/pde.12581] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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.
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Affiliation(s)
- Lauren Geller
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nina K Antonov
- College of Physicians and Surgeons, Columbia University, New York, New York
| | - Christine T Lauren
- Department of Dermatology, Columbia University, New York, New York.,Department of Pediatrics, Columbia University, New York, New York
| | - Kimberly D Morel
- Department of Dermatology, Columbia University, New York, New York.,Department of Pediatrics, Columbia University, New York, New York
| | - Maria C Garzon
- Department of Dermatology, Columbia University, New York, New York.,Department of Pediatrics, Columbia University, New York, New York
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Markus JR, Carvalho VO, Lima MN, Abagge KT, Nascimento A, Werner B. The relevance of recognizing clinical and morphologic features of pityriasis lichenoides: clinicopathological study of 29 cases. Dermatol Pract Concept 2013; 3:7-10. [PMID: 24282656 PMCID: PMC3839824 DOI: 10.5826/dpc.0304a02] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 07/09/2013] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Pityriasis lichenoides (PL) is a lymphoproliferative disease of unknown origin; its diagnosis is based on clinical characteristics and confirmed by histology. OBJECTIVES To describe clinical and histological features of PL in 29 pediatric patients. MATERIALS AND METHODS Retrospective descriptive study of children (patients less than 15 years old) diagnosed with PL between 1986 and 2010 at a Reference Service in Pediatric Dermatology from South Brazil. RESULTS Twenty-nine PL cases were found by chart review in 24 years. Mean age of diagnosis was 8 years (22 to 178 months) and a mean time of diagnosis was 13.8 months (1 to 120 months). Twenty cases (69%) were male. Seasonal correlation was found with colder months in 62% of cases (p<0.01). Clinical diagnosis was pityriasis lichenoides chronica (PLC) in 25 cases, and pityriasis lichenoides et varioliformis acuta (PLEVA) in four. Itching was the main reported symptom occurring in 13 (45%). Fourteen cases had been histologically evaluated. In six, microscopic findings were consistent with PLC, in four consistent with PLEVA, and four biopsies exhibited mixed characteristics of both forms. Concordance between clinical and histological diagnosis was seen in most cases. CONCLUSION PL occurs in children and young adults, more commonly in males, and during cold months. PLC was the more frequent clinicohistologic form, and necrotic lesions characterized PLEVA. Associating clinical and histological findings is important for differentiating between PLC and PLEVA diagnosis.
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Brazzelli V, Carugno A, Rivetti N, Cananzi R, Barruscotti S, Borroni G. Narrowband UVB phototherapy for pediatric generalized pityriasis lichenoides. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2013; 29:330-3. [DOI: 10.1111/phpp.12075] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/12/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Valeria Brazzelli
- Department of Clinical-Surgical, Diagnostic and Pediatric Science; Institute of Dermatology; Fondazione IRCCS Policlinico San Matteo; University of Pavia; Pavia Italy
| | - Andrea Carugno
- Department of Clinical-Surgical, Diagnostic and Pediatric Science; Institute of Dermatology; Fondazione IRCCS Policlinico San Matteo; University of Pavia; Pavia Italy
| | - Nicolò Rivetti
- Department of Clinical-Surgical, Diagnostic and Pediatric Science; Institute of Dermatology; Fondazione IRCCS Policlinico San Matteo; University of Pavia; Pavia Italy
| | - Raffaello Cananzi
- Department of Clinical-Surgical, Diagnostic and Pediatric Science; Institute of Dermatology; Fondazione IRCCS Policlinico San Matteo; University of Pavia; Pavia Italy
| | - Stefania Barruscotti
- Department of Clinical-Surgical, Diagnostic and Pediatric Science; Institute of Dermatology; Fondazione IRCCS Policlinico San Matteo; University of Pavia; Pavia Italy
| | - Giovanni Borroni
- Department of Clinical-Surgical, Diagnostic and Pediatric Science; Institute of Dermatology; Fondazione IRCCS Policlinico San Matteo; University of Pavia; Pavia Italy
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Pityriasis Lichenoides and Cutaneous T Cell Lymphoma: An Update on the Diagnosis and Management of the Most Common Benign and Malignant Cutaneous Lymphoproliferative Diseases in Children. CURRENT DERMATOLOGY REPORTS 2013. [DOI: 10.1007/s13671-013-0054-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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23
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Oliveira LM, de Seixas Rocha M, Patriota GS, Cunha GT, Paiva GR, Souza ASC, Fauth AC, Guerreiro de Moura CG, Cruz CMS. Febrile ulceronecrotic mucha habermann disease: case report of a dark-skinned patient. Case Rep Dermatol 2013; 5:4-10. [PMID: 23466681 PMCID: PMC3573822 DOI: 10.1159/000346742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
A male dark-skinned patient, 33 years old, complaining of a 1-month history of skin lesions in the abdominal region and high fever was admitted to the clinical ward. There were ulcerated and coalescent skin lesions all over the body but sparing the palmar region. The culture of material obtained from the penile lesions was positive for Staphylococcus aureus. He was treated with oxacillin and prednisone. The patient persisted with high fever and skin lesions. After histopathological diagnosis of Mucha Habermann's disease, treatment was started with tetracycline with rapid improvement of the lesions. He was reexamined by the dermatologic service with no recurrences during the 12 months of follow-up. At this time, there was a great number of keloid scars from the skin lesions.
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Abstract
Pityriasis lichenoides (PL) is not uncommon in childhood, but current knowledge about the efficacy of oral erythromycin therapy for its treatment in children is limited. To investigate the role of oral erythromycin therapy in the treatment of PL in children, the records of 24 children with PL who had been started on oral erythromycin treatment at our institution between 2005 and 2008 were retrospectively reviewed. The study included 24 patients (14 male, 10 female) with a median age of 7 years (range 2-14) of whom 15 (62.5%) had PL chronica (PLC), six (25%) PL et varioliformis acuta (PLEVA), and three (2.5%) PLEVA-PLC overlap. History of upper respiratory tract infection was reported in 33% (n = 8) of the patients. History of drug intake and vaccination was noted in 20% (n = 5) and 20% (n = 5), respectively. The disease began during spring (30%, n = 7) or fall (30%, n = 7) in the majority of patients. The median duration of the disease was 11 months (range 1-48 months). Fifteen (68.2%) patients had more than 100 lesions. Distribution was diffuse in 82% (n = 18) of the cases and peripheral in the remainder (n = 6). Oral erythromycin was started at a dosage of 30 to 50 mg/kg per day in three to four divided dosages for 1 to 4 months. Good response was recorded in 64% and 73% of patients in the first and second months of therapy, respectively. Response rate rose to 83% in the third month. In those for whom follow-up data were available (n = 16), relapse was recorded in 12.5% (n = 3). Oral erythromycin may be an effective and well-tolerated treatment option for PL in children and should be continued for at least 3 months.
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Affiliation(s)
- Asli Hapa
- Department of Dermatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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26
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Guerra AAH, Osguthorpe RJ, Putnam A, Vanderhooft SL. Visual diagnosis: a 7-month-old who has a persistent rash. Pediatr Rev 2011; 32:e105-9. [PMID: 22135427 DOI: 10.1542/pir.32-12-e105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Angel Alberto Herrera Guerra
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
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Lymphomatoid Papulosis Followed by Pityriasis Lichenoides: A Common Pathogenesis? Am J Dermatopathol 2011; 33:835-40. [DOI: 10.1097/dad.0b013e3181f4d8c3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Gunatheesan S, Ferguson J, Moosa Y. Pityriasis lichenoides et varioliformis acuta: A rare association with the measles, mumps and rubella vaccine. Australas J Dermatol 2011; 53:e76-8. [DOI: 10.1111/j.1440-0960.2011.00781.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Pugashetti R, Koo J. Phototherapy in pediatric patients: choosing the appropriate treatment option. ACTA ACUST UNITED AC 2010; 29:115-20. [PMID: 20579600 DOI: 10.1016/j.sder.2010.03.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Phototherapeutic modalities, including narrowband-UVB, broadband-UVB, PUVA photochemotherapy, and excimer laser therapy are valuable tools that can be used for photoresponsive dermatoses in children. As a systematically safer alternative compared with internal agents, including the prebiologic and biological therapies, phototherapy should be considered a possible treatment option for children with diseases including psoriasis, atopic dermatitis, pityriasis lichenoides chronica, and vitiligo.
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Affiliation(s)
- Rupa Pugashetti
- University of California, School of Medicine, Irvine, CA, USA.
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Fernandes NF, Rozdeba PJ, Schwartz RA, Kihiczak G, Lambert WC. Pityriasis lichenoides et varioliformis acuta: a disease spectrum. Int J Dermatol 2010; 49:257-61. [DOI: 10.1111/j.1365-4632.2008.03915.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fölster-Holst R, Kreth HW. Viral exanthems in childhood. Part 3: Parainfectious exanthems and those associated with virus-drug interactions. J Dtsch Dermatol Ges 2009; 7:506-10. [DOI: 10.1111/j.1610-0387.2008.06870.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Asahina A, Mitomi H, Yamamoto M, Fujita H. Pityriasis lichenoides et varioliformis acuta in a 2-year-old boy. Clin Exp Dermatol 2009; 34:533-4. [DOI: 10.1111/j.1365-2230.2008.02986.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Di Costanzo L, Balato N, La Bella S, Balato A. Successful association in the treatment of pityriasis lichenoides et varioliformis acuta. J Eur Acad Dermatol Venereol 2009; 23:971-2. [PMID: 19175486 DOI: 10.1111/j.1468-3083.2008.03077.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Birnie A, Langan S, English J. Updates from the British Association of Dermatologists 87th Annual Meeting, 10–13 July 2007, Birmingham, U.K. Br J Dermatol 2008; 158:1182-8. [DOI: 10.1111/j.1365-2133.2008.08568.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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