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Lichenoid Eruptions: Can You Match that Rash with the Dx?

Lichenoid Eruptions: Can You Match that Rash with the Dx?

  • Lichenoid Eruptions: Lichen nitidus, lichen spinulosis, lichen striatus

    Let's have a look at some lichenoid rashes that you will likely see in the course of primary care practice.
  • Lichenoid Eruptions: Lichen nitidus, lichen spinulosis, lichen striatus

    The slides that follow provide a brief visual guide to differential diagnosis of rashes in the same family as lichen planus.
  • Lichenoid Eruptions: Lichen nitidus, lichen spinulosis, lichen striatus

    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.
  • Lichenoid Eruptions: Lichen nitidus, lichen spinulosis, lichen striatus

    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).
  • Lichenoid Eruptions: Lichen nitidus, lichen spinulosis, lichen striatus

    Patient #1. hundreds of ≤1-mm flat-topped, flesh-colored papules on the dorsum of the foot.
  • Lichenoid Eruptions: Lichen nitidus, lichen spinulosis, lichen striatus

    Patient #1. Linear array of papules in an area that was scratched (koebnerization).
  • Lichenoid Eruptions: Lichen nitidus, lichen spinulosis, lichen striatus

    Patient #2. Small horny spines that extrude from follicular flesh-colored papules that occur in circular patches.
  • Lichenoid Eruptions: Lichen nitidus, lichen spinulosis, lichen striatus

    Patient #2. A well-circumscribed patch that is roughened and has lichenified follicular accentuation.
  • Lichenoid Eruptions: Lichen nitidus, lichen spinulosis, lichen striatus

    Patient #2. Follicular accentuation that is rough in texture/ lichenified.
  • Lichenoid Eruptions: Lichen nitidus, lichen spinulosis, lichen striatus

    Patient #3. Note a unilateral, linear, papular eruption of minute, confluent, lichenified papules. .
  • Lichenoid Eruptions: Lichen nitidus, lichen spinulosis, lichen striatus

    Patient #3. Note the linear papular lesion and evidence of mild inflammation.
  • Lichenoid Eruptions: Lichen nitidus, lichen spinulosis, lichen striatus

    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.
  • Lichenoid Eruptions: Lichen nitidus, lichen spinulosis, lichen striatus

    Answers:Patient 1. Lichen nitidus; Patient #2. Lichen spinulosis; Patient #3. Lichen striatus
  • Lichenoid Eruptions: Lichen nitidus, lichen spinulosis, lichen striatus

    Lichen nitidus: Benign; falls into broad category of papulosquamous skin conditions.
  • Lichenoid Eruptions: Lichen nitidus, lichen spinulosis, lichen striatus

    Lichen nitidus: Treatment. Mild steroids may be worth a try.
  • Lichenoid Eruptions: Lichen nitidus, lichen spinulosis, lichen striatus

    Lichen spinulosis. Papulosquamous disease. Histology: perifollicular hyperkeratosis.
  • Lichenoid Eruptions: Lichen nitidus, lichen spinulosis, lichen striatus

    Lichen spinulosis: Treatment.
  • Lichenoid Eruptions: Lichen nitidus, lichen spinulosis, lichen striatus

    Lichen spinulosis: Treatment. moisturizing soaps, mild keratolytic agents, topical moisturizers.
  • Lichenoid Eruptions: Lichen nitidus, lichen spinulosis, lichen striatus

    Lichen striatus: Papulosquamous disease. Resolution - months to years. Treat with keratolytics and steroids, sometimes in combination.
  • Lichenoid Eruptions: Lichen nitidus, lichen spinulosis, lichen striatus

    Lichen striatus: Treatment. Lactic acid lotions, alpha hydroxy acid lotions, urea creams, salicylic acid.

A previous slide show that presented a case of lichen planus sparked requests for a closer look at other lichenoid dermatoses.

The overview in the slides above lets you test your visual diagnostic skills by looking at 3 different rashes, all asymptomatic, all present from several weeks to several months, and all in patients with medical histories that were non-contributory.

Can you match that rash x3?

 

 

 

Comments

Awesome, very nice slides.

ANIL @

I am unable to see more than first 3 slides

camille @

Thank you for the elucidation

Jessica @

Interesting!

dr @

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