Clinical Review
Lichenoid eruptions in children☆

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Abstract

Lichenoid eruptions are quite common in children and can result from many different origins. In most instances the precise mechanism of disease is not known, although it is usually believed to be immunologic in nature. Certain disorders are common in children, whereas others more often affect the adult population. Lichen striatus, lichen nitidus, Gianotti-Crosti syndrome, and lichen spinulosus are examples of lichenoid lesions that are more common in children than adults. Distinguishing these diseases is necessary for prediction of the course of the eruption and for optimal management. In most cases, certain clinical characteristics enable the clinician to reach a diagnosis, whereas in other cases biopsy is required for a definitive answer. Many of these lesions are self-limited and only require symptomatic treatment, although corticosteroids can hasten resolution in certain disorders. Discontinuation of the medication is often sufficient for resolution of lichenoid drug eruptions.

Section snippets

LP

LP is the classic lichenoid eruption. It is rare in children, but occurs most frequently in individuals aged 30 to 60 years. There are numerous published reports of LP in children; however, most of these are series that include only a small number of pediatric patients, or are single childhood cases. We identified only 4 series of LP in children in the English-language literature that include more than 15 patients each.1, 2, 3, 4

In an early report, children composed approximately 1% of all LP

Lichen nitidus

Lichen nitidus (LN) is an uncommon inflammatory skin disease, primarily of children, particularly of preschool and school age.48 There is no documented sex preference. Individual lesions are sharply demarcated, pinpoint to pinhead sized, round or polygonal, and strikingly monomorphous in nature. The papules are usually flesh-colored, however, the color varies from yellow and brown to violet hues depending on the background color of the patient's skin. This variation in color is in contrast with

Lichen striatus

Lichen striatus (LStr) is a relatively uncommon, acquired, asymptomatic dermatosis most often seen in children 5 to 15 years of age.73 Others dispute this age range and claim that LStr most often affects younger children, with a median age of 2 to 3 years.74, 75 There is no consensus on sex preference. Some studies have shown an increased incidence in girls,76, 77 whereas others show an equal sex incidence. There is no known racial predilection or any basis in heredity.

Individual lesions are

Lichen sclerosus

Lichen sclerosus (LScl) affects people of all ages, from 6 months to late adulthood, with approximately 10% to 15% of cases occurring in children.83, 84 There is a female predominance with a female:male ratio of 10:1 and a bimodal distribution in prepubertal and postmenopausal female patients. Most reported cases are in white patients; however, this may reflect a reporting bias because most studies have been conducted in Great Britain and the United States.85

LScl lesions occur most often in

Gianotti-crosti syndrome

Gianotti-Crosti (G-C) syndrome is an acrally distributed papular viral exantham seen mainly in children aged 2 to 6 years, with most cases occurring in those younger than 4 years. It is also known as papular acrodermatitis of childhood, or infantile acrodermatitis. There is no racial predilection, but the disorder is more frequent in boys. The disease is more common in spring and early summer.94, 95

A week-long prodrome of fever, malaise, and upper respiratory tract symptoms sometimes precedes

Pigmented purpura

Lichen aureus (LA) and pigmented purpura (PP) lichenoid dermatosis (PPLD) of Gougerot and Blum are also in the differential diagnosis for lichenoid lesions in children, as they can appear as clusters of papules. These two diseases belong to the broader family of dermatoses known as the PPs. The PPs, as a group, are characterized by a maculopapular eruption that is pigmented because of an extravasation of erythrocytes within the papillary dermis. Within the group of PPs, PPLD of Gougerot and

Pityriasis lichenoides

Pityriasis lichenoides (PL) is an uncommon benign skin disease consisting of two variants: acute PL, also known as PL et varioliformis acuta (PLEVA) or Mucha-Habermann disease; and chronic PL (PL chronica [PLC]). The distinction between the chronic and acute forms of PL is not always clear as they appear to be interrelated both clinically and immunohistologically and are generally considered to exist along a clinicopathologic spectrum.120, 121

Lichenoid sarcoidosis

Lichenoid sarcoidosis is a very rare specific type of sarcoidosis estimated at approximately 1% to 2% of all cases of cutaneous sarcoidosis.142 Although pulmonary and mediastinal involvement predominate in adults and older children, there is a specific constellation of features seen in those under 6 years of age known as preschool sarcoidosis. Preschool sarcoidosis specifically involves the joints, skin, and eyes, and usually spares the lungs and lymph nodes. Lichenoid papules appear as

Lichen spinulosus

Lichen spinulosus is a rare and benign disorder characterized by follicular keratotic papules that are grouped into large patches that are symmetrically located. Unlike the other lichenoid diseases described herein, lichen spinulosus is a hyperkeratotic disease. Commonly involved areas include the neck, buttocks, abdomen, trochanteric regions, knees, and extensor surfaces of the arms. The individual lesion is a flat to conical projection, 1 to 3 mm in diameter, which has a pathognomonic

FLE

FLE is a mildly pruritic condition mainly affecting children, more often boys, in the first decade. The disorder has been given several names including recurrent papular reaction of childhood, summertime pityriasis of the elbows and knees, recurrent papular eruption of childhood, and summer lichenoid dermatitis of the elbows. It consists of coalescing 1- to 2-mm, skin-colored papules on the back of the hands, fingers, elbows, and knees, although it may occur elsewhere on the body.153, 154 The

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    Conflicts of interest: None identified.

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    Copyright © 2004 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.