Beyond the Scales: Histopathologic Insights into Pityriasis Lichenoides Chronica

Utiya Nur Laili, Alamanda Murasmita

Abstract


Introduction: Pityriasis lichenoides is an inflammatory skin condition characterized by papular, squamous or necrotic lesions. Currently, studies that accurately correlate clinical subtypes with histologic features are rare. The aim of this study is to describe the clinical and histopathologic features of chronic pityriasis lichenoides especially in adults. Case: A 30-year-old male with complaints of reddish papules and nodules on the body and both hands since 10 years ago. The patient initially complained of reddish papules and nodules on the chest then increasingly spread to the whole body, back and both hands. The papules and nodules were slightly painful and did not itch. On histopathological examination, the epidermal layer showed hyperkeratosis, acanthosis, spongiosis and basal cell vacuolization, while the dermis layer showed perivascular infiltrate dominated by lymphocytes with eosinophil cells obtained 1 cell and a little melanin dropping. Discussion: The histopathologic impression supports the diagnosis of chronic pityriasis lichenoides. The histopathologic picture of the patient showed vacuolar interface dermatitis with parakeratosis, exocytosis, erythrocyte extravasation, necrotic keratinocytes, spongiosis and perivascular lymphocytic infiltration. This case report shows the characteristic histopathologic features of lichenoid (interface) dermatitis and lymphocytic vasculitis which are typical histopathologic markers in patients with chronic pityriasis lichenoides. Conclussion: Pityriasis lichenoides is essentially a lymphocytic vasculitis with associated inflammatory cell infiltration showing exocytosis into the epidermis with blurring of the dermoepidermal interface

Keywords


pityiriasis, lichenoides, histopathology, lichenoid, interface

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References


. Lupu J, Chosidow O, Wolkenstein P, Bergqvist C, Ortonne N, Ingen‐Housz‐Oro S. Pityriasis lichenoides: a clinical and pathological case series of 49 patients with an emphasis on follow‐up. Clin Exp Dermatol. 2021;46(8):1561–6.

. Elbendary A, Youssef R, Abdel-Halim MRE, Abdel Halim D, El Sharkawy DA, Alfishawy M, et al. Role of streptococcal infection in the etiopathogenesis of pityriasis lichenoides chronica and the therapeutic efficacy of azithromycin: a randomized controlled trial. Arch Dermatol Res. 2023;315(3):521–30.

. Fernandes NF, Rozdeba PJ, Schwartz RA, Kihiczak G, Lambert WC. Pityriasis lichenoides et varioliformis acuta: a disease spectrum. Int J Dermatol. 2010;49(3):257–61.

. Koh W, Koh MJ, Tay Y. Pityriasis lichenoides in an Asian population. Int J Dermatol. 2013;52(12):1495–9.

. Agarwala S, Hafeez F. Pityriasis lichenoides-like drug reaction with numerous eosinophils. Int J Clin Exp Pathol. 2021;14(9):1010.

. Balan R, Grigoraş A, Popovici D, Amălinei C. The histopathological landscape of the major psoriasiform dermatoses. Archive of clinical cases. 2019;6(3):59.

. Sechi A, Pierobon E, Pezzolo E, Germi L, Trevisan G, Zardo D, et al. Abrupt onset of Sweet syndrome, pityriasis rubra pilaris, pityriasis lichenoides et varioliformis acuta and erythema multiforme: unravelling a possible common trigger, the COVID‐19 vaccine. Clin Exp Dermatol. 2022;47(2):437–40.

. Filippi F, Patrizi A, Sabattini E, Varotti E, Bertuzzi C, Pileri A. Pityriasis lichenoides triggered by measles‐mumps‐rubella vaccine injection. JDDG: Journal der Deutschen Dermatologischen Gesellschaft. 2020;18(7):758–60.

. Hrin ML, Bowers NL, Jorizzo JL, Feldman SR, Huang WW. Methotrexate for pityriasis lichenoides et varioliformis acuta (Mucha-Habermann disease) and pityriasis lichenoides chronica: A retrospective case series of 33 patients with an emphasis on outcomes. J Am Acad Dermatol. 2022;86(2):433–7.

. Zhang J, Lei Z, Xu C, Zhao J, Kang X. Current perspectives on severe drug eruption. Clin Rev Allergy Immunol. 2021;61(3):282–98.

. Clarey DD, Lauer SR, Trowbridge RM. Clinical, dermatoscopic, and histological findings in a diagnosis of pityriasis lichenoides. Cureus. 2020;12(6).

. Gru AA, Salavaggione AL. Lichenoid and interface dermatoses. In: Seminars in Diagnostic Pathology. Elsevier; 2017. p. 237–49.

. Daye M, Işık B, Kılınç F. Lichen planus due to hirudotherapy. Turkiye Parazitol Derg. 2021;45(2):149–52.

. Kusari A, Ahluwalia J. Lichen Planus. N Engl J Med. 2018 Aug;379(6):567.

. Cheng HM, Chuah SY, Gan EY, Jhingan A, Thng STG. A retrospective clinico‐pathological study comparing lichen planus pigmentosus with ashy dermatosis. Australasian Journal of Dermatology. 2018;59(4):322–7.

. Romiti R, Biancardi Gavioli CF, Anzai A, Munck A, Costa Fechine CO, Valente NYS. Clinical and histopathological findings of frontal fibrosing alopecia-associated lichen planus pigmentosus. Skin Appendage Disord. 2017;3(2):59–63.

. Dupire G, Droitcourt C, Hughes C, Le Cleach L. Antistreptococcal interventions for guttate and chronic plaque psoriasis. Cochrane Database of Systematic Reviews. 2019;(3).

. Garritsen FM, Kraag DE, De Graaf M. Guttate psoriasis triggered by perianal streptococcal infection. Clin Exp Dermatol. 2017;42(5):536–8.

. Grolleau C, Bettuzzi T, Wang L, Wolkenstein P, Sbidian E, Ortonne N. Guttate psoriasis shares histological features with pustular psoriasis and often shows neutrophil exocytosis and pustules. Pathology. 2024;56(4):606–8.

. Jindal R, Chauhan P, Sethi S. Dermoscopic characterization of guttate psoriasis, pityriasis rosea, and pityriasis lichenoides chronica in dark skin phototypes: an observational study. Dermatol Ther. 2021;34(1):e14631.

. Armstrong AW, Read C. Pathophysiology, clinical presentation, and treatment of psoriasis: a review. JAMA. 2020;323(19):1945–60.

. Mihu C, Neag MA, Bocşan IC, Melincovici CS, Vesa ŞC, Ionescu C, et al. Novel concepts in psoriasis: histopathology and markers related to modern treatment approaches. Romanian Journal of Morphology and Embryology. 2021;62(4):897.

. Deng Y, Chang C, Lu Q. The inflammatory response in psoriasis: a comprehensive review. Clin Rev Allergy Immunol. 2016;50:377–89.

. Huang YW, Tsai TF. HLA-Cw1 and psoriasis. Am J Clin Dermatol. 2021;22(3):339–47.

. Kamiya K, Kishimoto M, Sugai J, Komine M, Ohtsuki M. Risk factors for the development of psoriasis. Int J Mol Sci. 2019;20(18):4347.

. Nurfaiqoh E, Evanti AM, Primisawitri PP, Irawanto ME. Relationship between severity of psoriasis vulgaris based on Psoriasis Area And Severity Index (PASI) scores and depression. Journal of Pakistan Association of Dermatologists. 2023;33(1):101–7.

. Fitriani F, Dharmawan N, Hakim FA, Wasita B, Widhiati S. The difference of histopathological profile of early onset and late onset psoriasis in tertiary hospital in Central Java, Indonesia. Journal of Pakistan Association of Dermatologists. 2023;33(2):587–92.

. Niculet E, Radaschin DS, Nastase F, Draganescu M, Baroiu L, Miulescu M, et al. Influence of phytochemicals in induced psoriasis. Exp Ther Med. 2020;20(4):3421–4.




DOI: https://doi.org/10.33854/heme.v7i3.1728

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