Pityriasis Lichenoides Medication

  • Author: Peter A Klein, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Mar 7, 2012
 

Medication Summary

No randomized controlled trials have been performed in Mucha-Habermann disease. Since the disease course tends towards self-resolution, evaluation of treatments without adequate controls cannot result in rational recommendations. Nevertheless, a number of open trials have reported success with light therapy and oral medications.

Phototherapy has been reported useful in the treatment of subacute or chronic disease.[21] Psoralen plus UV-A (PUVA) therapy (150-200 J/cm2) has been reported, with as many as 4 treatments per week to a total of 30-35 treatments, depending on the patient's skin type. UV-A without psoralens and UV-B may result in clearing. Relapses are not uncommon. Narrow-band ultraviolet B phototherapy and photodynamic therapy have also been reported as effective.[22, 23, 24, 25]

Case reports suggest the use of multiple oral medications including tetracycline,[18] azithromycin, erythromycin, sulfonamides, dapsone, chloroquine, streptomycin, isoniazid, penicillin, methotrexate (MTX),[26] etretinate, and pentoxifylline. Potent topical corticosteroids may be useful if few lesions are present. Systemic corticosteroids may have a role in severe cases of PLEVA. Despite a lack of randomized controlled trials, oral tetracycline and erythromycin have been prescribed most often in case series.

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Antibiotics

Class Summary

May have immunomodulatory activity. Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

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Tetracycline (Sumycin)

 

Treats gram-positive and gram-negative organisms, as well as mycoplasmal, chlamydial, and rickettsial infections. Inhibits bacterial protein synthesis by binding with 30S and possibly 50S ribosomal subunit(s).

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Erythromycin (E.E.S., E-Mycin, Ery-Tab)

 

Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes causing RNA-dependent protein synthesis to arrest. For treatment of staphylococcal and streptococcal infections.

In children, age, weight, and severity of infection determine proper dosage. When bid dosing is desired, half-total daily dose may be administered q12h. For more severe infections, dose is doubled.

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Psoralens

Class Summary

Tricyclic furocoumarins, when combined with UV radiation, produce DNA photoproducts resulting in suppression of both DNA synthesis and cell division.

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Methoxsalen (Oxsoralen-Ultra, 8-MOP)

 

Inhibits mitosis by binding covalently to pyrimidine bases in DNA when photoactivated by UV-A.

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Retinoids

Class Summary

Regulate cell growth and proliferation.

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Acitretin (Soriatane)

 

Retinoic acid analog, similar to etretinate and isotretinoin. Etretinate is main metabolite and has demonstrated clinical effects close to those seen with etretinate. Mechanism of action is unknown.

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Antimetabolites

Class Summary

MTX inhibits dihydrofolate reductase, thereby hindering DNA synthesis and cell reproduction.

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Methotrexate (Folex, Rheumatrex)

 

May suppress immune system. Ameliorates symptoms of inflammation (eg, pain, swelling, stiffness).

Satisfactory response seen in 3-6 wk following administration. Adjust dose gradually to attain satisfactory response.

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Contributor Information and Disclosures
Author

Peter A Klein, MD  Residency Program Director, Department of Dermatology, University Hospital, State University of New York at Stony Brook

Disclosure: Nothing to disclose.

Coauthor(s)

Jeffrey P Callen, MD  Professor of Medicine (Dermatology), Chief, Division of Dermatology, University of Louisville School of Medicine

Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and American College of Rheumatology

Disclosure: Amgen Honoraria Consulting; Celgene Honoraria Safety Monitoring Committee

Specialty Editor Board

Gregory J Raugi, MD, PhD  Professor, Department of Internal Medicine, Division of Dermatology, University of Washington at Seattle School of Medicine; Chief, Dermatology Section, Primary and Specialty Care Service, Veterans Administration Medical Center of Seattle

Gregory J Raugi, MD, PhD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Daniel S Loo, MD  Associate Professor of Dermatology, Residency Program Director, Department of Dermatology, Tufts Medical Center

Daniel S Loo, MD is a member of the following medical societies: American Academy of Dermatology and Association of Professors of Dermatology

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous Chief Editor, William D. James, MD, to the development and writing of this article.

References

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  26. Lazaridou E, Fotiadou C, Tsorova C, et al. Resistant pityriasis lichenoides et varioliformis acuta in a 3-year-old boy: successful treatment with methotrexate. Int J Dermatol. Feb 2010;49(2):215-7. [Medline].

 
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Typical hemorrhagic crusted papules of pityriasis lichenoides et varioliformis acuta.
Close-up view of typical lesions of pityriasis lichenoides et varioliformis acuta.
Scaling papules of pityriasis lichenoides chronica.
Close-up view of typical pityriasis lichenoides chronica lesions. Note papules in different stages of evolution and the scale with frosted-glass appearance in the lower right-hand corner.
 
 
 
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