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Pityriasis Lichenoides Workup

  • Author: Mark Tye Haeberle, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Aug 26, 2015
 

Laboratory Studies

Laboratory workup largely is a function of the acuity of the disease. A patient presenting with febrile ulceronecrotic pityriasis lichenoides et varioliformis acuta (PLEVA) requires an entirely different approach than a patient presenting with pityriasis lichenoides chronica (PLC).

The following laboratory tests address both implicated causes of Mucha-Habermann disease and other disorders in the differential diagnosis; tailor the workup to each patient's presentation:

  • Antistreptolysin O titers
  • EBV IgM/IgG viral capsid antigen and nuclear antigen antibody
  • Erythrocyte sedimentation rate
  • Hepatitis B surface antigen, antisurface antibody, and anticore IgM
  • Hepatitis C virus antibody
  • HIV screening
  • Monospot or heterophil antibody test
  • Rapid plasma reagin
  • Throat cultures
  • Toxoplasma Sabin-Feldman dye test, enzyme-linked immunoassay, and indirect immunofluorescence/hemagglutination
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Other Tests

A punch biopsy of 3 mm or larger or shave biopsy should be strongly considered to ensure the diagnosis and rule out lymphomatoid papulosis.

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Histologic Findings

Ackerman has established histopathologic criteria for fully developed lesions of PLEVA and PLC.[22] Early lesions in both variants are smooth, since areas of parakeratosis initially are overlain by a normal cornified layer with a basket-woven appearance.

PLEVA lesions are characterized by a wedge-shaped superficial and deep dermal lymphohistiocytic infiltrate with intravascular margination of neutrophils, a confluent parakeratotic scale crust, thinning of the granular layer, basilar necrosis of keratinocytes, vacuolar interface dermatitis with a lymphocyte in nearly every vacuole, erythrocyte extravasation, and dermal edema.

Rare cases of γδ T-cell–predominant disease may mimic more aggressive lymphomas histologically.[23]

PLC lesions are characterized by a superficial dermal infiltrate, focal parakeratosis, preservation of the granular layer, and focal disappearance of the dermal-epidermal interface.

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Contributor Information and Disclosures
Author

Mark Tye Haeberle, MD Resident Physician, Department of Medicine, Division of Dermatology, University of Louisville School of Medicine

Mark Tye Haeberle, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Student Association/Foundation, American Society of Dermatopathology

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, American College of Rheumatology

Disclosure: Received income in an amount equal to or greater than $250 from: Eli Lilly; XOMA; Biogen/IDEC; Novartis; Celgene<br/>Received honoraria from UpToDate for author/editor; Received honoraria from JAMA Dermatology for associate editor and intermittent author; Received royalty from Elsevier for book author/editor; Received i do not control these accounts, but have directed our managers to divest pharmaceutical stocks as is fiscally prudent from Stock holdings in various trust accounts include some pharmaceutical companies and device makers for i inherited these trust accounts; .

Specialty Editor Board

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

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

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

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

Disclosure: Nothing to disclose.

Additional Contributors

Peter A Klein, MD Associate Professor, Department of Dermatology, University Hospital, State University of New York at Stony Brook

Disclosure: Nothing to disclose.

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.

Acknowledgements

Peter A Klein, MD  Associate Professor, Department of Dermatology, University Hospital, State University of New York at Stony Brook

Disclosure: Nothing to disclose.

References
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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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