Lichen Spinulosus Clinical Presentation

  • Author: Stephen W White, MD; Chief Editor: William D James, MD   more...
 
Updated: Aug 5, 2011
 

History

Lichen spinulosus tends to have a sudden onset and is not accompanied by other signs or symptoms. The keratotic papules group into large plaques that can spread rapidly to affect large areas of skin.

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Physical

Patches and plaques of follicular papules have a diameter that ranges from 2-5 cm.

  • Patches are distributed symmetrically over the integument.
  • Patches affect the neck, buttocks, abdomen, trochanters, knees, and extensor surfaces of the arms.

Individual papules are flat to conical.

  • Individual papules usually are small, approximately 1-3 mm in diameter.
  • Papules have a pointed or hairlike horny spine that extends approximately 1 mm around the tip of the follicle.
  • When a patch is rubbed gently with the fingers, it feels similar to a nutmeg grater.
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Causes

The cause of lichen spinulosus is unknown. Infection has been postulated, but no data support this hypothesis. Other authors have suggested that lichen spinulosus is part of atopy, but no association of lichen spinulosus with atopy was found in the Philippines. A report notes a family with lichen spinulosus in 4 generations, an observation that suggests a genetic predisposition.

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Contributor Information and Disclosures
Author

Stephen W White, MD  Clinical Assistant Professor, Department of Dermatology, George Washington University Hospital; Chief, Sub-section of Dermatology, Suburban Hospital

Stephen W White, MD is a member of the following medical societies: American Academy of Dermatology, International Society of Dermatology, Society for Investigative Dermatology, and Society for Pediatric Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Christopher R Gorman, MD  Bethesda Dermatology, Private Practice; Assistant Clinical Professor, George Washington University School of Medicine and Health Sciences; Staff Dermatologist, National Naval Medical Center

Christopher R Gorman, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

Specialty Editor Board

James J Nordlund, MD  Professor Emeritus, Department of Dermatology, University of Cincinnati College of Medicine

James J Nordlund, MD is a member of the following medical societies: American Academy of Dermatology, Sigma Xi, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Rosalie Elenitsas, MD  Herman Beerman Associate Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System

Rosalie Elenitsas, MD is a member of the following medical societies: American Academy of Dermatology and American Society of Dermatopathology

Disclosure: Lippincott Williams Wilkins Royalty Textbook editor; DLA Piper Consulting fee Consulting

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

William D James, MD  Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

References
  1. Friedman SJ. Lichen spinulosus. Clinicopathologic review of thirty-five cases. J Am Acad Dermatol. Feb 1990;22(2 Pt 1):261-4. [Medline].

  2. Cohen SJ, Dicken CH. Generalized lichen spinulosus in an HIV-positive man. J Am Acad Dermatol. Jul 1991;25(1 Pt 1):116-8. [Medline].

  3. Kano Y, Orihara M, Yagita A, Shiohara T. Lichen spinulosus in a patient with Crohn's disease. Int J Dermatol. Sep 1995;34(9):670-1. [Medline].

  4. Kabashima R, Sugita K, Kabashima K, Nakamura M, Tokura Y. Lichen spinulosus in an alcoholic patient. Acta Derm Venereol. 2009;89(3):311-2. [Medline].

  5. Tilly JJ, Drolet BA, Esterly NB. Lichenoid eruptions in children. J Am Acad Dermatol. Oct 2004;51(4):606-24. [Medline].

  6. Cömert A, Akin O, Demirkesen C. Follicular mucinosis mimicking lichen spinulosus in an 11-year-old boy. Eur J Dermatol. Nov-Dec 2007;17(6):544-5. [Medline].

  7. Caccetta TP, Dessauvagie B, McCallum D, Kumarasinghe SP. Multiple minutedigitate hyperkeratosis: A proposed algorithm for the digitate keratoses. J Am Acad Dermatol. Nov 1/2010;[Epub ahead of print]. [Medline].

  8. Maiocco KJ, Miller OF. Lichen spinulosus: response to therapy. Cutis. Feb 1976;17(2):294-99. [Medline].

  9. Forman SB, Hudgins EM, Blaylock WK. Lichen spinulosus: excellent response to tretinoin gel and hydroactive adhesive applications. Arch Dermatol. Jan 2007;143(1):122-3. [Medline].

  10. Kim SH, Kang JH, Seo JK, Hwang SW, Sung HS, Lee D. Successful treatment of lichen spinulosus with topical tacalcitol cream. Pediatr Dermatol. Sep-Oct/2010;27(5):546-7. [Medline].

  11. Boyd AS. Lichen spinulosus: case report and overview. Cutis. Jun 1989;43(6):557-60. [Medline].

  12. Tilly JJ, Drolet BA, Esterly NB. Lichenoid eruptions in children. J Am Acad Dermatol. Oct 2004;51(4):606-24. [Medline].

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Lichen spinulosus on the abdomen.
Close-up view.
 
 
 
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