Medication Summary
The goal of treatment for lichen spinulosus is to improve the cosmetic disfigurement caused by the disorder.
Keratolytic Agents
Class Summary
Topical lactic acid creams have provided the most successful therapy to date. Salicylic acid gel and urea containing lotions also have been reported to help soften the horny papules. Gentle abrasion with a pad, soft brush, or luffa pad can be tried to remove the horny spines.
Ammonium lactate (Lac-Hydrin)
Contains lactic acid, an alpha-hydroxy acid with keratolytic action, thus facilitating release of comedones. Available in 12% and 5% strengths. The 12% form may cause irritation on the face. Causes disadhesion of corneocytes. Found in a variety of topical emollient lotions.
May be combined with 10-20% urea cream or be used with salicylic acid gel.
Salicylic acid topical (cream, lotion, or gel)
Beta-hydroxy acid reported to soften papules. By dissolving intercellular cement substance, produces desquamation of the horny layer of skin, while not affecting structure of viable epidermis. Comes as a cream, lotion, or gel.
Urea
Promotes hydration and removal of excess keratin.
Friedman SJ. Lichen spinulosus. Clinicopathologic review of thirty-five cases. J Am Acad Dermatol. Feb 1990;22(2 Pt 1):261-4. [Medline].
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].
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].
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].
Tilly JJ, Drolet BA, Esterly NB. Lichenoid eruptions in children. J Am Acad Dermatol. Oct 2004;51(4):606-24. [Medline].
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].
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].
Maiocco KJ, Miller OF. Lichen spinulosus: response to therapy. Cutis. Feb 1976;17(2):294-99. [Medline].
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].
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].
Boyd AS. Lichen spinulosus: case report and overview. Cutis. Jun 1989;43(6):557-60. [Medline].
Tilly JJ, Drolet BA, Esterly NB. Lichenoid eruptions in children. J Am Acad Dermatol. Oct 2004;51(4):606-24. [Medline].

