Lichen Spinulosus

Author: Stephen W White, MD; Chief Editor: William D James, MD more...

Updated: Aug 5, 2011

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Background
Pathophysiology
Epidemiology
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Background

Lichen spinulosus is an uncommon dermatosis manifested by large patches of follicular papules topped by keratotic spines, as shown below. In 1883, Crocker published a description of lichen spinulosus. Since then, few other similar reports were published until 1990, when Friedman presented data on 35 patients with lichen spinulosus.^[1]The etiology is unknown. Some minor progress has been made in therapy for lichen spinulosus.

Lichen spinulosus on the abdomen.

Close-up view.

Pathophysiology

The classic lesion of lichen spinulosus is a keratotic plug located within the dilated follicular orifice. Histologically, an inflammatory lymphohistiocytic infiltrate occurs around the follicle and in the dermis. Hyperkeratosis, parakeratosis, and acanthosis are visible in the follicle. Differentiating lichen spinulosus from keratosis pilaris by microscopy may not be possible.

In the past, lichen spinulosus was reported to be associated with the administration of arsphenamine, thallium, gold, and diphtheria toxin. More recently, authors have noted association with HIV disease^[2]and Crohn disease.^[3]These associations may reflect the interests of the authors. Kabashima et al reported lichen spinulosus in an alcoholic patient.^[4]

Frequency

United States

Apparently, lichen spinulosus is not a common disorder. This conclusion is based on the paucity of published reports regarding lichen spinulosus.

International

Lichen spinulosus has been reported worldwide. In 1990, Friedman described 35 patients with lichen spinulosus. He and his coworkers in the Philippines examined 7435 people attending a dermatology clinic.^[1]The incidence of lichen spinulosus was approximately 5 cases per 1000 population with skin disorders. This prevalence exceeds reports from various American surveys on cutaneous diseases in children and adolescents.

Mortality/Morbidity

Lichen spinulosus affects only the skin and is not known to be associated with abnormalities of internal organ systems. Occasionally, a patient with lichen spinulosus reports pruritus. Otherwise, the disorder mostly is of cosmetic significance. Misdiagnosis can result in inappropriate treatment.

Race

Worldwide distribution suggests no predilection of lichen spinulosus in any ethnic group.

Sex

Case reports suggest an equal distribution of lichen spinulosus in males and females. Friedman's study in the Philippines included 14 males and 21 females.

Age

Reports indicate that lichen spinulosus is a disease that occurs during childhood to young adulthood. Peak incidence appears to occur during adolescence. Lichen spinulosus can persist for decades. In most patients, lichen spinulosus remits spontaneously within 1-2 years. Friedman calculated that in the Philippines, the average age at onset was 16.2 years ± 10.1 years.

Proceed to Clinical Presentation

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

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].