eMedicine Specialties > Dermatology > Reactive & Inflammatory Dermatoses

Lichen Spinulosus: Treatment & Medication

Author: Stephen W White, MD, Clinical Assistant Professor, Department of Dermatology, George Washington University Hospital; Chief, Sub-section of Dermatology, Suburban Hospital
Coauthor(s): Christopher R Gorman, MD, Bethesda Dermatology, private practice
Contributor Information and Disclosures

Updated: Oct 30, 2009

Treatment

Medical Care

No cure exists for lichen spinulosus, but some medications ameliorate its clinical manifestations. Because of the horny plug, keratolytics have been used as a treatment. These include salicylic acid, lactic acid, and/or urea in various creams, ointments, gels, and lotions.7 The literature does not support the use of topical steroids in lichen spinulosus. The combination of tretinoin gel at bedtime with hydroactive adhesives the following morning has been reported to be efficacious.8

Consultations

Consultation with an experienced dermatologist is indicated if any doubt exists concerning the diagnosis.

Medication

The goal of treatment for lichen spinulosus is to improve the cosmetic disfigurement caused by the disorder.

Keratolytic agents

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.


Lactic acid (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.

Adult

Apply topically qd/bid

Pediatric

Apply as in adults

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

May sting or cause pain if applied on broken skin; may cause irritation with erythema, burning, and peeling if applied to face in 12% concentrations


Salicylic acid 6% (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.

Adult

Apply topically several times/d

Pediatric

To avoid salicylate toxicity, use care when applying to large areas

Documented hypersensitivity; prolonged use in infants and patients with diabetes or impaired circulation; use on moles, birthmarks, warts with hair growth, genital or facial warts, warts on mucous membranes, irritated skin, or infected or reddened areas

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Avoid contact with mucous membranes; immediately flush with water for 15 min if contact with eyes or mucous membranes occurs


Urea 40% cream or lotion

Promotes hydration and removal of excess keratin.

Adult

Apply prn to affected area

Pediatric

Apply as in adults

Documented hypersensitivity; viral skin disease

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Do not use near eyes; caution if applied to broken or swollen skin

More on Lichen Spinulosus

Overview: Lichen Spinulosus
Differential Diagnoses & Workup: Lichen Spinulosus
Treatment & Medication: Lichen Spinulosus
Follow-up: Lichen Spinulosus
Multimedia: Lichen Spinulosus
References
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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. Maiocco KJ, Miller OF. Lichen spinulosus: response to therapy. Cutis. Feb 1976;17(2):294-99. [Medline].

  8. 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].

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

  10. 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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Further Reading

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Keywords

lichen spinulosus, keratosis follicularis spinulosa, lichen pilaris seu spinulosus of Crocker, keratosis follicularis spinosa of Unna

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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
Christopher R Gorman, MD is a member of the following medical societies: Alpha Omega Alpha
Disclosure: Nothing to disclose.

Medical Editor

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.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University 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.

Managing Editor

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: Nothing to disclose.

CME Editor

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, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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