Pityriasis Lichenoides Treatment & Management

Updated: Sep 11, 2020
  • Author: Jeffrey P Callen, MD; Chief Editor: Dirk M Elston, MD  more...
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Treatment

Medical Care

Large ulcerations found in the febrile ulceronecrotic variant of pityriasis lichenoides et varioliformis acuta (PLEVA) require local wound care. [35] Infected lesions may be treated with topical mupirocin and sterile dressing changes twice daily.

No randomized controlled trials of the use of medications have been performed in Mucha-Habermann disease. Since the disease tends towards self-resolution, evaluation of treatments without adequate controls cannot result in useful recommendations. A number of open trials have reported success with light therapy and oral medications. [36] Phototherapy is generally the most effective approach, with methotrexate reserved for severe or refractory disease. [37, 38, 39, 40, 41]

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Surgical Care

Two cases in the literature have reported a tonsillectomy in patients with chronic tonsillitis or high ASO titer and PLC and PLEVA, respectively. [42, 43]  One patient's skin disease resolved within days of the tonsillectomy, while the other's persisted for over 5 years.

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Prevention

No preventive methods have been identified.

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Long-Term Monitoring

Patients with a waxing and waning course of Mucha-Habermann disease require follow-up monitoring and additional treatment depending on the severity of the disease.

The exact etiology of pityriasis lichenoides has yet to be elucidated; a relationship with mycosis fungoides and lymphomatoid papulosis has been proposed based on the overlap of clinical, histologic, and immunohistochemical findings. [44] Although most cases of pityriasis lichenoides are self-limited, patients exhibiting a prolonged or atypical course warrant continued follow up and serial tissue sampling as clinically indicated.

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