Lichen Spinulosus Clinical Presentation

Updated: Aug 14, 2017
  • Author: Christopher R Gorman, MD; Chief Editor: William D James, MD  more...
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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.


Physical Examination

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.



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 four generations, an observation that suggests a genetic predisposition.



Lichen spinulosus is confined to the skin and has no known associations with internal disorders or genetic syndromes.