Annular lichenoid dermatitis of youth - 29/08/11

Doi : 10.1016/S0190-9622(03)02147-9

Giorgio Annessi, MD ^a,^⁎ , Mauro Paradisi, MD ^a, Corrado Angelo, MD ^a, Marie Perez, PhD ^a, Pietro Puddu, MD ^a, Giampiero Girolomoni, MD ^a
^a Istituto Dermopatico dell'Immacolata, IRCCS, Rome, Italy

^*Reprint requests: Giorgio Annessi, MD, Servizio di Istopatologia, Istituto Dermopatico dell'Immacolata, IRCCS, Via Monti di Creta 104, 00167 Roma, Italy

Abstract

Background

Lichenoid dermatoses are composed of a wide spectrum of disorders with a common histopathologic interface pattern but diverse causes and pathophysiology.

Objective

We describe a series of young patients with a peculiar annular lichenoid dermatitis, the clinical appearance of which initially suggested diagnoses of morphea, mycosis fungoides, or annular erythema.

Results

The study involved 23 patients (median age 10 years; age range 5-22 years). Lesions consisted of persistent asymptomatic erythematous macules and round annular patches with a red-brownish border and central hypopigmentation, mostly distributed on the groin and flanks. Histology revealed a peculiar lichenoid dermatitis with massive necrosis/apoptosis of the keratinocytes limited to the tips of rete ridges, in the absence of dermal sclerosis and epidermotropism of atypical lymphocytes. The infiltrate was composed mainly of memory CD4⁺ CD30⁻ T cells with few B cells and macrophages. Analysis of T-cell receptor-γ-chain gene rearrangement in skin biopsy specimens revealed polyclonality in all the 15 cases studied. Topical and systemic corticosteroids or phototherapy were effective in most patients with relapse after treatment withdrawal.