You are in: eMedicine Specialties > Dermatology > REACTIVE AND INFLAMMATORY DERMATOSES Lichen SpinulosusArticle Last Updated: Dec 15, 2006AUTHOR AND EDITOR INFORMATIONSection 1 of 11
  Author: Stephen W White, MD, Clinical Assistant Professor, Department of Dermatology, George Washington University Hospital Stephen W White 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 Coauthor(s): Christopher R Gorman, MD, Resident Physician, Department of Dermatology, University of Virginia School of Medicine Editors: James J Nordlund, MD, Professor Emeritus, Department of Dermatology, University of Cincinnati College of Medicine; Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA; Rosalie Elenitsas, MD, Associate Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System; Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University; 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 Author and Editor Disclosure Synonyms and related keywords: keratosis follicularis spinulosa, lichen pilaris seu spinulosus of Crocker, keratosis follicularis spinosa of Unna INTRODUCTIONSection 2 of 11
  BackgroundLichen spinulosus (LS) is an uncommon dermatosis manifested by large patches of follicular papules topped by keratotic spines (see Media Files 1-2). In 1883, Crocker published a description of LS. Since then, few other similar reports were published until 1990, when Friedman presented data on 35 patients with LS. The etiology is unknown. Some minor progress has been made in therapy. PathophysiologyThe classic lesion of LS 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 LS from keratosis pilaris by microscopy may not be possible. FrequencyUnited StatesApparently, LS is not a common disorder. This conclusion is based on the paucity of published reports regarding LS. In the past, LS was reported to be associated with the administration of arsphenamine, thallium, gold, and diphtheria toxin. More recently, authors have noted association with HIV and Crohn disease. These associations may reflect the interests of the authors. InternationalLS has been reported worldwide. In 1990, Friedman described 35 patients with LS. He and his coworkers in the Philippines examined 7435 people attending a dermatology clinic. The incidence of LS 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/MorbidityLS affects only the skin and is not known to be associated with abnormalities of internal organ systems. Occasionally, a patient with LS complains of pruritus. Otherwise, the disorder mostly is of cosmetic significance. Misdiagnosis can result in inappropriate treatment. RaceWorldwide distribution suggests no predilection of LS in any ethnic group. SexCase reports suggest an equal distribution in males and females. Friedman's study in the Philippines included 14 males and 21 females. AgeReports indicate that LS is a disease that occurs during childhood to young adulthood. Peak incidence appears to occur during adolescence. The condition can persist for decades. In most patients, LS remits spontaneously within 1-2 years. Friedman calculated that in the Philippines, the average age at onset was 16.2 years ± 10.1 years. CLINICALSection 3 of 11
HistoryLS 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
CausesThe cause of LS is unknown. Infection has been postulated, but no data support this hypothesis. Other authors have suggested that LS is part of atopy, but no association of LS with atopy was found in the Philippines. A report notes a family with the condition in 4 generations, an observation that suggests a genetic predisposition. DIFFERENTIALSSection 4 of 11
Keratosis Pilaris
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| Drug Name | Lactic acid (Lac-Hydrin) |
|---|---|
| Description | 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 Dose | Apply topically qd/bid |
| Pediatric Dose | Apply as in adults |
| Contraindications | Documented hypersensitivity |
| Interactions | None reported |
| Pregnancy | B - Usually safe but benefits must outweigh the risks. |
| 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 |
| Drug Name | Salicylic acid 6% (cream, lotion, or gel) |
|---|---|
| Description | 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 Dose | Apply topically several times/d |
| Pediatric Dose | To avoid salicylate toxicity, use care when applying to large areas |
| Contraindications | 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 |
| Interactions | None reported |
| Pregnancy | C - Safety for use during pregnancy has not been established. |
| Precautions | Avoid contact with mucous membranes; immediately flush with water for 15 min if contact with eyes or mucous membranes occurs |
| Drug Name | Urea 40% cream or lotion |
|---|---|
| Description | Promotes hydration and removal of excess keratin. |
| Adult Dose | Apply prn to affected area |
| Pediatric Dose | Apply as in adults |
| Contraindications | Documented hypersensitivity; viral skin disease |
| Interactions | None reported |
| Pregnancy | C - Safety for use during pregnancy has not been established. |
| Precautions | Do not use near eyes; caution if applied to broken or swollen skin |
| Media file 1: Lichen spinulosus on the abdomen. | |
 | View Full Size Image | Media type: Photo |
| Media file 2: Close-up view. | |
 | View Full Size Image | Media type: Photo |
Article Last Updated: Dec 15, 2006
