Pityriasis lichenoides chronica presenting in skin of color
-
Bailey Cook
and
Richard Miller
A 40-year-old Black male with a history of pityriasis lichenoides et varioliformis acuta (PLEVA) 15 years prior presented to a dermatology clinic in February 2023 with occasional red scaly papules that became hypopigmented macules over time. He denied any cutaneous symptoms and gross review of systems was negative. A physical examination, including Wood’s lamp evaluation, showed several hypopigmented macules and patches on his back and thighs (Figure 1A and C). Histopathology revealed vacuolar changes in basal epidermal keratinocytes, scattered cytoid bodies, and an inflammatory infiltrate at the dermal-epidermal junction in a superficial to deep dermal, perivascular distribution. Histopathologic correlation was consistent with pityriasis lichenoides chronica (PLC) and the patient was successfully treated with 25 narrowband UVB (311–313 nm) sessions between February 2023 and July 2023 with significant re-pigmentation of his trunk and extremities (Figure 1B and D).
Pre- and post-treatment photographs of the patient described in this report. (A) Widespread hypopigmented non-scaly macules coalescing into patches on the back. (B) Re-pigmentation of hypopigmented macules and patches on back after treatment with narrowband UVB. (C) Several large hypopigmented patches with evidence or follicular sparring on right anterior upper leg. (D) Re-pigmentation of hypopigmented patches on right anterior upper leg after treatment with narrowband UVB.
Plaque-like lesions of PLC, which is a T-cell lymphoproliferative disorder with a CD4+ T-cell infiltrate, often resemble scaly, erythematous to red-brown papules that involute over weeks to months, leaving hypopigmented macules and patches [1]. Histopathological examination often reveals vacuolar alteration of basal epidermal keratinocytes, a dermal-epidermal inflammatory infiltrate, and a perivascular distribution of inflammatory cells [1]. This disorder likely exists on the spectrum of pityriasis lichenoides, exhibiting a chronic course compared to its acute counterpart, PLEVA [2]. PLC predominantly affects adolescents and young adults, with a variable clinical presentation ranging from mildly symptomatic to more severe and widespread lesions [3]. While the diagnosis can be made clinically, a biopsy may be required to clinically differentiate other hypopigmented dermatoses including tinea versicolor, progressive macular hypomelanosis, post-inflammatory hypopigmentation, hypopigmented mycosis fungoides, and pityriasis alba. Interestingly, a cross-sectional study performed by Elbednary et al. demonstrated the hypopigmentation present in PLC can represent active disease, residual, or post-inflammatory hypopigmentation [4]. Therapeutic interventions for PLC aim to alleviate symptoms, such as pruritus, and prevent disease progression [3]. Treatments with the most consistent clinical efficacy include erythromycin and narrowband UVB. Other therapies include psoralen and ultraviolet A, methotrexate, and TNF-α antagonists [3], 5]. The choice of therapy depends on individual severity and response to treatment.
Acknowledgements
The authors would like to thank Kelli Hutchens, MD, MBA (Forefront Dermatology) for her histopathologic expertise.
-
Research ethics: Not applicable.
-
Informed consent: The patient provided written consent for publication of his photographs.
-
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
-
Use of Large Language Models, AI and Machine Learning Tools: None declared.
-
Conflict of interest: None declared.
-
Research funding: None declared.
-
Data availability: Not applicable.
References
1. Bolognia, JL, Schaffer, JV, Cerroni, L, editors. Dermatology, 4th ed. Elsevier; 2018.Search in Google Scholar
2. Bowers, S, Warshaw, EM. Pityriasis lichenoides and its subtypes. J Am Acad Dermatol 2006;55:557–72; quiz 573–6, https://doi.org/10.1016/j.jaad.2005.07.058.Search in Google Scholar PubMed
3. Scorer, MJ, Johnston, GA. Pityriasis lichenoides chronica. In: Lebwohl, MG, Heymann, WR, Coulson, IH, Murrell, DF, editors. Treatment of skin disease comprehensive therapeutic strategies, 6th ed. Elsevier; 2022:648–50 pp.Search in Google Scholar
4. Elbendary, A, Abdel-Halim, MRE, Youssef, R, Abdel Halim, D, Elmasry, MF, Gad, A, et al.. Hypopigmented lesions in pityriasis lichenoides chronica patients: are they only post-inflammatory hypopigmentation? Australas J Dermatol 2022;63:68–73. https://doi.org/10.1111/ajd.13746.Search in Google Scholar PubMed
5. Said, BB, Kanitakis, J, Graber, I, Nicolas, JF, Saurin, JC, Berard, F. Pityriasis lichenoides chronica induced by adalimumab therapy for Crohn’s disease: report of 2 cases successfully treated with methotrexate. Inflamm Bowel Dis 2010;16:912–3. https://doi.org/10.1002/ibd.21110.Search in Google Scholar PubMed
© 2025 the author(s), published by De Gruyter, Berlin/Boston
This work is licensed under the Creative Commons Attribution 4.0 International License.
Articles in the same Issue
- Frontmatter
- General
- Original Article
- Determining the effects of social media engagement on surgery residents within the American College of Osteopathic Surgeons
- Medical Education
- Commentary
- Pioneering the future: incorporating lifestyle medicine tools in osteopathic medical education
- Musculoskeletal Medicine and Pain
- Original Article
- Urinary incontinence in elite female powerlifters aged 20–30: correlating musculoskeletal exam data with incontinence severity index and survey data
- Neuromusculoskeletal Medicine (OMT)
- Original Article
- Effects of a single osteopathic manipulative treatment on intraocular pressure reduction: a pilot study
- Public Health and Primary Care
- Original Article
- Impact of a clinician-directed educational program on communicating with patients regarding gun violence at two community urban healthcare centers
- Clinical Image
- Pityriasis lichenoides chronica presenting in skin of color
Articles in the same Issue
- Frontmatter
- General
- Original Article
- Determining the effects of social media engagement on surgery residents within the American College of Osteopathic Surgeons
- Medical Education
- Commentary
- Pioneering the future: incorporating lifestyle medicine tools in osteopathic medical education
- Musculoskeletal Medicine and Pain
- Original Article
- Urinary incontinence in elite female powerlifters aged 20–30: correlating musculoskeletal exam data with incontinence severity index and survey data
- Neuromusculoskeletal Medicine (OMT)
- Original Article
- Effects of a single osteopathic manipulative treatment on intraocular pressure reduction: a pilot study
- Public Health and Primary Care
- Original Article
- Impact of a clinician-directed educational program on communicating with patients regarding gun violence at two community urban healthcare centers
- Clinical Image
- Pityriasis lichenoides chronica presenting in skin of color
