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• W2145213071 abstract "To the Editor: A 55-year-old white female presented with a 2-year history of pruritic, erythematous, 2- to 4-mm thin papules on the upper chest arising on a photodamaged background. She was previously treated with triamcinolone acetonide ointment 0.1% and liquid nitrogen with only temporary improvement followed by recurrence. Similarly, a 62-year-old white female presented with a 1-year history of multiple 3- to 7-mm smooth, moderately erythematous, round papules on the upper chest, upper back, and proximal extremities, also arising on a poikilodermatous background (Fig 1). Three biopsy specimens from the first patient and a single biopsy specimen from the second patient all revealed similar findings. These included hypogranulosis, a few dyskeratotic cells in the epidermis, moderate basal vacuolization, and a dense band-like lymphocytic infiltrate obscuring the dermoepidermal junction that is characteristic of lichenoid keratosis (LK; Fig 2).Fig 2Hypogranulosis, few dyskeratotic cells in the epidermis, moderate basal vacuolization, and a dense band-like lymphocytic infiltrate obscuring the dermoepidermal junction, which is characteristic of lichenoid keratosis. (Hematoxylin–eosin stain; original magnification: ×20.)View Large Image Figure ViewerDownload Hi-res image Download (PPT)LK, also referred to as lichen planus (LP)–like keratosis, is a common lesion most often presenting as a single discrete papule. LK occurs most commonly on the chest and proximal upper extremities of fair-skinned women in their fifth and sixth decades of life. It has a round contour with a sloping periphery ranging in size from 3 to 10 mm and varies in color from light pink to intensely violaceous.1Laur W.E. Posey R.E. Waller J.D. Lichen planus-like keratosis.J Am Acad Dermatol. 1981; 4: 329-336Abstract Full Text PDF PubMed Scopus (42) Google Scholar When LK was first described, it was thought to be a “form fruste” of LP.2Lumpkin L.R. Helwig E.B. Solitary lichen planus.Arch Dermatol. 1966; 93: 54-55Crossref PubMed Scopus (56) Google Scholar Since then, there have been few reports of multiple LK in a single patient similar to those described herein.3Toll A. Gilaberte M. Gallardo F. Iglesias M. Barranco C. Pujol R.M. Multiple and extensive lichen planus–like keratoses: an underestimated cutaneous eruption observed in patients with intense sun damage.J Eur Acad Dermatol Venereol. 2006; 20: 472-473Crossref PubMed Scopus (8) Google Scholar, 4Barranco V.P. Multiple benign lichenoid keratoses simulating photodermatoses: evolution from senile lentigenes and their spontaneous regression.J Am Acad Dermatol. 1985; 13: 201-206Abstract Full Text PDF PubMed Scopus (19) Google Scholar, 5Cohen H.J. Lichen planus-like keratosis.Cutis. 1979; 23: 194-197PubMed Google Scholar Clinically, multiple LK and LP differ clinically in several ways. The population of patients with LP includes both children and adults; multiple LK occurs primarily in women in their fifth to sixth decades of life.1Laur W.E. Posey R.E. Waller J.D. Lichen planus-like keratosis.J Am Acad Dermatol. 1981; 4: 329-336Abstract Full Text PDF PubMed Scopus (42) Google Scholar The distribution of LP is that of the flexural aspects, lower back, and oral mucosa. In contrast, both patients described here and those previously reported had multiple LK in a photodistribution, with predominance on the upper chest. The lesions of LP are violaceous, polygonal, planar, and have scale in the form of Wickham striae. Histologically, there is some overlap. However, LK has parakeratosis not seen in LP, has less hyperkeratosis, and has an infiltrate that is frequently perivascular rather than band-like.1Laur W.E. Posey R.E. Waller J.D. Lichen planus-like keratosis.J Am Acad Dermatol. 1981; 4: 329-336Abstract Full Text PDF PubMed Scopus (42) Google ScholarWhile the clinical presentation of our cases is similar to that of multiple LK reported previously and supports the differentiation of multiple LK from LP, the clinical course in our cases differs from that of the reported cases. The previous cases report spontaneous resolution or clearance within 2 to 16 weeks after beginning topical steroid therapy. In contrast, the lesions in our patients were present for more than 1 year, and, as in the case of the first patient, persisted despite therapy with midpotency topical steroids and liquid nitrogen.In conclusion, we report two patients with multiple LK limited to photodamaged skin. The clinical and histologic findings were similar to solitary LK and differed from generalized LP. In one of the two patients, the lesions did not respond to midpotency topical steroids or cryodestruction. To the Editor: A 55-year-old white female presented with a 2-year history of pruritic, erythematous, 2- to 4-mm thin papules on the upper chest arising on a photodamaged background. She was previously treated with triamcinolone acetonide ointment 0.1% and liquid nitrogen with only temporary improvement followed by recurrence. Similarly, a 62-year-old white female presented with a 1-year history of multiple 3- to 7-mm smooth, moderately erythematous, round papules on the upper chest, upper back, and proximal extremities, also arising on a poikilodermatous background (Fig 1). Three biopsy specimens from the first patient and a single biopsy specimen from the second patient all revealed similar findings. These included hypogranulosis, a few dyskeratotic cells in the epidermis, moderate basal vacuolization, and a dense band-like lymphocytic infiltrate obscuring the dermoepidermal junction that is characteristic of lichenoid keratosis (LK; Fig 2). LK, also referred to as lichen planus (LP)–like keratosis, is a common lesion most often presenting as a single discrete papule. LK occurs most commonly on the chest and proximal upper extremities of fair-skinned women in their fifth and sixth decades of life. It has a round contour with a sloping periphery ranging in size from 3 to 10 mm and varies in color from light pink to intensely violaceous.1Laur W.E. Posey R.E. Waller J.D. Lichen planus-like keratosis.J Am Acad Dermatol. 1981; 4: 329-336Abstract Full Text PDF PubMed Scopus (42) Google Scholar When LK was first described, it was thought to be a “form fruste” of LP.2Lumpkin L.R. Helwig E.B. Solitary lichen planus.Arch Dermatol. 1966; 93: 54-55Crossref PubMed Scopus (56) Google Scholar Since then, there have been few reports of multiple LK in a single patient similar to those described herein.3Toll A. Gilaberte M. Gallardo F. Iglesias M. Barranco C. Pujol R.M. Multiple and extensive lichen planus–like keratoses: an underestimated cutaneous eruption observed in patients with intense sun damage.J Eur Acad Dermatol Venereol. 2006; 20: 472-473Crossref PubMed Scopus (8) Google Scholar, 4Barranco V.P. Multiple benign lichenoid keratoses simulating photodermatoses: evolution from senile lentigenes and their spontaneous regression.J Am Acad Dermatol. 1985; 13: 201-206Abstract Full Text PDF PubMed Scopus (19) Google Scholar, 5Cohen H.J. Lichen planus-like keratosis.Cutis. 1979; 23: 194-197PubMed Google Scholar Clinically, multiple LK and LP differ clinically in several ways. The population of patients with LP includes both children and adults; multiple LK occurs primarily in women in their fifth to sixth decades of life.1Laur W.E. Posey R.E. Waller J.D. Lichen planus-like keratosis.J Am Acad Dermatol. 1981; 4: 329-336Abstract Full Text PDF PubMed Scopus (42) Google Scholar The distribution of LP is that of the flexural aspects, lower back, and oral mucosa. In contrast, both patients described here and those previously reported had multiple LK in a photodistribution, with predominance on the upper chest. The lesions of LP are violaceous, polygonal, planar, and have scale in the form of Wickham striae. Histologically, there is some overlap. However, LK has parakeratosis not seen in LP, has less hyperkeratosis, and has an infiltrate that is frequently perivascular rather than band-like.1Laur W.E. Posey R.E. Waller J.D. Lichen planus-like keratosis.J Am Acad Dermatol. 1981; 4: 329-336Abstract Full Text PDF PubMed Scopus (42) Google Scholar While the clinical presentation of our cases is similar to that of multiple LK reported previously and supports the differentiation of multiple LK from LP, the clinical course in our cases differs from that of the reported cases. The previous cases report spontaneous resolution or clearance within 2 to 16 weeks after beginning topical steroid therapy. In contrast, the lesions in our patients were present for more than 1 year, and, as in the case of the first patient, persisted despite therapy with midpotency topical steroids and liquid nitrogen. In conclusion, we report two patients with multiple LK limited to photodamaged skin. The clinical and histologic findings were similar to solitary LK and differed from generalized LP. In one of the two patients, the lesions did not respond to midpotency topical steroids or cryodestruction." @default.
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• W2145213071 title "Multiple benign lichenoid keratoses" @default.
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