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Therapeutic Approach

Pityriasis lichenoides chronica (PLC) is an uncommon, inflammatory skin disease characterized by small red or brown scaly papules diffusely on the trunk and extremities. PLC lies on the chronic, indolent end of the pityriasis lichenoides spectrum, opposite to pityriasis lichenoides et varioliformis acuta (PLEVA). The etiology is unknown, with a T-cell mediated reaction triggered by an infection or drug as a leading hypothesis. Because PLC may display T-cell clonality, there is question of a connection or overlap with lymphoproliferative disorders. There are few therapeutic trials for PLC, with most evidence based on uncontrolled case series and retrospective reviews. As a result, there are no FDA-approved therapies. Due to the possibility of an infectious etiology, antimicrobials and anti-inflammatories are used sometimes with efficacy. Since PLC is a self-limited condition, treatment is based on cosmetic and symptomatic improvement. However, PLC usually follows a relapsing course over months to years. At our institution, limited PLC is treated with topical steroids. For extensive disease, phototherapy with topical steroids is first line, while antimicrobials, such as doxycycline, with topical steroids is second line. Lastly, we reserve methotrexate for recalcitrant cases. See Table 9-1.

Table 9-1Pityriasis Lichenoides Chronica Treatment Table

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