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Histology showed a deep&#44; perivascular lymphohistiocytic inflammatory infiltrate&#44; with fibrinoid necrosis in the vessel walls and involvement of the dermal-epidermal junction&#46; In the epidermis there was diffuse parakeratosis&#44; focal exocytosis&#44; isolated necrotic keratinocytes&#44; and small foci of necrosis &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Immunohistochemical staining with anti-S100 protein and CD1 antibodies was negative&#46; Based on the clinical and histologic findings&#44; we diagnosed PL and prescribed topical corticosteroid therapy &#40;methylprednisolone aceponate&#41;&#44; which resulted in slight improvement of the lesions&#46; The condition improved spontaneously over the following months&#44; leaving residual postinflammatory hypopigmented macules&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">PL is an inflammatory disease of unknown origin&#46; There have been some reports of T-cell clonality&#44; suggesting that the condition is either the result of an immune response to an as yet unidentified infectious agent or a cutaneous T-cell lymphoproliferative disorder&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However&#44; because progression to cutaneous T-cell lymphoma is so rare in children&#44; additional genetic factors would probably need to be present&#46; There are 2 clinical variants of PL&#58; pityriasis lichenoides chronica and pityriasis lichenoides et varioliformis acuta &#40;PLEVA&#41;&#46; However&#44; acute and chronic lesions may coexist&#46; Histologic findings may also vary according to the clinical variant&#44; but they do not always correlate with clinical morphology&#46; Prognosis is excellent&#44; and while PL can last for months&#44; or even years&#44; progression to T-cell lymphoma is very rare&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">PL can occur at any age&#44; but it is particularly common in children&#44; with incidence peaking at 2&#44; 5&#44; 10&#44; and 12 years of age&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> It is very rare in the first year of life&#46; In our review of the literature&#44; we found only 9 cases of onset before the age of 12 months&#46; These included 1 congenital case&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> 3 cases with onset at 8 months of age&#44;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;7</span></a> and 1 case with onset at 11 months of age&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> We also found mention of an additional 4 cases in children aged under 1 year in a retrospective study of 124 children with PL&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In the 9 cases described in the literature&#44; all the patients &#40;8 boys and 1 girl&#41; were otherwise healthy&#46; There was just 1 case with a history of previous infection&#44; in which pneumococci and <span class="elsevierStyleItalic">Haemophilus influenza</span> were isolated&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Six of the patients had lesions clinically consistent with PLEVA&#44; with ulceronecrotic lesions that resolved with topical corticosteroid therapy in a maximum of 2 months&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;7&#44;8</span></a> The remaining 3 patients had lesions that were clinically and histologically consistent with PL chronica&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;6</span></a> The disease followed an indolent course in 2 patients&#44; 1 of whom developed an indurated plaque in the right iliac fossa after a year and a half&#46; The plaque was initially compatible with lymphomatoid papulosis but 2 years later&#44; 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Case and Research Letters
Pityriasis Lichenoides in a 9-Month-Old Boy
Pitiriasis Liquenoide en un Lactante De 9 Meses
M.T. López-Villaescusaa, Á. Hernández-Martínb,
Corresponding author
ahernandez_hnj@yahoo.es

Corresponding author.
, I. Colmeneroc, A. Torrelob
a Servicio de Dermatología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
b Servicio de Dermatología, Hospital Infantil Niño Jesús, Madrid, Spain
c Servicio de Anatomía Patológica, Hospital Infantil Niño Jesús, Madrid, Spain
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A&#44; Deep perivascular lymphohistiocytic inflammatory infiltrate with involvement of the dermal-epidermal junction &#40;hematoxylin-eosin&#44; original magnification &#215;10&#41;&#46; B&#44; Detail showing interface alteration&#44; fibrinoid necrosis in the vessel walls&#44; and isolated necrotic keratinocytes &#40;hematoxylin-eosin&#44; original magnification &#215;40&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Pityriasis lichenoides &#40;PL&#41; is a skin disease of unknown origin that is characterized by scaling papules&#46; It is relatively common in childhood but very rare in the first year of life&#44; with just 9 cases described in the literature&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 9-month-old boy with no personal or family history of interest who was seen in our department for generalized skin lesions that had been present for a week&#46; The patient was afebrile and had no other symptoms or known history of prior infection&#46; Physical examination revealed papular scaling&#44; erythematous-brownish lenticular lesions on the trunk and proximal extremities &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; There was no mucosal involvement and the physical examination was otherwise normal&#46; Histology showed a deep&#44; perivascular lymphohistiocytic inflammatory infiltrate&#44; with fibrinoid necrosis in the vessel walls and involvement of the dermal-epidermal junction&#46; In the epidermis there was diffuse parakeratosis&#44; focal exocytosis&#44; isolated necrotic keratinocytes&#44; and small foci of necrosis &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Immunohistochemical staining with anti-S100 protein and CD1 antibodies was negative&#46; Based on the clinical and histologic findings&#44; we diagnosed PL and prescribed topical corticosteroid therapy &#40;methylprednisolone aceponate&#41;&#44; which resulted in slight improvement of the lesions&#46; The condition improved spontaneously over the following months&#44; leaving residual postinflammatory hypopigmented macules&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">PL is an inflammatory disease of unknown origin&#46; There have been some reports of T-cell clonality&#44; suggesting that the condition is either the result of an immune response to an as yet unidentified infectious agent or a cutaneous T-cell lymphoproliferative disorder&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However&#44; because progression to cutaneous T-cell lymphoma is so rare in children&#44; additional genetic factors would probably need to be present&#46; There are 2 clinical variants of PL&#58; pityriasis lichenoides chronica and pityriasis lichenoides et varioliformis acuta &#40;PLEVA&#41;&#46; However&#44; acute and chronic lesions may coexist&#46; Histologic findings may also vary according to the clinical variant&#44; but they do not always correlate with clinical morphology&#46; Prognosis is excellent&#44; and while PL can last for months&#44; or even years&#44; progression to T-cell lymphoma is very rare&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">PL can occur at any age&#44; but it is particularly common in children&#44; with incidence peaking at 2&#44; 5&#44; 10&#44; and 12 years of age&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> It is very rare in the first year of life&#46; In our review of the literature&#44; we found only 9 cases of onset before the age of 12 months&#46; These included 1 congenital case&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> 3 cases with onset at 8 months of age&#44;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;7</span></a> and 1 case with onset at 11 months of age&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> We also found mention of an additional 4 cases in children aged under 1 year in a retrospective study of 124 children with PL&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In the 9 cases described in the literature&#44; all the patients &#40;8 boys and 1 girl&#41; were otherwise healthy&#46; There was just 1 case with a history of previous infection&#44; in which pneumococci and <span class="elsevierStyleItalic">Haemophilus influenza</span> were isolated&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Six of the patients had lesions clinically consistent with PLEVA&#44; with ulceronecrotic lesions that resolved with topical corticosteroid therapy in a maximum of 2 months&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;7&#44;8</span></a> The remaining 3 patients had lesions that were clinically and histologically consistent with PL chronica&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;6</span></a> The disease followed an indolent course in 2 patients&#44; 1 of whom developed an indurated plaque in the right iliac fossa after a year and a half&#46; The plaque was initially compatible with lymphomatoid papulosis but 2 years later&#44; it was histologically diagnosed as cutaneous T-cell lymphoma&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The second patient developed parapsoriasis at 10 years of follow-up&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Given the scarcity of cases in the literature&#44; no clear conclusions can be drawn&#44; but based on our review&#44; PL would appear to be very rare in children under 12 months of age&#44; with just 10 cases&#44; including ours&#44; reported to date&#46; Within this age group&#44; PL is more common in boys and tends to occur in an acute form and to resolve spontaneously without complications&#46; Nevertheless&#44; given the possible association with lymphoproliferative disorders&#44; long-term monitoring is recommended&#46;</p></span>"
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Article information
ISSN: 15782190
Original language: English
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