What Is PLC or Pityriasis Lichenoides Chronica?
PLC or Pityriasis lichenoides chronica refers to a disorder of the skin characterized by development of skin lesions which are acute in the beginning but advance to become chronic. There is development of scales in the lesions with the skin having a flaky feel to it. Pityriasis lichenoides chronica can be both acute and chronic with acute form causing itchiness and pain and chronic being relatively symptom free. Virtually any region of body can get affected with Pityriasis lichenoides chronica; however, it mainly affects the back and chest and in some cases mouth and the genital areas as well. The lesions in case of PLC tend to wax and wane. They may persist for some months before they go away on their own accord. They may recur after a brief period of time and become chronic.
Pityriasis lichenoides chronica or PLC affects young adults and adolescents; however, it is not commonly seen in infants or the elderly population. If Pityriasis lichenoides chronica is mild then the prognosis is extremely good but severe cases pose a challenge for physicians to definitively treat it.
Is Pityriasis Lichenoides Chronica Contagious?
Pityriasis lichenoides chronica is a skin condition that is characterized by small, slightly raised pink lesions that tend to come together in clumps. There are two main types of Pityriasis lichenoides; which include the acute form namely Pityriasis Lichenoides Et Varioliformis Acuta and the chronic form namely Pityriasis Lichenoides Chronica. Both of these types are not contagious in nature. So, Pityriasis lichenoides chronica is not contagious and it cannot be spread by coming in contact with an individual who has the skin disorder.
What Causes Pityriasis Lichenoides Chronica?
The exact reason as to why Pityriasis lichenoides chronica or PLC occurs is not properly known. It is; however, known to be caused by hypersensitivity reaction of the body to various infectious agents to include Epstein-Barr virus. Adenovirus and Parvovirus B19, are some other infectious agents.
In some cases, people have developed Pityriasis lichenoides chronica or PLC after taking medications like, chemotherapy or hormone replacement therapy.
Apart from this, there is also some evidence that Pityriasis lichenoides chronica could be caused by Lymphoproliferatuve disorder or the overgrowth of cells of the lymphatic system.
Presenting Features of Pityriasis Lichenoides Chronica:
The presenting features of Pityriasis lichenoides chronica or PLC, include the appearance of papules on skin surface. Typically these papules begin as small, pink spots, and they may have a scaly layer on the top. Over time, these papules may turn brown in color and fade eventually.
The trunk, arms, buttocks, and legs are the most common locations for the papules; however, they may also occur on the hand, face, feet and scalp. These papules are typically located in groups, and generally are not painful or itchy. It must be mentioned that these papules of pityriasis lichenoides chronica, resemble those associated with psoriasis, insect bites or chicken pox.
Stages of Pityriasis Lichenoides Chronica:
It may take weeks to months for the lesions characteristic of Pityriasis lichenoides to appear. Depending on the stage of PLC, lesions may present themselves at any one time.
In the initial stage of PLC, there will be a tiny papule with pinkish tinge to it. As the condition advances, it becomes brown in color with a red tinge to it. Then, there is development of a scaly surface which is attached to the central part of the lesion. The individual can peel off the covering to reveal a shiny surface peeled off to reveal a shiny surface which has a pinkish tinge to it. In later stages, i.e. after several weeks, the lesions flattens out and there is a brown colored mark left behind which completely disappears after a few months.
Diagnosis of Pityriasis Lichenoides Chronica:
Physical Examination: Pityriasis lichenoides chronica or PLC may be suspected when a dermatologist observes papules on the skin that look like those that are associated with PLC. These papules can look like the papules caused by other diseases, such as psoriasis, chicken pox and insect bites. Apart from the physical examination, an extensive evaluation of the patient’s medical history would be required.
Dermoscopy. Dermoscopy is a skin examination done by the dermatologist utilizing a lens specially made to look at lesions seen with .
Skin Biopsy. This is also a mode of confirming the diagnosis and the tissue sample is sent to the lab for a detailed analysis. After piecing together the clinical findings, results of the tests and biopsy findings, and microscopic findings, the physician provides a confirmative diagnosis.
Differential Diagnosis. There may be a differential diagnosis done to rule out conditions like Guttate psoriasis, Varicella infection, Lymphomatoid papulosis. It must be noted that several clinical conditions have similar presentations, so your dermatologist or your doctor may perform some additional tests so as to come up with an accurate diagnosis and rule in or out other similar conditions.
Treatments of Pityriasis Lichenoides Chronica:
In many people, Pityriasis Lichenoides Chronica is self-limiting and fades away with time without any need for a treatment.
However, in individuals with persistent and recurring symptoms treatment is needed but as of now Pityriasis lichenoides Chronica cannot be definitively cured. The treatment approaches are aimed at controlling the symptoms and decreasing pain.
It must be noted that if the skin lesions are not a cause for concern in terms of symptoms, then the physician may opt for a wait and watch approach.
Oral antibiotics such as Erythromycin or tetracycline, are taken for at least 2-3 months in case a person suffers from Pityriasis lichenouides chronica.
Applying topical steroids could be beneficial in Pityriasis Lichenoides Chronica. Topical tacrolimus is an immunomodulator which is also quite beneficial in treating this condition. This cream or ointment is to be applied topically twice every day to treat Pityriasis lichenoides chronica.
The corticosteroid creams and ointments are applied to the affected area in the skin to control the rash and itching in PLC.
Treatments Through Methotrexate:
Methotrexate could also be used to treat symptoms of Pityriasis Lichenoides Chronica. The severe cases of Pityriasis lichenoides chronica are treated with systemic steroids or methotrexate.
Bromelain can also be considered as an effective therapeutic option for pityriasis lichenoides chronica. Its efficacy in treating the condition could be related to its anti-inflammatory, immunomodulatory and anti-viral properties.
In case oral antibiotics or other treatments do not work, phototherapy could be one treatment option for treating Pityraisis lichenoides chronica.
It is believed that exposure to sunlight or the ultraviolet rays of the sunlight, can help to resolve lesions. However, precaution is necessary to reduce sunburn due to sun exposure.
Treating PLC Lesions which get infected:
In case if the lesions in Pityriasis Lichenoides Chronica get infected then those can be treated by application of topical mupirocin along with sterile dressing changes at least twice daily.
Treating Psychological Discomfort:
The presence of skin lesions due to Pityriasis Lichenoides Chronica may be a cause for psychological distress and patients in some cases require assurance to calm down the stress levels and at times anxiety associated with Pityriasis lichenoides chronica. In order to treat this, one needs to do yoga and meditation under expert supervision.
NOTE. Even after the treatment, diligent followup is a necessity with close monitoring to prevent recurrences.
Complications of Pityriasis Lichenoides Chronica:
Some of the complications of Pityriasis lichenoides chronica include the following:
- When the skin lesions heal, there may be scar formation that may be a cosmetic issue.
- The longstanding lesions in Pityriasis lichenoides chronic can cause self-image issues, emotional stress and also psychological trauma in some patients, resulting in depression.
We are now aware of the condition of Pityriasis lichenoides chronica. It is essential for you to take care of your personal hygiene, try and avoid scratching the lesions even if they are extremely itchy, and also try and avoid prolonged sun exposure. Above all proper treatment is required to reduce the risk of the condition getting worse.