Tuscaloosa Family Medicine - Clinical Pearls

A CASE OF LICHEN SPINULOSUS

A CASE OF LICHEN SPINULOSUS:

4 year old AAM was brought by his mother with a complaint of rash on the body. Rash was there for few months. Initially was localized and now it has become more generalized. The rash was itchy. Denied any systemic symptoms.

On examination, spine like papules surrounding the hair follicle were arranged in groups. They were predominantly present on the trunk and buttocks (Figure 1 & 2).

A diagnosis of Lichen spinulosus was made on the basis of clinical presentation.

Discussion:  Lichen spinulosus represents grouping of hair follicles with prominent follicular plugs. The exact pathogenesis is unknown. It may be confused with keratosis pilaris. However, keratosis pilaris is more common on the extensor aspects of the extremities and face and it typically does not occur in groups. 

Lichen spinulosus is treated with topical low to medium potency steroids while keratosis pilaris is treated with topical hydration (moisturizers)

 

 Figure 1: Lichen spinulosus lesions on the buttocks (Note papules arranged in groups).

 Figure 2: Lichen spinulosus lesions on the back of the trunk (Note papules arranged in groups).

Allergic Contact Dermatitis - Case Report

Woman in her 70s with a past medical history of multiple myeloma, HTN, DM was admitted with fracture of fibula. She underwent open reduction with internal fixation. On the 8^th post-op day, three large bullae were noticed on the front of the left thigh (Figure 1). There were no lesions elsewhere. 

Given its acute and localized onset, and the fact that patient did not have any prior history of bullous disease, allergic contact dermatitis was suspected. When inquired, nurse had informed that patient had a foley stabilization kit (Figure 2) placed at the same site earlier. The lesions corresponded with the margins of the foley stabilization kit, raising suspicion that lesions could be due to allergic contact dermatitis to foley stabilization kit. The brochure given along with the foley stabilization kit, mentions that its use is contraindicated in people with known tape or adhesive allergy. Patient did have history of allergy to tape increasing our suspicion. A formal allergy challenge test was, however, not done.

Patient was treated with silver sulfadiazine cream and oral antihistamines. She was followed up to see if she had developed similar lesions. Patient did not develop any new lesions and existing lesions have begun to heal in the next couple of days.

Take home message: This case reiterates the fact that in all acute, localized bullous eruptions, allergic contact dermatitis should always be ruled out; more so if it occurs in hospitalized patients.

Figure: 1 Bullous lesions on front of the thigh

Figure: 2 Foley Stabilization Kit

Dermatology Cases

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