Pediatric emergency medicine trisk 1370 1370

represents a precursor to cutaneous T-cell lymphoma, periodic longer-term outpatient monitoring is advised Treatment for the condition typically involves an initial trial of macrolide derivatives such as erythromycin, and recalcitrant cases may be treated with ultraviolet light phototherapy More severe cases, including those with FUMH, typically require systemic immunosuppressive therapy with agents such as methotrexate Breaks from therapy can often be taken during the summer months when disease activity wanes from natural sunlight exposure Long term, the condition remits spontaneously over a period of several years Lichen nitidus Lichen nitidus is a benign, self-limited condition characterized by crops of small (1 to mm), discrete flat-topped off-white papules scattered over the torso and extremities ( Fig 70.11 ), but which can involve the face and genitalia as well Lesions often show characteristic groups of papules, with some in a linear configuration demonstrating the phenomenon of koebnerization at sites of minor trauma In contrast to follicular eczema, which is often pruritic, the skin in lichen nitidus is usually asymptomatic Treatment typically involves watchful waiting and reassurance, although some patients may respond to topical corticosteroids or calcineurin inhibitors such as pimecrolimus cream or tacrolimus ointment Lichen planus Lichen planus is often easily recognized by its intensely pruritic, purplish, often polygonal papules and plaques ( Fig 70.12 ) The condition can occur anywhere, but is usually seen involving the extremities Areas may show koebnerization, with lesions appearing at sites of minor skin trauma Affected patients should be asked about and examined for oral or genital involvement, which may or may not be symptomatic at these sites On the mucous membranes, the condition has a lacy white appearance