Purple, Pruritic, Polygonal Papules in a Boy

J.A. Schneider, DO Medical Director, Adolescent Medicine Mobile Health Outreach

St. Vincent Hospital - Jacksonville, FL CAPT, MC, USN (Ret)

Asst. Professor, Division of Adolescent Medicine, University of Florida (Ret)

Arthur Itis u 10-year-old male with a past hx of nummular

eczema presents to the clinic with a two week history of a rash that did not respond to 1% HC cream. This rash began as slightly erythematous PLANAR (flat topped) PAPULES that became increasingly POLYGONAL in configuration and coalesced into larger violacious PLAQUES that were PURPLE and PRURITIC and even involved the PENIS.

Overview of Arthur…

Purple, polygonal papules and plagues

Close-up of purple, polygonal papules and plaques

One picture says it all…

•Purple

•Polygonal

•Planar

•Papules

•Plaques

that are also

•Pruritic

and also...

on very close inspection are Penile in location

Another patient with a white , lacey pattern on the buccal mucosa that is often found in….

Answer: Lichen Planus “P”s of Lichen Planus üPURPLE üPOLYGONAL üPRURITIC üPLANAR üPAPULES üPLAQUES üPENILE

Agents That Cause Lichen Planus-like Eruptions

uArsenic uGold uPAS uIsoniazid uQuinidine

uStreptomycin uDiabinase uPhenothiazides uSalts in color film

Treatment uRemove offending agent if known uTopical steroids uAtarax

References l Shai A, Halevy S Lichen planus and lichen

planus-like eruptions: pathogenesis and associated diseases. Int J Dermatol (United States), Jun 1992, 31(6) p379-84

l Kanwar AJ, Handa S, Ghosh S, et al. Lichen planus in childhood: a report of 17 patients. Pediatr Dermatol (United States), Dec 1991, 8(4) p288-91

References • Boyd AS, Neldner KH Lichen planus J Am

Acad Dermatol (United States), Oct 1991, 25(4) p593-619

• Mokni M, Rybojad M, Puppin D Jr, et al. Lichen planus and hepatitis C virus. J Am Acad Dermatol (United States), May 1991, 24(5 Pt 1) p792