50-year-old with 12-month Pityriasis Lichenoides Chronic PLC 苔藓样糠疹
A 50-year-old woman sought treatment at our clinic with a peculiar skin condition. She presented with mica-like scales, itchy, erythematous-to-brown papules of varying sizes (ranging from 3 mm to 1 cm) on her trunk and extremities. The lesions on her legs exhibited crusting and necrosis (Fig.1). A skin biopsy confirmed the diagnosis of Pityriasis Lichenoides Chronic (PLC), revealing keratinocytes within the epidermis and a lichenoid infiltrate consisting of lymphocytes, histiocytes, and melanophages in the papillary dermis. Laboratory investigations yielded normal results, including complete blood count, liver function, renal panel, C-reactive protein, erythrocyte sedimentation rate, and allergen-specific IgE assay.
The woman recalled the sudden onset of small, reddish-brown papules that eventually developed into pus-filled vesicles a year ago. Seeking medical help, she visited a local hospital where she was administered oral steroids (prednisolone) and underwent a skin biopsy. However, the rashes persisted, and the vesicles transformed into crust erosions. Additional steroid injections provided temporary relief, but the rashes resurfaced once the steroids were discontinued. She was informed that she had a rare immunity-related skin disease, PLC, and was prescribed the anticancer drug Methotrexate (MTX) to control inflammation. Unfortunately, her PLC did not respond well to MTX, prompting the doctor to discontinue the treatment after a two-month course. She relied on topical steroids to manage flare-ups but sought alternative options.
At our TCM clinic, we prescribed personalized herbal remedies tailored to her condition. These included Tangs Derma and Tangs Psoria, along with our herbal Yufu cream. The use of steroids was discontinued. Initially, her skin reacted negatively to the withdrawal of steroids, and her condition worsened. However, as time passed, her symptoms gradually subsided, and her skin began to improve. She experienced cycles of regression and reactivation, which corresponded to her previous use of immunosuppressant medications (steroids and MTX). With each passing month, the flares became milder and less severe. The woman diligently followed the TCM herbal remedies. After three years of treatment, she achieved full remission, with no reported side effects from the TCM approach even during the four-year follow-up visit.
This case exemplifies a patient’s journey to find relief from rare challenging skin condition. After unsuccessful attempts with conventional medications, she turned to TCM and experienced gradual improvement and eventual remission through the personalized herbal treatments. The story highlights the potential benefits of alternative approaches in cases where conventional medicine may not provide satisfactory results.
Find out more about her journey to recovery here: our YouTube channel.
Discussion
Pityriasis lichenoides (PL) is an very rare skin condition of unknow cause, but it is believed to involve an abnormal immune response. The acute form, is pityriasis lichenoides et varioliformis acuta (PLEVA) also known as Mucha–Habermann disease, and the chronic form, is pityriasis lichenoides chronica (PLC) also known as Guttate parapsoriasis. This condition falls under a group of disorders known as papulosquamous disorders, which also include conditions like psoriasis and lichen planus. The diagnosis can often be made on clinical grounds but is usually confirmed with a skin biopsy. PLEVA lesions typically resolve within several weeks or months, but new crops of lesions may appear before the condition finally resolves. It’s important to note that the natural history of pityriasis lichenoides can be unpredictable, and the course of the condition may vary between individuals. It is always recommended to consult a dermatologist for an accurate diagnosis and appropriate management of the condition.
Privacy
In situations where the disease information had already been made publicly available (as evidenced by prior articles), genuine names of individuals have been utilized. Conversely, in instances where there was no pre-existing public disclosure or at the explicit request of patients for privacy, pseudonyms have been employed. Furthermore, identities have been deliberately obscured, and certain contextual details and diagnoses have been modified to hinder any attempts at identification. It is essential to emphasize that the patients and encounters described in this work are authentic, and their consent for publication was duly obtained. As responsible authors, we earnestly implore all our readers to honor the privacy and confidentiality of these individuals. Additionally, certain scenarios, assessments, and clinical interventions have been altered to safeguard the anonymity of both patients and healthcare providers.
