Differentials

Lymphomatoid papulosis

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

Lymphomatoid papulosis can clinically resemble pityriasis lichenoides, the pityriasis lichenoides et varioliformis acuta subtype, yet the lesions are more nodular as opposed to papular. Unlike pityriasis lichenoides, it presents around the fifth decade and has a higher likelihood to develop into cutaneous lymphoma.[20]

INVESTIGATIONS

Skin biopsy will show nodular infiltrate of atypical lymphocytes (some CD30+ with epidermotropism).[20]

Guttate psoriasis

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

Clinical exam of multiple pink flat papules with prominent scale mostly scattered on the torso differentiates this entity from pityriasis lichenoides.[1]

INVESTIGATIONS

Dermoscopy can differentiate between pityriasis lichenoides chronica and guttate psoriasis, decreasing the number of cases requiring biopsy.[18] Skin biopsy will demonstrate regular acanthosis and hypergranulosis.[20]

Drug eruption

SIGNS / SYMPTOMS
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SIGNS / SYMPTOMS

Clinical exam of generalized pink-to-red macules and papules, usually absent of scale, crust, or ulceration, and history of recent medication changes.

INVESTIGATIONS

No differentiating tests recommended; drug eruption is a clinical diagnosis.

Syphilis infection (secondary)

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

History of sexual activity and possible primary chancre. Polymorphic, multiple, pink-to-brown macules and papules in a diffuse distribution on clinical exam. Frequent involvement of palms and soles and accompanying mucosal ulcers.

INVESTIGATIONS

Venereal disease research laboratory/rapid plasma reagin tests are positive.

Lichen planus

SIGNS / SYMPTOMS
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SIGNS / SYMPTOMS

The lesions of lichen planus will be more purple, pruritic, and polygonal.[1]

INVESTIGATIONS

Skin biopsy will show irregular acanthosis and lichenoid dermal infiltrate.[20]

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