Prognosis

A case series of 22 children revealed a mean duration in pityriasis lichenoides et varioliformis acuta of 1.6 months to complete resolution and a mean duration in pityriasis lichenoides chronica of 7.5 months.[33] The natural tendency of the disease is to remit spontaneously, but some cases may wax and wane over years. Disease duration may be longer in adults.

Recurrent and chronic

Even though pityriasis lichenoides is an inflammatory benign skin disorder, it can be chronic, unpredictable and stubborn to respond to therapies. In order to ensure appropriate care, close and regular follow-up is recommended.[1]

Evolution to skin lymphoma

There are several reports that all forms of pityriasis lichenoides can transform into cutaneous lymphoma (mycosis fungoides).[1][4] Therefore, regular follow-up re-evaluations are recommended, even if the eruption has resolved, to monitor for any changes or new eruptions.[4] Should the skin eruption change or recur in a different presentation, skin biopsy must be done to evaluate for potential malignancy.[1] Furthermore and as a precaution, assessment of the review of systems such as fever and weight loss may assist in ruling out the paraneoplastic potential.

Febrile ulceronecrotic Mucha-Habermann disease variant

The ulceronecrotic form of pityriasis lichenoides should be urgently treated with multidisciplinary approach and likewise closely monitored for complete resolution and potential recurrence.[1][19] Mortality is around 20%; factors associated with a poorer prognosis include increased age, systemic involvement, and monoclonal T-cell receptor rearrangement.[1][34]

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