| disease | Lichen Scrofulosorum |
| alias | Lichen Tuberculosus, Lichen Scrofulo Sorum, Scrofulous Lichen, Disseminated Follicular Tuberculosis of the Skin |
Subcutaneous node lichen (Lichen Tuberculosus), also known as symmetrical scrofula lichen (lichen scrofulosorum), refers to clusters of follicular papules occurring on the trunk and limbs. It is also called disseminated follicular cutaneous subcutaneous node (tuberculosis cutis follicularis disseminatus).
bubble_chart Etiology
It is considered a type of subcutaneous nodule rash. It mostly occurs in children and young adults. Patients often have lymph node, bone, joint, and other subcutaneous nodule skin conditions. The subcutaneous nodule bacillus test is positive, but subcutaneous nodule bacilli are often undetectable in the rash. This disease can occur in individuals with a highly reactive response to subcutaneous nodule bacillus antigen when injected with it.
In recent years, Schuhmachers reported that this disease resembles generalized papular-type annular granuloma.
bubble_chart Pathological Changes
In the upper dermis near the hair follicles, there is a subcutaneous nodule-like infiltration. It mainly consists of clusters of epithelioid cells, surrounded by lymphocytes or not, with occasional macrophages. No caseous necrosis is present. The follicular epithelial cells show degeneration, and due to hyperkeratosis, keratin plugs can be seen at the follicular openings.
bubble_chart Clinical Manifestations
Needle-sized to millet-sized foxtail millet-like large round papules often occur on the trunk and limbs, most commonly on the shoulders, waist, and buttocks. Initially, the papules are scattered, then gradually cluster into oval, round, or annular shapes. The papules frequently appear at the follicular openings, with slightly pointed or flat tops, small keratinous spines, and often a small amount of bran-like scale. The papules are normal skin-colored or light red, and some patients may have tiny pustules at the top of the papules. There are no subjective symptoms, though some patients experience grade I cutaneous pruritus.
The disease progresses slowly, and the papules may naturally disappear after several months or years, leaving no trace or only temporary pigmentation. However, the condition can recur.bubble_chart Treatment Measures
Patients should pay attention to general health and nutrition. Identify and appropriately manage subcutaneous node sexually transmitted disease lesions. Oral medication includes isoniazid treatment, but the condition is self-limiting and usually does not require treatment.
Based on the symmetrically distributed lichenoid papules on the trunk, absence of subjective symptoms, combined with a history of subcutaneous nodules and pathological changes, the diagnosis is generally not difficult. However, it needs to be differentiated from the following diseases:
1. Vitamin A deficiency disease: Small follicular keratotic papules with central keratin plugs, mostly occurring on the extensor surfaces of the limbs. Often accompanied by symptoms such as night blindness and keratomalacia.
2. Lichen spinulosus: Small follicular keratotic papules densely clustered on the neck and buttocks, without any subjective symptoms.
3. Lichen nitidus: Lesions are round, flat papules the size of foxtail millet, with normal skin color, appearing independently without aggregation. The surface is smooth and has a shimmering luster. Mostly occurs on the abdomen and buttocks, with no subjective symptoms.
4. Papular eczema: Red papules, often coexisting with vesicles and erythema, acute onset, accompanied by intense cutaneous pruritus.
