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Table of Contents
Year : 2020  |  Volume : 38  |  Issue : 3  |  Page : 184-185

Annular lichenoid dermatitis of youth: A great imitator

Department of Dermatology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China

Date of Submission06-Oct-2018
Date of Decision23-Dec-2018
Date of Acceptance25-Dec-2018
Date of Web Publication10-Sep-2020

Correspondence Address:
Dr. Cheng Tan
Department of Dermatology, Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong Road, Nanjing 210029
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ds.ds_52_18

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How to cite this article:
Zhou L, Tan C. Annular lichenoid dermatitis of youth: A great imitator. Dermatol Sin 2020;38:184-5

How to cite this URL:
Zhou L, Tan C. Annular lichenoid dermatitis of youth: A great imitator. Dermatol Sin [serial online] 2020 [cited 2022 Dec 2];38:184-5. Available from: https://www.dermsinica.org/text.asp?2020/38/3/184/294712

Dear Editor,

Annular lichenoid dermatitis of youth (ALDY) is a recently described dermatosis that predominantly affects children.[1] It is characterized clinically by annular patches with central hypopigmentation. There have only been approximately 60 cases reported in the English-language literature.[2],[3] We recently observed a similar case that was first reported in China.

A 4-year-old girl was seen with annular patches for 5 months. The lesions first developed on her torso and then spread to her neck without noticeable cause. The patient reported no itching or other abnormal sensations, and her parents denied previously administering any drugs. She had not traveled abroad and did not have Borrelia or other infections. When her skin was examined, several patches were present on her torso and the posterior aspect of her neck. These lesions were annular with variable sizes ranging from 3–5 cm in diameter. The patches were unanimously hypopigmented in the center with a narrow erythematous rim. Neither scales nor other lesions were observed [Figure 1]. All other systemic findings were normal. A skin biopsy revealed elongated and quadrangular rete ridges with few necrotic keratinocytes. Lymphocytes were found around the tips of the rete ridges and capillary blood vessels in the superficial dermis [Figure 2]. An immunohistological investigation revealed a mixed infiltration of CD4+ and CD8+ T lymphocytes. Based on the clinicopathological features observed, a diagnosis of ALDY was rendered. The girl did not undergo any treatment and was placed under follow-up care.
Figure 1: The patch was hypopigmented in the center with an erythematous rim on the trunk

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Figure 2: Elongated rete ridge with a distinctive squared silhouette at the dermal-epidermal junction. Lymphohistiocytic infiltration and vacuolar degeneration are at the tip of flattened rete ridges (the insert) (H and E, ×100)

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ALDY is an uncommon skin disorder that was first described in 2003. Until now, approximately 60 cases have been reported in the English-language literature. Most ALDY patients are from the Mediterranean and Australia, with a few from Japan, The United States of America and other Europeans countries.[4] ALDY preferentially occurs among children and has an average onset age of 11 years.[3],[5] Males and females are equally affected by this dermatosis.

ALDY consistently manifests as annular or oval erythematous macules at first. It then spreads peripherally with a slightly palpable erythematous edge and hypopigmented center. Gradually, the erythematous rim becomes muted, leaving annular or semicircular brownish hyperpigmentation. Small lichenoid papules may uncommonly appear in its border without coalescence.[1],[4],[6] Lesions in ALDY appear alone or in groups. The flank, abdomen, and groin are preferentially affected, although the head, neck, axillary region, and calf area can be similarly affected.[2] Occasionally, some of these lesions have mild itching. Pathological features in ALDY vary depending on the clinical course. In early lesions, there is an elongated rete ridge with a distinctive squared silhouette at the basal layer. Lymphohistiocytic infiltration and vacuolar degeneration are mainly observed at the tips of flattened rete ridges. In late-stage lesions, colloid bodies and melanophages are seen in the papillary dermis or the epidermis. Immunohistochemical stains reveal the mixed infiltration of T lymphocytes into the dermis.[2],[6]

ALDY imitates morphea, hypopigmented mycosis fungoides, erythema annulare centrifugum, and annular erythema of infancy. The absence of dermal sclerosis and the loss of appendage structures make morphea unlikely.[6] Although ALDY and hypopigmented mycosis fungoides both manifest as hypopigmented macules among children, the lymphocytes that infiltrate in ALDY, in addition to dyskeratotic keratinocytes, are polyclonal and are typically confined to the tips of thin and flat-bottomed rete ridges.[5],[7] Annular erythema of infancy and erythema annulare centrifugum can usually be excluded by the age of the patient and the absence of lichenoid reactions.

Spontaneous regression occurs in some cases with ALDY, and most cures at present are ineffective. Topical glucocorticoids, tacrolimus, and narrow-band ultraviolet B/psoralen ultraviolet A phototherapy are the mainstay treatments with variable responses.[5] Clinicians, particularly pediatricians, should be aware of ALDY to avoid erroneous management of this inflammatory dermatosis as mycosis fungoides or other disorders.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that name and initials will not be published, and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

The study was financially supported in part by the 333 High-Level Personnel Training Project of Jiangsu Province.

Conflicts of interest

There are no conflicts of interest.

  References Top

Annessi G, Paradisi M, Angelo C, Perez M, Puddu P, Girolomoni G. Annular lichenoid dermatitis of youth. J Am Acad Dermatol 2003;49:1029-36.  Back to cited text no. 1
Wilk M, Zelger BG, Emberger M, Zelger B. Annular lichenoid dermatitis (of youth) immunohistochemical and serological evidence for another clinical presentation of borrelia infection in patients of Western Austria. Am J Dermatopathol 2017;39:177-80.  Back to cited text no. 2
Cesinaro AM. Annular lichenoid dermatitis (of youth): Report of a case with lichen planus-like features. Am J Dermatopathol 2017;39:914-5.  Back to cited text no. 3
Vázquez-Osorio I, González-Sabín M, Gonzalvo-Rodríguez P, Rodríguez-Díaz E. Annular lichenoid dermatitis of youth: A report of 2 cases and a review of the literature. Actas Dermosifiliogr 2016;107:e39-45.  Back to cited text no. 4
Malachowski SJ, Creasey M, Kinkley N, Heaphy MR Jr. Annular lichenoid dermatitis of youth: A chronic case managed using pimecrolimus. Pediatr Dermatol 2016;33:e360-1.  Back to cited text no. 5
Cesinaro AM, Sighinolfi P, Greco A, Garagnani L, Conti A, Fantini F. Annular lichenoid dermatitis of youth and beyond: A series of 6 cases. Am J Dermatopathol 2009;31:263-7.  Back to cited text no. 6
Kazlouskaya V, Trager JD, Junkins-Hopkins JM. Annular lichenoid dermatitis of youth: A separate entity or on the spectrum of mycosis fungoides&? Case report and review of the literature. J Cutan Pathol 2015;42:420-6.  Back to cited text no. 7


  [Figure 1], [Figure 2]


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