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Sherry Shieh, MD; Debra L. Mikkola, MS; Gary S. Wood, MD

Arch Dermatol. 2001;137:305-308.

Background  Pityriasis lichenoides chronica (PLC) and pityriasis lichenoides et varioliformis acuta (PLEVA) are benign T-cell diseases that share several overlapping clinicopathologic features, leading many to believe that they exist as a spectrum rather than as single entities. Previous molecular studies have shown that PLEVA is a clonal lymphoproliferative disorder. To further characterize the immunohistologic features of PLC and to determine whether PLC demonstrates clonality, we studied 6 cases of PLC using a frozen section–immunoperoxidase technique and polymerase chain reaction/denaturing gradient gel electrophoresis.

Observations  All 6 cases showed a mild to moderate superficial and deep perivascular infiltrate composed predominantly of CD4⁺ T cells, admixed with Langerhans cells and macrophages; most were associated with an HLA-DR⁺ epidermis. Three of 6 cases involved monoclonal T-cell receptor gamma (TCR) gene rearrangements detected by V1-8/J1-2 and V9/J1-2 primers.

Conclusions  Our findings enhance existing data showing that PLC shares many immunohistologic features with PLEVA and indicating that PLC is frequently a clonal T-cell disease. This provides further evidence that PLC and PLEVA are interrelated processes within the larger group of T-cell lymphoproliferative disorders.

From the Departments of Internal Medicine (Dr Shieh) and Dermatology (Ms Mikkola), Case Western Reserve University, University Hospitals of Cleveland, and the Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio; and the Department of Medicine (Dermatology), University of Wisconsin and Middleton Veterans Affairs Medical Center (Dr Wood), Madison.

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