No small number of patients reported on with a diagnosis of KLC display features morphologic very dissimilar from one another and different also from what was pictured in the seminal articles of Kaposi, Nekam, and Margolis. [9, 16, 34–45] Figs. 10 and 11 capture lesions clinical and histopathologic in patients diagnosed with KLC, the findings pictured being very different from what was depicted in the reports original by Kaposi, Nekam, and Margolis. A denominator in common is that the findings shown do not enable a diagnosis to be reached with surety. In the very few pieces in which more than a single patient was presented, the illustrations convey changes of more than just one disease; [16, 33, 40] e.g., in the publication by Menter, one patient had systemic sclerosis and another prurigo nodularis. Some patients diagnosed as having KLC probably had several diseases concurrently rather than a single entity distinctive. [10, 36, 39, 46] In a number of brief "reports of a case," neither photographs of lesions clinical nor photomicrographs were shown and, moreover, the findings described by the authors do not permit a specific diagnosis to be established. [10, 47, 48]

Several patients diagnosed as having KLC show variations on the theme of lichen simplex chronicus, including those known as severe "atopic dermatitis" and prurigo nodularis. [2, 9, 20, 49] Although many authors claimed to have observed "typical features" histopathologic of KLC, they usually do not picture them, [50] the lesions clinical actually pictured being those, for example, of "atopic dermatitis."

In many patients, "lichenoid dermatitides" of different types established were not excluded from consideration definitively, e.g., in a young patient reported on by Patrizi and coworkers in whom changes in photomicrographs could be interpreted as those of pityriasis lichenoides. [51] In other articles, lichen planus could be considered on the basis of findings histopathologic. [16, 23, 46, 52–56] A child observed by Raynaud, [41] a child reported on by Arata et al., [42] and a 37-year old woman presented by Nabai [44] probably had lupus erythematosus, a disease mentioned in the differential diagnosis put forth by the authors, but excluded by them because studies serologic were negative for autoantibodies. A patient told of by Pinol-Aguade and associates in 1974 presented himself with plaques whose border was prominent. [17] On examination by conventional microscopy, the lesions showed cornoid lamellation centered in acrosyringia of eccrine units. The authors designated the condition "lichenoid tri-keratosis," a term other authors deemed to be synonymous with KLC. The findings pictured are different from those shown in the articles by Kaposi, Nekam, and Margolis, and seem to be ones of a particular type of porokeratosis. A patient reported on by Kint and colleagues had a blistering disease, not KLC; the lesions resolved with formation of milia. [57] The changes pictured could be interpreted as being those of a type of dystrophic epidermolysis bullosa. The presentation clinical of the patient is somewhat reminiscent of that of the patient reported on by Mehregan and coworkers in 1984. [6] Figs. 12 –17 are taken from articles in which authors made a diagnosis of KLC, but the lesions clinical and the photomicrographs indicate that the diagnosis is something other than KLC, e.g., lichen simplex, prurigo nodularis, hypertrophic lichen planus, lupus erythematosus, and dystrophic epidermolysis bullosa.

Only a few patients reported on presented themselves with lesions very similar to one another clinically, namely, an eruption that involved the face in a manner reminiscent of seborrheic dermatitis and with tiny papules on the trunk and extremities, that assumed linear and reticulate shapes by way of confluence of lesions. [19,27, 29–31, 58] In several reports, the lesions pictured seem to be ones of the very same condition. [2,5,12,21,22,28, 59–65] Unfortunately, some of those reports were devoid of even a single photomicrograph, [18, 22, 29, 59–61, 64] excluding thereby the possibility of coming to a diagnosis with certainty. Pictures of lesions clinical and photomicrographs are reproduced in Figs. 18 –29, illustrations of lesions in one patient of our own being included.