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Dermatopathology: Practical & Conceptual April - June 2005
4. New Heights: Keratosis lichenoides chronica: Proposal of a concept
Almut Böer, M.D.
Correlation clinicopathologic of attributes morphologic in more than 60 patients diagnosed as having KLC
Proposal of a concept of KLC based on correlation clinicopathologic
keratosis lichenoides chronica
In many articles dedicated to the subject of KLC, the material pictorial and descriptions of attributes clinical and histopathologic do not allow a diagnosis to be made with certainty. Analysis critical of the material provided, however, suggests that more than 10 different diseases have been described in publications under the name KLC, among them lichen simplex chronicus, lichen planus, lupus erythematosus, and epidermolysis bullosa dystrophica, as well as others. The hodge-podge of conditions that have been called KLC has made it almost impossible to forge clear criteria for diagnosis of a single disease distinctive. Impediments to comprehension of the subject are many, but the most serious are the small number and the bad quality of material pictorial printed in articles, the lack of precise correlation clinicopathologic in many publications, the misinterpretation of features clinical and findings histopathologic pictured in them, and the fact that only rarely did authors have their own experience personal with more than a single patient, the latter critique being applicable to me. Another difficulty is that shapes artificial of lesions pictured may come into being by way of a Köbner phenomenon in a variety of diseases, among them being psoriasis and lichen planus. Lesions evoked by trauma external may assume shapes artificial that look similar to each other even though the conditions underlying are different from one another. As but one example, lesions striate on flexor aspects of extremities were for long believed to be diagnostic of KLC, but those may be encountered in conditions unrelated entirely such as lichen simplex chronicus, lichen planus, and psoriasis. Unfortunately, "peer-reviewers" for journals often fail to prevent reports from being published in which the authors clearly came to a wrong diagnosis. Considering the lack of criteria precise in the early publications devoted to the subject of KLC, it is surprising that, as a rule, textbooks of dermatology and dermatopathology present the condition as if a clear concept of it existed.
Only 24 patients described in articles under the name of KLC presented themselves with attributes morphologic that were very similar to one another, those not conforming to any disease specific yet known. The findings in all of those patients seem to be ones of a condition unique and dissimilar from lichen planus, lupus erythematosus, pityriasis lichenoides, pityriasis rubra pilaris, psoriasis, porokeratosis, and mycosis fungoides, including parakeratosis variegata and "folliculocentric" mycosis fungoides. The patient observed by us presented himself with features very similar to what was set forth by authors of those latter 23 articles.
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