What are the other Names for this Condition? (Also known as/Synonyms)

• Discrete Papular Lichen Myxoedematosus
• Discrete Papular Lichenmyxedematosus
• Discrete Papular LM

What is Discrete Papular Lichen Myxedematosus? (Definition/Background Information)

• Discrete Papular Lichen Myxedematosus (DPLM) is the localized form of lichen myxedematosus, which is a rare skin abnormality characterised by mucin deposition in skin
• Discrete Papular Lichen Myxedematosus is an uncommon skin condition that presents tiny, firm, skin-colored papules confined to certain parts of the body, particularly the limbs and trunk
• The exact cause of development of Discrete Papular Lichen Myxedematosus is currently unknown. In some cases, the condition is seen in association with an underlying infection such as HIV or hepatitis C viral infection
• Discrete Papular Lichen Myxedematosus is usually diagnosed by a skin biopsy. Following its diagnosis, if necessary, a treatment of the condition is undertaken. In many cases, DPLM is a self-resolving skin condition
• The treatment measures may include light therapy, use of topical creams, dermabrasion, and intralesional injections. The prognosis of Discrete Papular Lichen Myxedematosus is usually good, in a majority of cases, since only skin manifestations are observed

Who gets Discrete Papular Lichen Myxedematosus? (Age and Sex Distribution)

• Discrete Papular Lichen Myxedematosus is a rare skin condition that is usually diagnosed in adults
• Both males and females are affected, although a male predominance is noted
• All racial and ethnic groups are affected and no predilection is reported

What are the Risk Factors for Discrete Papular Lichen Myxedematosus? (Predisposing Factors)

The risk factors identified for Discrete Papular Lichen Myxedematosus may include:

• HIV infection, in some cases
• Hepatitis C virus infection
• Some localized forms of lichen myxedematosus are associated with exposure to toxic substances, such as certain oils, and contaminated L-tryptophan (an amino acid)

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Discrete Papular Lichen Myxedematosus? (Etiology)

• The exact cause of Discrete Papular Lichen Myxedematosus (DPLM) formation is generally unknown. It may be due to an abnormal immune function that typically involves the skin (not a systemic condition)
• It is a non-contagious condition that cannot spread from one individual to another. This means that one cannot get DPLM through direct contact or from being in close proximity to an individual having the condition

What are the Signs and Symptoms of Discrete Papular Lichen Myxedematosus?

The signs and symptoms of Discrete Papular Lichen Myxedematosus may include:

• Presence of numerous, small round papules on skin that are between 2-5 mm in size
• The skin lesions are firm and flesh-colored, to red in color
• A papule is an area of abnormal skin tissue that is less than 1 centimeter around. Usually a papule has distinct borders, and it can appear in a variety of shapes
• The papules can be present anywhere on the body, notably on the proximal limbs (arms and legs including thighs) and chest and back region
• The presentation of the skin lesions are often symmetric on the body
• Thickening of skin

How is Discrete Papular Lichen Myxedematosus Diagnosed?

Discrete Papular Lichen Myxedematosus may be diagnosed through the following tools:

• Complete physical examination with evaluation of medical history
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Blood tests for HIV and hepatitis C virus infections
• Blood testing for increased serum antibody levels, all of one non-functional type. If positive, this indicates the systemic form of the disease and not the localized form discussed in this article
• Skin biopsy: A skin biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis
• A differential diagnosis may be undertaken to exclude scleromyxedema (that presents systemic symptoms) and other localized forms of papular mucinosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Discrete Papular Lichen Myxedematosus?

The complications of Discrete Papular Lichen Myxedematosus may include:

• Scratching or itching of the lesions may lead to bleeding and ulceration. This can cause secondary bacterial or fungal infections to develop
• Emotional stress due to cosmetic concerns

How is Discrete Papular Lichen Myxedematosus Treated?

Discrete Papular Lichen Myxedematosus is difficult to treat, but can resolve spontaneously on its own, like all localized cutaneous forms of papular mucinosis. In case the condition does not get better, then the following treatment options may be considered:

• Use of topical steroids and oral retinoid
• Psoralen and ultraviolet A (PUVA) therapy
• Dermabrasion
• CO2 laser therapy
• Intralesional steroid injections and intralesional hyaluronidase injections
• Newer treatment methods, such as topical tacrolimus creams, have been shown to be successful in some cases
• Symptomatic and supportive therapy, if needed

How can Discrete Papular Lichen Myxedematosus be Prevented?

• Current medical research has not established a method of preventing the occurrence of Discrete Papular Lichen Myxedematosus
• Undertaking early and appropriate treatment of viral infections (caused by hepatitis C virus or HIV) is important to reduce the risk for DPLM

What is the Prognosis of Discrete Papular Lichen Myxedematosus? (Outcomes/Resolutions)

• The prognosis of Discrete Papular Lichen Myxedematosus is generally good with adequate treatment
• Also, in many cases, the condition is known to be self-limiting and it gets better on its own without the need for any treatment
• However, the overall prognosis may depend on the severity of the underlying infection, if any present

Additional and Relevant Useful Information for Discrete Papular Lichen Myxedematosus:

• Do not pick or scratch the skin lesions
• Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken avoid strong soaps and chemicals that could potentially worsen the condition