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

• Keratosis Spinulosa

What is Lichen Spinulosus? (Definition/Background Information)

• Lichen Spinulosus is an uncommon and benign skin condition observed in young individuals. It is marked by the sudden onset of a collection of tiny flesh-colored papules with pointed tips on the trunk or limbs, which may be mildly itchy
• The cause and risk factors for Lichen Spinulosus are not well-understood. Some medical researchers believe that it may be immune-mediated due to certain infections, one’s genetic susceptibility, or due to other allergic skin conditions
• The treatment of Lichen Spinulosus is not well-defined, but may include the use of topical moisturizers, retinoids, and laser therapy, if necessary. The prognosis of Lichen Spinulosus is typically good in most individuals. The condition resolves spontaneously but may last about 1-2 years

Who gets Lichen Spinulosus? (Age and Sex Distribution)

• Lichen Spinulosus is a rare condition that is generally observed during childhood, adolescence, teenage, or young adulthood
• The condition affects both males and females; a slight male predominance is reported
• It may be seen worldwide among all racial and ethnic groups

What are the Risk Factors for Lichen Spinulosus? (Predisposing Factors)

• The risk factors for Lichen Spinulosus are currently unknown
• A positive family history of the condition is not reported

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 Lichen Spinulosus? (Etiology)

Lichen Spinulosus is caused by factors that are presently unknown or remain unidentified.

• Some researchers believe that Lichen Spinulosus is a subtype of keratosis pilaris, a very common skin condition that presents small bumps usually on the arms and legs
• Some of the proposals to explain the cause include:
  • Immune response of the body to infections
  • Genetic factors
  • Presence of atopic skin disorders such as asthma, atopic dermatitis, or allergic rhinitis
  • Malnutrition

What are the Signs and Symptoms of Lichen Spinulosus?

The signs and symptoms associated with Lichen Spinulosus may vary from one individual to another, and may include:

• Sudden onset of tiny benign lesions that appear like a patch of spiny papules (each about 1 to 3 mm in size)
• A papule is a small, well-defined (with clear borders), discolored, raised skin bump
• The round or oval skin patches may vary in size from 2 to 6 cm, and usually appear symmetrical (on both right and left side of the body)
• A single patch or multiple skin patches may be observed; following onset, they may quickly spread to involve other areas of skin over the next few days
• The skin feels rough like fine sandpaper (nutmeg grater)
• Occasionally, the lesions are mildly itchy, but pain is uncommon
• The lesions are usually present on the neck, abdomen, buttocks, thighs, knees, and arms, but may appear anywhere on the body surface
• The skin patches usually take the surrounding skin color, or can even be slightly darker than the surrounding skin

Even though no systemic signs and symptoms are noted, certain underlying conditions may lead to exacerbation of Lichen Spinulosus. These include chronic alcoholism, inflammatory bowel disease (Crohn’s disease), and HIV infection, among others.

How is Lichen Spinulosus Diagnosed?

The diagnosis of Lichen Spinulosus may involve:

• A complete evaluation of medical history along with a thorough examination of the skin lesions by a dermatologist. A visual examination by the healthcare expert is mostly helpful in arriving at a diagnosis, and other tests are generally not necessary
• 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
• Skin biopsy, if necessary: A skin tissue 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

Since, on a biopsy, Lichen Spinulosus may appear identical to several other skin conditions, a differential diagnosis to exclude them may be undertaken. The differential diagnosis may include:

• Frictional lichenoid eruption
• Keratosis pilaris
• Lichen planopilaris
• Lichen planus
• Pityriasis rubra pilaris

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 Lichen Spinulosus?

Complications associated with Lichen Spinulosus may include:

• Increased psychological stress due to the skin condition
• Cosmetic issues
• Scratching the skin lesions may result in scars on healing
• Recurrence of the condition
• Treatment side effects
• In some individuals, the condition can be treatment-resistant and hence longstanding (present for decades)

How is Lichen Spinulosus Treated?

There is no definite treatment for Lichen Spinulosus. The healthcare provider may recommend the following treatment options:

• Wait and watch approach
• Use of moisturizing creams (containing urea or salicylic acid) 
• Use of non-soap body cleansers; also, while bathing, using an exfoliating sponge or sugar scrub on the patches
• Use of topical gels and ointments containing retinoids
• Laser therapy, if necessary
• Undertaking treatment of any underlying condition if present

Regular follow up visits with the healthcare providers are important.

How can Lichen Spinulosus be Prevented?

Currently, there are no specific methods or guidelines to prevent Lichen Spinulosus. However, in order to prevent aggravation of the condition, the following may be considered:

• Use of home humidifiers, in case of dry indoor air
• Use moisturizing creams regularly to prevent dry skin
• While showering do not use rough scrubbers, it can make the condition worse
• Avoid tanning the skin
• Avoid shaving or skin waxing
• Avoid or minimize consumption of alcohol

What is the Prognosis of Lichen Spinulosus? (Outcomes/Resolutions)

• The prognosis of Lichen Spinulosus is generally good in a majority of cases. It resolves spontaneously within a couple of years
• In some individuals, the condition may persist for many decades due to treatment resistance

Additional and Relevant Useful Information for Lichen Spinulosus:

• 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

The presence of dirt on the body is not a causative factor for Lichen Spinulosus. However, it helps to be clean and hygienic, which will help the condition from getting worse