Differential Diagnosis of Hypertrophic Lichen Planus in a Child
Single Most Likely Diagnosis
- Lichen simplex chronicus: This condition is characterized by thickening of the skin due to chronic scratching or rubbing, which can mimic the clinical appearance of hypertrophic lichen planus. The history of itching and the presence of excoriations can help differentiate it.
Other Likely Diagnoses
- Psoriasis: Especially the plaque type, can present with thickened, scaly lesions that may resemble hypertrophic lichen planus. The presence of other psoriatic lesions and a family history can aid in diagnosis.
- Keratosis pilaris: This condition causes rough, dry skin with small bumps, which can sometimes be confused with the hypertrophic variant of lichen planus, especially if the child has a history of atopic diseases.
- Chronic eczema (atopic dermatitis): Can lead to lichenification, which is thickening of the skin with accentuated markings, similar to hypertrophic lichen planus. A history of atopy and the distribution of lesions can help differentiate.
Do Not Miss Diagnoses
- Cutaneous T-cell lymphoma (Mycosis fungoides): Although rare in children, this condition can present with various skin manifestations, including plaques that might resemble hypertrophic lichen planus. It's crucial to consider this diagnosis due to its potential severity and the need for early intervention.
- Infectious diseases (e.g., leprosy, tuberculosis): Certain infectious diseases can cause skin lesions that might be confused with hypertrophic lichen planus. These conditions are critical to identify due to their public health implications and the need for specific treatments.
Rare Diagnoses
- Sarcoidosis: A systemic disease that can cause skin lesions, among other symptoms. While rare in children, it's a diagnosis that should be considered, especially if there are systemic symptoms or other organ involvement.
- Lichen amyloidosis: A condition characterized by the deposition of amyloid in the skin, leading to intense itching and skin thickening, which can be mistaken for hypertrophic lichen planus. It's more common in adults but can occur in children.
- Dermatopathic lymphadenopathy: Although not primarily a skin condition, it can cause skin changes that might be confused with hypertrophic lichen planus, especially in the context of underlying diseases like atopic dermatitis.