From the Guidelines
Spigot's lichenoid dermatitis is not a recognized medical condition, and treatment should follow guidelines for lichenoid dermatitis, which includes high-potency topical steroids, such as clobetasol 0.05% or fluocinonide 0.05% cream or ointment, or tacrolimus 0.1% ointment, as recommended by the NCCN guidelines 1. The term "Spigot's lichenoid dermatitis" appears to be a misunderstanding or combination of terms. Lichenoid dermatitis is a real skin condition characterized by flat-topped, itchy, purple-colored lesions that can occur due to medication reactions, autoimmune disorders, or environmental exposures. Some key points to consider in the management of lichenoid dermatitis include:
- Topical corticosteroids, such as clobetasol 0.05% cream, applied twice daily for 2-4 weeks, are a common treatment option 1.
- For more severe cases, oral corticosteroids like prednisone 20-40mg daily with a gradual taper over 2-3 weeks may be prescribed 1.
- Other treatment options include topical calcineurin inhibitors, such as tacrolimus 0.1% ointment, phototherapy, or oral antihistamines for itch relief 1. The condition results from an inflammatory reaction where T-lymphocytes attack the skin's basal layer, causing characteristic histological and clinical features. Proper diagnosis requires a skin biopsy to differentiate it from similar conditions like lichen planus, psoriasis, or cutaneous lupus erythematosus. It is essential to note that the management of lichenoid dermatitis may vary depending on the underlying cause and severity of the condition, and treatment should be individualized based on the patient's specific needs and medical history.
From the Research
Spigots Lichenoid Dermatitis
- There are no direct research papers on Spigots lichenoid dermatitis, however, similar conditions such as pityriasis lichenoides and pigmented purpuric lichenoid dermatitis have been studied.
- Pityriasis lichenoides is a spectrum of inflammatory skin diseases, and its treatment has been summarized in a systematic review 2.
- The review suggests narrow-band UVB phototherapy as a first-line treatment, and oral erythromycin with or without topical corticosteroids and low-dose methotrexate as second-line therapies.
- Pigmented purpuric lichenoid dermatitis of Gougerot-Blum (PPLD) has been treated successfully with topical corticosteroids in a case report 3.
- A systematic review of treatments for pityriasis lichenoides found that phototherapy led to complete remission in the highest proportion of patients, and topical corticosteroids were found to have been trialled in the highest number of patients 4.
- Lichen planus and lichenoid reactions have been studied as a systemic disease, and treatment is mainly symptomatic, with topical or systemic corticosteroids being the first-line therapies 5.
- Intralesional steroid has been used to treat inflammatory dermatoses such as psoriasis and localized dermatitis, and has been found to be safe and effective 6.