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represents a precursor to cutaneous T-cell lymphoma, periodic longer-term
outpatient monitoring is advised.
Treatment for the condition typically involves an initial trial of macrolide
derivatives such as erythromycin, and recalcitrant cases may be treated with
ultraviolet light phototherapy. More severe cases, including those with
FUMH, typically require systemic immunosuppressive therapy with agents
such as methotrexate. Breaks from therapy can often be taken during the
summer months when disease activity wanes from natural sunlight exposure.
Long term, the condition remits spontaneously over a period of several
years.

Lichen nitidus
Lichen nitidus is a benign, self-limited condition characterized by crops of
small (1 to 2 mm), discrete flat-topped off-white papules scattered over the
torso and extremities ( Fig. 70.11 ), but which can involve the face and
genitalia as well. Lesions often show characteristic groups of papules, with
some in a linear configuration demonstrating the phenomenon of
koebnerization at sites of minor trauma. In contrast to follicular eczema,
which is often pruritic, the skin in lichen nitidus is usually asymptomatic.
Treatment typically involves watchful waiting and reassurance, although
some patients may respond to topical corticosteroids or calcineurin inhibitors
such as pimecrolimus cream or tacrolimus ointment.

Lichen planus
Lichen planus is often easily recognized by its intensely pruritic, purplish,
often polygonal papules and plaques ( Fig. 70.12 ). The condition can occur
anywhere, but is usually seen involving the extremities. Areas may show
koebnerization, with lesions appearing at sites of minor skin trauma.
Affected patients should be asked about and examined for oral or genital
involvement, which may or may not be symptomatic at these sites. On the
mucous membranes, the condition has a lacy white appearance.