Pediatrics and Neonatology 63 (2022) 432e433
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Letter to the Editor
Frictional lichenoid dermatitis: A skin
disorder with many names
Dear Editor,
The first description of the disease frictional lichenoid
dermatitis dates back to 1956 when it was named summer-
time pityriasis of the elbow and knee by Sutton.1 Ever since,
several reports have been published and the skin disease is
well-known by dermatologists, although its diagnosis re-
mains difficult. A striking phenomenon regarding this skin
disease is the variety of names it is called, which is based on
the uncertainty of its pathogenesis. Over the years, it has
been named juvenile papular dermatosis (dermatitis pap-
ulosa juvenilis), frictional lichenoid eruption in children,
summer lichenoid dermatitis of the elbows in children,
dermatite du toboggan, Sutton’s summer prurigo of the
elbows, dermatitis papulosa juvenilis, papular neuro-
dermatitis, and recurrent papular eruption of childhood.2e5
Histological changes explain the clinic features of the dis-
ease by showing nonspecific changes, such as hyperkerato-
sis, acanthosis, and lymphocytic infiltrate, in the upper
dermis around the small vessels.
Diagnosis is based on the clinical picture, which is
associated with the age of the child, period of the year
when it occurs, type of treatment, and recurrences over
the following years.
Skin lesions are characterized by skin-colored or
hypopigmented lichenoid small, flat papules; they are
sometimes associated with discrete erythema and exco-
riations caused due to scratching. The number of lesions
varies from few to many since it can confluent into small
plaques. The lesions are strictly distributed on the dorsal
side of the hands, elbows, and knees (Fig. 1). Pruritus is
more often described by the child or family members
during the daytime.
Differential diagnosis is mostly based on clinical fea-
tures; a biopsy is rarely performed, especially in children. It
is pertinent to note that lesions can mimic other skin dis-
orders. Keratosis pilaris is diagnosed during childhood, with
no age-related peak incidence; however, it is also visible
https://doi.org/10.1016/j.pedneo.2022.02.003
1875-9572/Copyright ª 2022, Taiwan Pediatric Association. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-
NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
during summertime and characterized by diffused spiny
papules and perifollicular erythema localized on the
extensor areas of the face, arms, and thighs and can be
associated with pruritus. Lichen planopilaris is rarer and
papules are lichenoid but violaceus and with different dis-
tribution. Pityriasis rubra pilaris variants III, IV, or V are
seen in children and are easily excluded by diagnostic
criteria that include hyperkaratotic papules on the elbows,
knees, and ankles, pustulosis palmo-plantaris, and other
associated cutaneous manifestations. Lichen nitidus should
be recognized by the presence of shiny small skin-colored
papules spread on the trunk and limbs. The polymorphic
light eruption is associated with pruritic erythematous or
skin-colored papules scattered on sun-exposed areas; ves-
icles or even bullae can appear. Gianotti-Crosti syndrome is
a papular rash on the extensor areas of the inferior and
superior limbs, face, and buttocks, which is diagnosed once
in a lifetime, probably at the post-infectious state.
The disease affects children of school age and is absent
in adults or younger children. The disease is reported at the
beginning of summer and disappears, even without treat-
ment, during late summer. It has never been reported in
winter, although xerosis is prevalent during humid and cold
months. It is not associated with other skin or systemic
manifestations. Topical steroids and emollients clear the
lesions without scars. Additionally, no prophylactic treat-
ment is required and a new flare-up can appear in the
following summertime.
The pathogenesis of the disease remains ambiguous.
Friction and natural ultra-violet light exposure could be
considered the trigger factors. Its relation to atopy is
controversial. For some authors, it is a minor form of atopic
dermatitis, although the criteria established by Hanifin and
Rajka were not fulfilled. There was no family and personal
history of atopic eczema, no specific Immunoglobulin E
antibody for inhaled or food allergens are depicted in these
children, and no eczematous histology and course of the
disease.
 Pediatrics and Neonatology 63 (2022) 432e433
Figure 1 Skin colored, lichenoid small flat papules surrounded by skin-colored and areas of discrete erythema localized on the
dorsal side of the hand (A), elbow (B), and knees (C, D) frictional lichenoid dermatitis.
Funding
No funding was received for this study.
Declaration of competing interest
The authors have no conflicts of interest to disclose.
References
1. Sutton RL. Summertime pityriasis of the elbow and knee. In:
Sutton RL Jr (ed) Disease of the skin, 2edn. CV Mosby, St. Louis,
1956. p. 898.
2. Fölster-Holst R, Kiene P, Brodersen JP, Christophers E. Derma-
titis papulosa juvenilis. Hautarzt 1996;47:129e31. [Article in
German].
3. Waisman M, Gables C, Sutton RL Jr. Frictional lichenoid eruption
in children. Recurrent pityriasis of the elbows and knee. Arch
Dermatol 1966;94:592e3.
4. Goldman L, Kitzmiller KW, Richfield DF. Summer lichenoid
dermatitis of the elbows in children. Cutis 1974;13:836e8.
5. Dupre MMA, Christol B, Bonafe JL. La dermatite du toboggan
(variant de “frictional lichenoid eruption in children”). Bull Soc
Fr Dermatol Syphiligr 1974;81:203e5.
433
Anca Chiriac
Nicolina Medical Center, Department of Dermatology, Iași,
Romania
Apollonia University, Iași, Romania
“Petru Poni”” Institute of Macromolecular Chemistry,
Romanian Academy, Iași, Romania
Uwe Wollina
Clinic for Dermatology and Allergology, Dresden City
Clinic, Dresden, Germany
Cristian Podoleanu
Cardiology Department, University of Medicine, Pharmacy,
Sciences and Technology of Targu Mures, Romania
Simona Stolnicu*
Pathology Department, University of Medicine, Pharmacy,
Sciences and Technology of Targu Mures, Romania
*Corresponding author. Department of Pathology, Univer-
sity of Medicine, Pharmacy, Science and Technology of
Targu Mures, 38 Gheorghe Marinescu Street, Targu Mures
540139, Romania.
E-mail address: stolnicu@gmx.net (S. Stolnicu)
Aug 28, 2021