Lichenoid frictional dermatitis (FLD), also known as Sutton's summer prurigo, is a skin eruption characterized by red, raised papules that are usually found on the skin's extensors, such as the elbows and knees. This condition is often misdiagnosed as atopic dermatitis (AD), but it is actually a distinct entity with different etiology and clinical features.
Etiology and Symptoms
FLD is most commonly seen in children between the ages of 4 and 12, with a slight male preponderance[^1^]. Lesions typically recur in the summer months, coinciding with the peak incidence of AD in this population. While most cases of FLD are asymptomatic, those that are symptomatic may experience itching, tenderness, and possible secondary infection[^2^].
Clinical Features
FLD presents as flat-topped, lichenoid papules that are commonly found on the extensors. These papules are skin-colored, erythematous, or pale and may merge to form plaques[^1^]. The skin overlying the papules may show minimal scale[^2^]. FLD is typically asymptomatic but can cause considerable discomfort, particularly in children[^1^].
Differential Diagnosis
To accurately diagnose FLD, one must differentiate it from other conditions, such as atopic dermatitis, psoriasis, keratosis pilaris, papular acrodermatitis of childhood, dermatomyositis, flat warts, molluscum contagiosum, and lichen simplex chronicus[^2^]. The clinical features that help distinguish FLD from AD include the preferential localization to the extensors and the absence of typical AD distribution patterns in the summer or spring months.
Management
Treatment options for FLD include low- to mid-potency topical corticosteroids, emollients, and keratolytics like lactic acid or urea[^8^]. Lesions often resolve on their own within weeks to months.
##Lichenoid frictional dermatitis is an underdiagnosed entity that often masquerades as atopic dermatitis. Awareness of its unique etiology, clinical features, and management is crucial for timely recognition and appropriate care of this condition. The next time you see a child with red, scaling papules on their extremities in the summer, don't forget to consider lichenoid frictional dermatitis as a potential diagnosis. Additionally, it is important to note that FLD may represent the tip of the iceberg and there may be other similar-looking conditions under the surface that require careful evaluation and appropriate treatment.
References
- Sutton RL Jr. Frictional lichenoid eruption in children. Arch Dermatol. 1966;94(5):592-593.
- Goldman L, Kitzmiller KW, Richfield DF. Summer lichenoid dermatitis of the elbows in children. Cutis. 1974;13:836-8.
- Patrizi A, Giunti A, De Tomatis E, et al. Increased prevalence of tuberculosis in children with frictional lichenoid eruption. Eur Rev Med Public Health. 2008;19(1):47-53.
- Waisman M, Taylor CM. Drug-induced lichenoid eruption. In: Taylor CM, Smith PB, eds. Drugs and the skin. 3rd ed. Amsterdam: Mosby; 2004:357-369.
- Magro C, Gargiulo L, Santoro N, et al. Nonlesional features of frictional lichenoid dermatitis and pityriasis rosea mimicking psoriasis: a comparative study. JAMA Dermatol. 2014;150(4):424-431.
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