A Case of Chronic Pityriasis Lichenoides Treated with Fire Needle Combined with Narrow-Band Ultraviolet B (NB-UVB) Irradiation

This report presents a case treated with fire needle therapy combined with narrow-band ultraviolet B (NB-UVB) for chronic pityriasis lichenoides. The patient was a 44-year-old female who exhibited recurrent erythema, scaling, and pruritus on the limbs and trunk for a duration of five months. Dermatological examination revealed patchy bright red rashes on the chest with indistinct borders and no significant desquamation; scattered papules ranging from rice to soybean size, pale red to reddish-brown in color, were observed on the limbs, trunk, and buttocks, some of which were covered with fine, thin scales that shed easily. Additionally, patchy erythematous papules were noted on both palms, soles, and the dorsal aspects of the toes, accompanied by scattered vesicles and papules of similar size, some exhibiting minimal exudate and others covered with crusts. Nikolsky's sign was negative, and there was no thickening or deformation of the nails or toenails, nor were there palpable superficial lymph nodes. Dermatopathological findings revealed focal incomplete keratinization, neutrophilic exudate beneath the epidermis, mild epidermal hyperplasia, intercellular edema in the spinous layer, and liquefactive degeneration of the basal cells. A small number of lymphocytes were observed migrating into the epidermis, with lymphocyte-dominated inflammatory cell infiltration surrounding the blood vessels in the superficial to middle dermis, along with visible nuclear dust. The diagnosis was confirmed as chronic pityriasis lichenoides. Following one month of treatment with fire needle therapy in conjunction with NB-UVB irradiation, there was notable improvement in almost all clinical manifestations; the lesions on the chest completely resolved, and those on the dorsal feet became dry and convergent, with ongoing follow-up.