Most patients describe the gradual onset of an asymptomatic to mildly pruritic papular eruption. Papules appear in crops and resolve spontaneously within 2-8 weeks. Waxing and waning of the crops of papules may continue for decades. Unless accompanied by systemic lymphoma, most patients have no constitutional symptoms. Unless accompanied by systemic lymphoma, physical findings are limited to the skin.
Some lesions develop a necrotic eschar before healing spontaneously.
Each papule heals within 2-8 weeks, leaving a hypopigmented or hyperpigmented depressed oval varioliform scar. Large nodules and plaques may take months to resolve. A few investigators have discovered viruslike particles in LyP lesions examined by electron microscopy. No WBC or serum chemistry abnormalities are expected. Obtain skin biopsies of 2 or more fully developed inflammatory papules without necrosis or excoriation.