eMedicine Specialties > Dermatology > Reactive & Inflammatory Dermatoses

Lichen Nitidus

Author: Zeina Tannous, MD, Consulting Staff, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School
Coauthor(s): Nelly Rubeiz, MD, Consulting Staff, Department of Dermatology, American University of Beirut Medical Center; Associate Professor, Department of Dermatology, American University of Beirut, Lebanon
Contributor Information and Disclosures

Updated: Mar 20, 2008

Introduction

Background

Lichen nitidus is a relatively rare, chronic skin eruption that is characterized clinically by asymptomatic, flat-topped, skin-colored micropapules. Lichen nitidus mainly affects children and young adults.

Pathophysiology

The skin is the primary organ system affected. Mucous membranes and nails1 also might be involved. Lichen planus can clinically mimic lichen nitidus and can sometimes coexist with lichen nitidus.

Frequency

International

The frequency of lichen nitidus is unknown because of its uncommon occurrence. In a study of skin diseases in blacks over a 25-year period, the incidence of lichen nitidus was 0.034%.2

Mortality/Morbidity

Lichen nitidus is a benign disease with no associated mortality or complications.

Race

No racial predilection is reported.

Sex

No sexual predilection exists. However, generalized variants appear to occur predominantly in females.

Age

Lichen nitidus may affect any age group, but it most commonly develops in childhood or early adulthood.

Clinical

History

  • Lichen nitidus is usually an asymptomatic eruption; however, patients occasionally complain of pruritus.
  • Familial cases have been described.3

Physical

  • The primary lesions consist of multiple 1- to 3-mm, sharply demarcated, round or polygonal, flat-topped, skin-colored shiny papules that often appear in groups.
  • The Köbner phenomenon (or an isomorphic response) may be observed. This phenomenon causes the occasional linear pattern of the lesions associated with lichen nitidus.
  • The most common sites of involvement are the trunk, flexor aspects of upper extremities, dorsal aspects of hands, and genitalia. Infrequently, the lower extremities, palms, soles, face, nails, and mucous membranes may be affected. Nail changes include pitting, ridging, splitting, and linear striations.
  • Clinical variants of lichen nitidus include generalized,4 linear, actinic,5 perforating,6,7 keratodermic,8,9 vesicular,10 and purpuric7 /hemorrhagic10 forms.
  • Reported associated diseases include atopic dermatitis,11 lichen planus,12 condyloma,13 amenorrhea,14 Crohn disease,15,16 and juvenile chronic arthritis.17

Causes

  • The cause of lichen nitidus is unknown. Controversy exists regarding the relationship between lichen planus and lichen nitidus.

More on Lichen Nitidus

Overview: Lichen Nitidus
Differential Diagnoses & Workup: Lichen Nitidus
Treatment & Medication: Lichen Nitidus
Follow-up: Lichen Nitidus
Multimedia: Lichen Nitidus
References
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References

  1. Bettoli V, De Padova MP, Corazza M, Virgili A. Generalized lichen nitidus with oral and nail involvement in a child. Dermatology. 1997;194(4):367-9. [Medline].

  2. Hazen HH. Syphilis and skin diseases in the American Negro: personal observations. Arch Dermatol Syph. 1935;31:316.

  3. Kato N. Familial lichen nitidus. Clin Exp Dermatol. Jul 1995;20(4):336-8. [Medline].

  4. Al-Mutairi N, Hassanein A, Nour-Eldin O, Arun J. Generalized lichen nitidus. Pediatr Dermatol. Mar-Apr 2005;22(2):158-60. [Medline].

  5. Glorioso S, Jackson SC, Kopel AJ, Lewis V, Nicotri T Jr. Actinic lichen nitidus in 3 African American patients. J Am Acad Dermatol. Feb 2006;54(2 Suppl):S48-9. [Medline].

  6. Itami A, Ando I, Kukita A. Perforating lichen nitidus. Int J Dermatol. May 1994;33(5):382-4. [Medline].

  7. Yoon TY, Kim JW, Kim MK. Two cases of perforating lichen nitidus. J Dermatol. Apr 2006;33(4):278-80. [Medline].

  8. Munro CS, Cox NH, Marks JM, Natarajan S. Lichen nitidus presenting as palmoplantar hyperkeratosis and nail dystrophy. Clin Exp Dermatol. Jul 1993;18(4):381-3. [Medline].

  9. Yáñez S, Val-Bernal JF. Purpuric generalized lichen nitidus: an unusual eruption simulating pigmented purpuric dermatosis. Dermatology. 2004;208(2):167-70. [Medline].

  10. Jetton RL, Eby CS, Freeman RG. Vesicular and hemorrhagic lichen nitidus. Arch Dermatol. Mar 1972;105(3):430-1. [Medline].

  11. Lestringant GG, Piletta P, Feldmann R, Galadari I, Frossard PM, Saurat JH. Coexistence of atopic dermatitis and lichen nitidus in three patients. Dermatology. 1996;192(2):171-3. [Medline].

  12. Kawakami T, Soma Y. Generalized lichen nitidus appearing subsequent to lichen planus. J Dermatol. Jun 1995;22(6):434-7. [Medline].

  13. Scheinfeld NS, Lehman D. Condyloma with lichen nitidus. Skinmed. May-Jun 2005;4(3):177-8. [Medline].

  14. Taniguchi S, Chanoki M, Hamada T. Recurrent generalized lichen nitidus associated with amenorrhea. Acta Derm Venereol. May 1994;74(3):224-5. [Medline].

  15. Kano Y, Shiohara T, Yagita A, Nagashima M. Erythema nodosum, lichen planus and lichen nitidus in Crohn's disease: report of a case and analysis of T cell receptor V gene expression in the cutaneous and intestinal lesions. Dermatology. 1995;190(1):59-63. [Medline].

  16. Scheinfeld NS, Teplitz E, McClain SA. Crohn's disease and lichen nitidus: a case report and comparison of common histopathologic features. Inflamm Bowel Dis. Nov 2001;7(4):314-8. [Medline].

  17. Bercedo A, Cabero MJ, Garcia-Consuegra J, Hernado M, Yaez S, Fernandez-Llaca H. Generalized lichen nitidus and juvenile chronic arthritis: an undescribed association. Pediatr Dermatol. Sep-Oct 1999;16(5):406-7. [Medline].

  18. Dobbs CR, Murphy SJ. Lichen nitidus treated with topical tacrolimus. J Drugs Dermatol. Nov-Dec 2004;3(6):683-4. [Medline].

  19. Sehgal VN, Jain S, Kumar S, et al. Generalized lichen nitidus in a child's response to cetirizine dihydrochloride/levamisol. Australas J Dermatol. Feb 1998;39(1):60. [Medline].

  20. Lucker GP, Koopman RJ, Steijlen PM, van der Valk PG. Treatment of palmoplantar lichen nitidus with acitretin. Br J Dermatol. Jun 1994;130(6):791-3. [Medline].

  21. Libow LF, Coots NV. Treatment of lichen planus and lichen nitidus with itraconazole: reports of six cases. Cutis. Nov 1998;62(5):247-8. [Medline].

  22. Kano Y, Otake Y, Shiohara T. Improvement of lichen nitidus after topical dinitrochlorobenzene application. J Am Acad Dermatol. Aug 1998;39(2 Pt 2):305-8. [Medline].

  23. Randle HW, Sander HM. Treatment of generalized lichen nitidus with PUVA. Int J Dermatol. Jun 1986;25(5):330-1. [Medline].

  24. Do MO, Kim MJ, Kim SH, Myung KB, Choi YW. Generalized lichen nitidus successfully treated with narrow-band UVB phototherapy: two cases report. J Korean Med Sci. Feb 2007;22(1):163-6. [Medline].

  25. Kim YC, Shim SD. Two cases of generalized lichen nitidus treated successfully with narrow-band UV-B phototherapy. Int J Dermatol. May 2006;45(5):615-7. [Medline].

  26. Park JH, Choi YL, Kim WS, et al. Treatment of generalized lichen nitidus with narrowband ultraviolet B. J Am Acad Dermatol. Mar 2006;54(3):545-6. [Medline].

  27. Lapins NA, Willoughby C, Helwig EB. Lichen nitidus. A study of forty-three cases. Cutis. May 1978;21(5):634-7. [Medline].

  28. Scheler M, Proelss J, Bräuninger W, Bieber T, Wenzel J. Generalized lichen nitidus with involvement of the palms following interferon alpha treatment. Dermatology. 2007;215(3):236-9. [Medline].

  29. Thibaudeau A, Maillard H, Croue A, Belperron P, Avenel Audran M, Verret JL. [Palmoplantar lichen nitidus: a rare cause of palmoplantar hyperkeratosis.]. Ann Dermatol Venereol. Aug-Sep 2004;131(8-9):822-4. [Medline].

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Further Reading

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Keywords

flat-topped lesions, Köbner phenomenon, Koebner phenomenon, isomorphic response

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Contributor Information and Disclosures

Author

Zeina Tannous, MD, Consulting Staff, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School
Zeina Tannous, MD is a member of the following medical societies: Alpha Omega Alpha
Disclosure: Nothing to disclose.

Coauthor(s)

Nelly Rubeiz, MD, Consulting Staff, Department of Dermatology, American University of Beirut Medical Center; Associate Professor, Department of Dermatology, American University of Beirut, Lebanon
Nelly Rubeiz, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Medical Editor

David P Fivenson, MD, Associate Director, St Joseph Mercy Hospital Dermatology Program, Ann Arbor, Michigan
David P Fivenson, MD is a member of the following medical societies: American Academy of Dermatology, Medical Dermatology Society, Michigan Dermatological Society, Michigan State Medical Society, Photomedicine Society, Society for Investigative Dermatology, and Wound Healing Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Warren R Heymann, MD, Head, Division of Dermatology, Professor, Department of Internal Medicine, University of Medicine and Dentistry of New Jersey
Warren R Heymann, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology
Disclosure: elsevier Royalty Other; american college of physicians Honoraria Other

 
 
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