eMedicine Specialties > Dermatology > Reactive & Inflammatory Dermatoses

Lichen Nitidus: Treatment & Medication

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

Medication

No therapeutic modality has been rigorously evaluated for the treatment of lichen nitidus because of the rarity, lack of significant symptomatology, and disappearance of this disease within 1 or several years. Reported therapies, mostly from isolated case reports, include topical and systemic steroids, topical tacrolimus,18 systemic cetirizine,19 levamisole,19 etretinate, acitretin,20 itraconazole,21 cyclosporine, topical dinitrochlorobenzene,22 psoralen plus UV-A light,23 and narrow-band UV-B light.24,25,26

Corticosteroids

Have anti-inflammatory properties and cause profound and varied metabolic effects. In addition, these agents modify the body's immune response to diverse stimuli.


Prednisone (Deltasone)

May decrease inflammation by reversing increased capillary permeability and suppressing PMN activity.

Adult

0.05-2 mg/kg/d PO divided bid/qid; not to exceed 80 mg/d or divided bid/qid; taper over 1-2 wk, as symptoms resolve

Pediatric

4-5 mg/m2/d PO; alternatively, 0.05-2 mg/kg PO divided bid/qid; taper over 2 wk, as symptoms resolve

Coadministration with estrogens may decrease prednisone clearance; when used with digoxin, digitalis toxicity secondary to hypokalemia may increase; phenobarbital, phenytoin, and rifampin may increase metabolism of glucocorticoids (consider increasing maintenance dose); monitor for hypokalemia with coadministration of diuretics

Documented hypersensitivity; viral infection; peptic ulcer disease; hepatic dysfunction; connective tissue infections; fungal or tubercular skin infections

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Abrupt discontinuation of glucocorticoids may cause adrenal crisis; hyperglycemia, edema, osteonecrosis, myopathy, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, myasthenia gravis, growth suppression, and infections may occur with glucocorticoid use


Methylprednisolone (Solu-Medrol, Depo-Medrol)

Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.

Adult

2-60 mg/d PO or divided bid/qid initially; followed by gradual reduction to lowest level that will maintain clinical response

Pediatric

0.5-1.7 mg/kg/d or 5-25 mg/m2/d PO/IV/IM divided q6-12h

Coadministration with digoxin may increase digitalis toxicity secondary to hypokalemia; estrogens may increase levels of methylprednisolone; phenobarbital, phenytoin, and rifampin may decrease levels of methylprednisolone (adjust dose); monitor patients for hypokalemia when taking medication concurrently with diuretics

Documented hypersensitivity; viral, fungal, or tubercular skin infections

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Hyperglycemia, edema, osteonecrosis, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, growth suppression, myopathy, and infections are possible complications of glucocorticoid use

Antihistamines

Act by competitive inhibition of histamine at the H1 receptor. Mediate bronchial constriction, mucous secretion, smooth muscle contraction, edema, hypotension, CNS depression, and cardiac arrhythmias.


Cetirizine (Zyrtec)

Forms complex with histamine for H1-receptor sites in blood vessels, GI tract, and respiratory tract.

Adult

5-10 mg PO qd

Pediatric

<2 years: Not established
2-5 years: 2.5 mg PO qd
>5 years: Administer as in adults

Increases CNS toxicity of depressants

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Caution in hepatic or renal dysfunction; doses higher than 10 mg/d may cause drowsiness

Retinoids

Have the ability to modulate cell proliferation.


Acitretin (Soriatane)

Retinoic acid analog, like etretinate and isotretinoin. Etretinate is main metabolite and has demonstrated clinical effects close to those seen with etretinate. Mechanism of action is unknown.

Adult

25 mg/d or 50 mg/d initially given as single dose with main meal; 25-50 mg/d after initial response to treatment; terminate therapy when lesions have resolved sufficiently

Pediatric

Not established

Increases toxicity methotrexate; avoid concomitant use; interferes with effects of microdosed progestin minipill; coadministration with alcohol may enhance synthesis of etretinate, which has much longer half-life than acitretin (>120 d)

Pregnancy

X - Contraindicated; benefit does not outweigh risk

Precautions

Do not use in severe obesity; women of childbearing age must be capable of complying with effective contraceptive measures; recommended that contraception be continued for at least 3 y after stopping treatment with acitretin; etretinate may form from acitretin, which takes about 2-3 y to clear from body; caution if impaired renal or liver function; perform AST, ALT, and LDH tests prior to initiation of acitretin therapy at 1- to 2-wk intervals until stable and thereafter at intervals as clinically indicated

More on Lichen Nitidus

Overview: Lichen Nitidus
Differential Diagnoses & Workup: Lichen Nitidus
Treatment & Medication: Lichen Nitidus
Follow-up: Lichen Nitidus
Multimedia: Lichen Nitidus
References
[ CLOSE WINDOW ]

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].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

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

[ CLOSE WINDOW ]

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

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.