Lichen Nitidus 

Updated: Nov 20, 2019
Author: Zeina Tannous, MD; Chief Editor: William D James, MD 

Overview

Background

Lichen nitidus is a relatively rare, chronic skin eruption that is characterized clinically by asymptomatic, flat-topped, skin-colored micropapules (see image below).[1] Lichen nitidus mainly affects children and young adults.[2]

Multiple skin-colored shiny papules associated wit Multiple skin-colored shiny papules associated with lichen nitidus.

Pathophysiology

The skin is the primary organ system affected. Mucous membranes and nails[3] also might be involved. Lichen planus can clinically mimic lichen nitidus and can sometimes coexist with lichen nitidus.

Etiology

The etiology of lichen nitidus is unknown. Controversy exists regarding the relationship between lichen planus and lichen nitidus.[4]

Epidemiology

Frequency

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%.[5]

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.

Prognosis

Lichen nitidus is a benign disease with no associated mortality or complications. Lichen nitidus may remain active for several years; however, spontaneous resolution usually occurs.

 

Presentation

History

Lichen nitidus is usually an asymptomatic eruption; however, patients occasionally complain of pruritus. Familial cases have been described.[6]

Physical Examination

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 (see image below).

Multiple shiny lichens over the penis. Multiple shiny lichens over the penis.

The Köbner phenomenon (or an isomorphic response) may be observed, as shown below. This phenomenon causes the occasional linear pattern of the lesions associated with lichen nitidus.

Köbner phenomenon in lichen nitidus. Köbner phenomenon in lichen nitidus.

The most common sites of involvement are the trunk, flexor aspects of upper extremities, dorsal aspects of hands (see image below), 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.

Lichen nitidus. Lichen nitidus.

Clinical variants of lichen nitidus include generalized,[7] linear, actinic,[8] perforating,[9, 10] keratodermic,[11, 12] vesicular,[13] and purpuric[10] /hemorrhagic[13] forms.

Reported associated diseases include atopic dermatitis,[14] lichen planus,[15] condyloma,[16] amenorrhea,[17] Crohn disease,[18, 19] , juvenile chronic arthritis,[20] and Down syndrome.[21, 22]

 

DDx

 

Workup

Procedures

A skin biopsy for histopathologic examination may be obtained to confirm the clinical diagnosis.

Histologic Findings

The papule of lichen nitidus consists of a lymphohistiocytic inflammatory cell infiltrate that lies in close proximity to the epidermis and is associated with basal cell hydropic degeneration. The overlying epidermis is flattened and parakeratotic. At the lateral margins of the papule, the rete ridges extend downward and seem to hug the inflammatory infiltrate, which may be granulomatous.

 

Treatment

Approach Considerations

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 one or several years. Reported therapies, mostly from isolated case reports, include topical and systemic steroids, topical tacrolimus,[23, 24, 25] systemic cetirizine,[26] levamisole,[26] etretinate, acitretin,[27] itraconazole,[28] cyclosporine, topical dinitrochlorobenzene,[29] psoralen plus UV-A light,[30] and narrow-band UV-B light.[31, 32, 33]

 

Medication

Corticosteroids

Class Summary

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)

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

Methylprednisolone (Solu-Medrol, Depo-Medrol)

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

Antihistamines

Class Summary

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

Cetirizine (Zyrtec)

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

Retinoids

Class Summary

Retinoids have the ability to modulate cell proliferation.

Acitretin (Soriatane)

Acitretin is a retinoic acid analog, like etretinate and isotretinoin. Etretinate is the main metabolite and has demonstrated clinical effects close to those seen with etretinate. Its mechanism of action is unknown.