Patients with both types of lesions can be considered to have related diagnoses or diagnoses that lie on a continuum, which is comparable to the cooccurrence of classic lp and lichen. Lichen nitidus ln is a benign micropapular eruption of unknown etiology that often follows an unpredictable course. Lichen nitidus is a relatively rare, chronic skin eruption that is characterized clinically by asymptomatic, flattopped, skincolored micropapules see image below. Lichen nitidus rarely causes discomfort and usually clears up on its own without treatment. Lichen nitidus was once associated with lichen planus believed to be a variant but is now deemed a separate disease. It is more frequent in women 7080%, with a peak age of onset between 30 and 60 years. Aug 31, 2010 the term aln should describe miliary papules with lichen nitidus like histopathology, and alp should refer to annular lesions with lplike histological features. Case report blaschkolinear acquired inflammatory skin eruption, or blaschkitis, with features of lichen nitidus maya aravind, md,a thy thy do, mbbs,a hyuk c. Lichen spinulosus is an uncommon dermatosis manifested by large patches of follicular papules topped by keratotic spines, as shown in the image below. Lichen planus has characteristic clinical and histopathological features which make the diagnosis relatively easy. Palmar purpuric lichen nitidusclinicopathological and. Blaschkolinear acquired inflammatory skin eruption, or. Individual lesion shows conical projection, hair like horny spine. Lichen nitidus mainly affects children and young adults.
He also found grouping of the lesions in lichen nitidus, the condition differing in this respect from all the cases reported except that of kyrle and mcdonagh. A case report and comparison of common histopathologic features we describe a 54yearold black woman with crohns disease, who developed lichen. Josef feit, hana jedlickova, gunter burg, ludek matyska, spasoje radovanovic et al. Nov 20, 2019 lichen nitidus is a relatively rare, chronic skin eruption that is characterized clinically by asymptomatic, flattopped, skincolored micropapules see image below. Lichen nitidus is a rare, usually asymptomatic chronic eruption characterized by the presence of multiple, small fleshcolored papules, 12 mm in diameter. Lichen nitidus ln is an uncommon dermatosis of unknown etiology that was first described by felix pinkus in 1901. Lichen planus lp is a chronic inflammatory and immune mediated disease that affects the skin, nails, hair, and mucous membranes. Lichen planusa clinicohistopathological indian j dermatol. Three years later, she presented with scattered hyperpigmented macules with oval pinkviolaceous plaques bilaterally on her forearms and on her neck, clinically consistent with actinic lichen planus.
Lichen nitidus of the palms and soles jama dermatology. It has a tendency to disappear spontaneously at puberty. Lichen planusflat topped violaceous papules with fine scale clinically and histopathology showing hyperkeratosis, irregular acanthosis, and bandlike inflammatory cells. Summary lichen nitidus is a rar e condition occurring in childr en and young adults. However 7 cases were diagnosed as lichen planus hypertrophicus lph on histopathology. Characteristic features include distinctive purplish, flattopped papules discrete or coalescent into plaques on the trunk and flexor surfaces. Up to now, to our knowledge, no treatment has ever been described as more than partially successful. Lichen nitidus is a skin condition that causes small, fleshcolored bumps. Scanning power view of lichen nitidus identifies a focal dermal inflammatory infiltrate enclosed within collarettes of epidermal acanthosis figures 1 and 2. It is characterized by tiny, skin eruptions or papules that are somehow discrete but uniform in distribution, and are pale to reddishbrown in color. At the moment, it is known that, in this disease, the skin cells present an abnormal inflammatory activity but the exact cause of the inflammation has yet to be identified. Lichen nitidus is a rare chronic condition of unknown etiology. Lichenoid dermatitis is a histological term that refers to a combination of histological findings that is close to those of lichen planus 1. Introduction lichen spinulosus ls is a genetic disorder of keratinization of hair follicles.
What is of note regarding the treatment is that there are no randomized controlled trials to asses effectiveness of different forms of treatment. Lichen nitidus consists of small, glistening, monomorphic, fleshcolored to pink or reddishbrown papules of unknown etiology. To our knowledge, only eight cases of this disease with this distribution have been reported previously, and no detailed histologically documented cases were found in the american literature. Lichen nitidus clinically presents as multiple shiny, pinheadsized, fleshcolored, domeshaped papules typically involving the genitalia, upper extremities, and torso, though it also can be generalized. Lichen nitidus is a rare dermatitis of unknown etiology, benign, with spontaneous resolution in months to years.
In 1985, okamoto and colleagues described a case of micropapular sarcoidosis mimicking lichen nitidus. Given the onset of our patients skin lesions in the setting of sarcoidosis, papular variant of cutaneous sarcoidosis was a major consideration, as well as lichen nitidus and drug eruption. In 1883, crocker published a description of lichen spinulosus. Lichen nitidus is a rare, inflammatory skin condition, in which skincolored, micropapules that glisten appear on the skin. Lichen nitidus is an uncommon inflammatory skin eruption of unknown cause that typically affects children and young adults, without sex or racial bias. The disease usually affects children and young adults and is. Generalized lichen nitidus in a middleaged adult lacour. Ive included some questions throughout \rlecture to encourage active learning.
Dec 09, 2014 lichen nitidus is an uncommon inflammatory skin eruption of unknown cause that typically affects children and young adults, without sex or racial bias. Although it has been considered a variant of lichen planus, lichen nitidus is now believed to be a separate and distinct entity. Lichen nitidus latin nitidus, shiny or glistening is an uncommon, usually asymptomatic cutaneous eruption first described by felix pinkus in 1901 and. Lichenoid dermatitis is a form of neurodermatitis, characterized by intense pruritus with exudative, weeping patches on the skin scattered irregularly over most of the body, many of which are of the eczematous type and undergo. The etiology of it is still unknown and the majority of instances appear in children and young adults. A clinical and histopathological study of lichen planus. Lichen nitidus is an unusual condition with chronic evolution. There is irregular epidermal hyperplasia forming a characteristic sawtooth appearance with wedgeshaped hypergranulosis. Lichen nitidus primary care dermatology society uk. Occasionally, minimal scaling is present or can be induced by rubbing the surface of the papules. Lna has also been reported under the pseudonyms actinic lichen nitidus 2, 3 actinic lichenoid eruption, and summertime actinic lichenoid eruption sale 4.
We present our patient because of the rarity of the generalized form of lichen nitidus with palm involvement in adulthood. Although the majority of reports are from countries with subtropical climates, we emphasize the presence of this entity in the united states. Lichen nitidus was first described by pinkus more than a century ago in 1907. Lichen nitidus is a chronic inflammatory disease of unknown cause characterized by 12 mm, discrete and uniform, shiny, flattopped, pale fleshcolored or reddishbrown papules that may appear as hypopigmented against dark skin. After it clears up, the appearance of the skin is usually normal with no scarring or permanent change to skin color. Lichen striatus ls is a benign, uncommon, selflimited, linear inflammatory skin disorder that primarily affects children up to 15 years of age, most commonly around 2 to 3 years of age, and is seen more frequently in girls. Lichen nitidus symptoms lichen nitidus is hallmarked by the development of the tiny glistering papules that is skintoned or may be hypopigmented in the individuals with dark skin. Since then, few other similar reports were published until 1990, when friedman presented data on 35 patients with lichen spinulosus.
Lichen nitidus is a rare and chronic inflammatory dermatosis first described by pinkus in 1907. Lichen nitidus and lichen striatus are often confused because they are thought to share similar clinical and histopathologic features. Histology of lichen nitidus scanning power view of lichen nitidus identifies a focal dermal inflammatory infiltrate enclosed within collarettes of epidermal acanthosis figures 1 and 2. Scanning power view of lichen planus shows a lichenoid reaction pattern figure 1 characterised by the combination of degeneration of the basal layer of the epidermis and a band like lymphocytic infiltrate obscuring the dermoepidermal junction. Lichen nitidus is a chronic eruption that classically appears in children and young adults. Histologically, there is a focal lichenoid infiltrate with admixture of histiocytes and giant cells indistinguishable from lichen nitidus. Aug 14, 2017 lichen spinulosus is an uncommon dermatosis manifested by large patches of follicular papules topped by keratotic spines, as shown in the image below. Lichen planus lp is an inflammatory, pruritic disease of the skin and mucous membranes and can be generalized or localized. Successful treatment of lichen nitidus jama dermatology. Lichen nitidus which involved the palms and soles occurred in two patients. Lichen nitidus is a rare, chronic inflammatory skin condition that is idiopathic in cause. The classical description of this fairly common dermatosis is asymptomatic, multiple, shiny, skincolored and flattopped papules usually seen over the dorsa of the hands and genitalia, though generalized forms are seen. In all clinically diagnosed cases of lph, histopathology was confirmatory.
Lichen nitidus is a relatively rare condition that usually presents in children and young adults, and is characterised by the presence of many asymptomatic, skincoloured or white, small, flattopped papules that have a shiny surface. T1 histopathological and immunohistochemical study of lichen nitidus and lichen striatus. It is characterized by follicular hyperkeratotic papules that may coalesce into plaques. While the eruption is generally asymptomatic, the patient may seek a dermatologic opinion for cosmetic reasons. Although rare, it represents 25% of the cases of cicatricial alopecia. Pathology of lichen planopilaris top 8 facts dr sampurna. Children with asymptomatic, pinpoint, round, fleshcolored papules on trunk, genitalia, abdomen and forearms may coexist with lichen planus. Roundish foci of dense intrapapillary infiltrate, consisting of lymphocytes and epithelioid histiocytes, forming tiny granulomas.
It is characterized by small papules, 1 to 2 mm each, normal skin color, smooth and shiny surface, usually asymptomatic and compromise flexor. Lichen nitidus pictures, treatment, contagious, symptoms. Although the eruption usually is asymptomatic, itching andor a burning sensation occasionally have. The characteristic shiny, flattopped, skincoloured, pinheadsized papules are usually arranged in groups on. Our case represents only the fifth reported case of actinic lichen nitidus. Lichen nitidus definition of lichen nitidus by medical. The histology of lichen nitidus has been described previously but a follicular variant has not been emphasized. On histopathology, lichen nitidus has a distinct, circumscribed infiltrate of lymphocytes, histiocytes, and giant cells in papillary dermis directly beneath a thinned epidermis. Lichen nitidus is a harmless condition that doesnt result. In a previous study 1, the microscopic findings in lichen planus were considered to be more than 90 per cent diagnostic. Histopathology of lichen planus based on analysis of one. Lichen nitidus diagnosis and treatment mayo clinic. Typically lichen nitidus presents as a localised bumpy skin eruption involving the flexor aspects of the forearms, backs of hands, the penis, chest, abdomen and buttocks, although any site can be involved including the face. Illustration omitted lichen planusgeneralised with koebners phenomenon, histopathology showing basal degeneration and civatte bodies.
Histopathology demonstrates noncaseating granulomas. Nov 01, 2001 one case of familial lichen nitidus has been reported 26. Lichen nitidus usually begins in childhood, particularly. Some of the relevant pages from first aid are found at the end of these notes. The clinical manifestations of ln are small, glistening, fleshcolored to pink or reddish papules, which are often located on the penis.
Ln typically affects children and young adults and presents with asymptomatic, discrete, uniform, skin colored, pinpoint sized papules. It was originally regarded as a variant of lichen planus but it is now considered a distinct entity. The papules bumps have the following characteristics. Focal erosion of the epidermis in figure 1 indicates excoriation. Lichenoid eruption an overview sciencedirect topics.
Lichen nitidus is a rare clinical entity first described by pinkus in 1907. We report a case of lichen nitidus with periappendageal inflammation resulting in histologic similarities to lichen striatus. Lichen nitidus is an uncommon inflammatory skin condition that usually presents with tiny skincoloured bumps in children. Lichen planopilaris, also called follicular lichen or follicular lichen planus, was initially described by pringle in 1895. Linear lichen nitidus with onychodystrophy in a child relhan.
The etiology is unknown but genetic predisposition has been suggested as a possible cause. The classical description of this fairly common dermatosis is asymptomatic, multiple, shiny, skincolored and flattopped papules usually seen over the dorsa of the hands. Our case represents only the fifth reported case of actinic lichen nitidus in the united states. It arises as multiple tiny, shiny papules with a flat surface. Actinic lichen nitidus is characterized by classic lesions of lichen nitidus developing predominantly on photoexposed sites and may show koebnerization as in classic lichen nitidus. The characteristic shiny, flattopped, skincoloured, pinheadsized papules are usually arranged in groups on the chest, abdomen, genitalia and upper extremities. Lichen nitidus is a rare benign chronic papular lesion of unknown etiology. The authors also found that 20% of cases of malignant transformation involved the gingival mucosa, further reinforcing the importance of histopathology in the final diagnosis of this disease. Well show you what these bumps look like, where they can pop up, and. We present the case of a 29yearold black female with an initial clinical and histopathologic diagnosis of actinic lichen nitidus. We describe a case of lichen nitidus with the unique finding of epidermal perforation, a feature that made the usual straightforward diagnosis of lichen nitidus much more difficult. Duke university medical center durham, north carolina 6846423 rex. Other diagnoses like lichen planus actinicus lpa, lichen planopilaris lpp figure 2 and oral lp were also confirmed histopathologically.
Linear lichen nitidus with onychodystrophy in a child. It is characterized by polygonal, flattopped, violaceous papules and plaques with overlying, reticulated, fine white scale wickhams striae, commonly affecting dorsal hands, flexural wrists and forearms, trunk, anterior lower legs and oral mucosa. Lichen nitidus pictures, treatment, symptoms, causes. For most people, lichen nitidus lasts for a few months to a year. The condition usually clears up on its own without treatment. Lichen nitidus results from abnormal inflammatory activity in skin cells, but the cause of inflammation is unknown. A case of lichen nitidus mimicking papular sarcoidosis. Lichen nitidus actinicus lna is a rare variant of ln, which features lesions localized to sunexposed areas of the body, typically the dorsal hands and the extensor forearms.
Histopathological and immunohistochemical study of lichen. The lichen nitidus was superimposed on the lichen planus, and in certain regions it was practically impossible to distinguish one from the other. Jul 31, 20 dermatopathology reference describes lichen nitidus histopathology including histologic features and provides links to additional medical references. Clinically it is characterized by the presence of numer ous micropapules, usually asymptomatic, localized on the upper limbs, thorax, abdomen or genital area. The electron microscopy revealed primary changes in hydropic degeneration of basal cells which possibly indicated severe edema between the basal keratinocytes and in the subepidermal area. A lesion of lichen nitidus in a 53yearold man was examined by histology and electron microscopy. This case extends the spectrum of histologic findings in lichen nitidus and shows overlap in the distribution of the inflammatory. The histopathologic examination of the punch biopsy specimen revealed a lichenoid lymphohistiocytic infiltrate and abundant melanophages, expanding the papillary dermis, mimicking the classic ballinclaw histology of lichen nitidus. One case of familial lichen nitidus has been reported 26.
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