Lichen nitidus
Encyclopedia
Lichen nitidus is a chronic inflammatory disease of unknown etiology
characterized by 1-2 mm, discrete and uniform, shiny, flat-topped, pale flesh-colored or reddish-brown papules that may appear as hypopigmented
against dark skin. Occasionally, minimal scaling is present or can be induced by rubbing the surface of the papules. The disease usually affects children and young adults and is painless and usually nonpruritic
, although protracted itching may occur in some cases. It is sometimes referred to by dermatologists as "mini lichen planus
".
), especially on the forearms, but may occasionally be grouped, though not confluent, on flexural areas. Generally, the initial lesions are localized, and remain so, to the chest, abdomen, glans penis, and flexor aspects of the upper extremities; however, less commonly, the disease process can (1) be strictly isolated to the palms and soles, presenting with many hyperkeratotic, yellow papules that may coalesce into plaques that fissure or “...sometimes a non-specific keratoderma resembling chronic eczema,” or (2) become more widespread, with papules widely distributed on the body—the extensor surfaces of the elbows, wrists, and hands, folds of the neck, submammary region in females, groin, thighs, ankles, and feet—and fusing into erythematous, minimally scaled plaques, with reddness that develops tints of violet, brown, and yellow.
of lichen nitidus is significant for a "...localized granulomatous lymphohistiocytic infiltrate in an expanded dermal papilla
with thinning of overlying epidermis and downward extension of the rete
ridges at the lateral margin of the infiltrate, producing a typical 'claw clutching a ball' picture...."
, acitretin
, and etretinate
.
When appears with sun/humidity; air conditioning (cool dry air) reduces swelling and discomfort.
Etiology
Etiology is the study of causation, or origination. The word is derived from the Greek , aitiologia, "giving a reason for" ....
characterized by 1-2 mm, discrete and uniform, shiny, flat-topped, pale flesh-colored or reddish-brown papules that may appear as hypopigmented
Hypopigmentation
Hypopigmentation is the loss of skin color. It is caused by melanocyte or melanin depletion, or a decrease in the amino acid tyrosine, which is used by melanocytes to make melanin.-Treatments:...
against dark skin. Occasionally, minimal scaling is present or can be induced by rubbing the surface of the papules. The disease usually affects children and young adults and is painless and usually nonpruritic
Itch
Itch is a sensation that causes the desire or reflex to scratch. Itch has resisted many attempts to classify it as any one type of sensory experience. Modern science has shown that itch has many similarities to pain, and while both are unpleasant sensory experiences, their behavioral response...
, although protracted itching may occur in some cases. It is sometimes referred to by dermatologists as "mini lichen planus
Lichen planus
Lichen planus is a chronic mucocutaneous disease that affects the skin, tongue, and oral mucosa. The disease presents itself in the form of papules, lesions, or rashes. Lichen planus does not involve lichens, the fungus/algae symbionts that often grow on tree trunks; the name refers to the dry and...
".
Presentation
Linear arrangements of these papules is common (referred to as a Koebner PhenomenonKoebner Phenomenon
The Koebner phenomenon, also called the "Koebner response" or the "isomorphic response", refers to skin lesions appearing on lines of trauma. The Koebner phenomenon may result from either a linear exposure or irritation...
), especially on the forearms, but may occasionally be grouped, though not confluent, on flexural areas. Generally, the initial lesions are localized, and remain so, to the chest, abdomen, glans penis, and flexor aspects of the upper extremities; however, less commonly, the disease process can (1) be strictly isolated to the palms and soles, presenting with many hyperkeratotic, yellow papules that may coalesce into plaques that fissure or “...sometimes a non-specific keratoderma resembling chronic eczema,” or (2) become more widespread, with papules widely distributed on the body—the extensor surfaces of the elbows, wrists, and hands, folds of the neck, submammary region in females, groin, thighs, ankles, and feet—and fusing into erythematous, minimally scaled plaques, with reddness that develops tints of violet, brown, and yellow.
Pathology
The histologyHistology
Histology is the study of the microscopic anatomy of cells and tissues of plants and animals. It is performed by examining cells and tissues commonly by sectioning and staining; followed by examination under a light microscope or electron microscope...
of lichen nitidus is significant for a "...localized granulomatous lymphohistiocytic infiltrate in an expanded dermal papilla
Papilla
The term papilla generally means a nipple-like structure, and may refer to:* Mammary papilla, or nipple* Amphibian papilla and basal papilla, part of the inner ear of the frog.* Interdental papilla, part of the gingiva between teeth...
with thinning of overlying epidermis and downward extension of the rete
Rete
Rete may refer to: An interwoven network of nerves, blood vessels or passageways.-Italy:*Net , in Latin*La Rete , the common name given to Movimento per la Democrazia , an Italian political party-Technology:...
ridges at the lateral margin of the infiltrate, producing a typical 'claw clutching a ball' picture...."
Treatment
Generally, lichen nitidus is asymptomatic and self-limited; therefore, no treatment is required. However, if persistent pruritus is present, or the appearance “...interferes with daily activities or outlook...” topical glucocorticoids may be tried. If the disease process is symptomatic, generalized and extensive, oral glucocorticoids may be indicated. Other reported treatments include PUVA, UVA/UVB phototherapy, astemizoleAstemizole
Astemizole was a second generation antihistamine drug which has a long duration of action. Astemizole was discovered by Janssen Pharmaceutica in 1977...
, acitretin
Acitretin
Acitretin is a second generation retinoid. It is taken orally, and is typically used for psoriasis....
, and etretinate
Etretinate
Etretinate is a medication developed by Hoffmann–La Roche that was approved by the FDA in 1986 to treat severe psoriasis...
.
When appears with sun/humidity; air conditioning (cool dry air) reduces swelling and discomfort.
External links
- Lichen Nitidus at DermNet photo library