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Lichen nitidus

Author: Dr Delwyn Dyall-Smith FACD, Dermatologist, 2011.

What is lichen nitidus?

Lichen nitidus is an uncommon inflammatory skin condition that usually presents with tiny skin-coloured bumps in children. Although it has been considered a variant of lichen planus, lichen nitidus is now believed to be a separate and distinct entity.

Who gets lichen nitidus and why?

Lichen nitidus usually begins in childhood, particularly preschool and school-aged children, or in young adult life. It affects both sexes equally and occurs in all races.

The cause of lichen nitidus is unknown.

Lichen nitidus has been reported in association with:

It is sometimes familial.

Clinical features of lichen nitidus

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.

The papules (bumps) have the following characteristics:

The Köbner or isomorphic phenomenon is common, appearing as lichen nitidus papules arranged in a line along scratch mark sites.

The palms and soles may be affected. This may be unilateral or bilateral, localised or in combination with lesions in more typical sites. Lichen nitidus confined to the palms seems to affect an older age group (age range 37-52 years) and tends to be very persistent.

Lichen nitidus can involve the lining of the mouth, perhaps more commonly than is reported. The clinical features in this location are:

Changes in the nails are seen in approximately 10%, particularly in adults. These may include:

Reported clinical variants of lichen nitidus include:

How is lichen nitidus diagnosed?

Although the clinical presentation will suggest the diagnosis, lichen nitidus usually requires a skin biopsy to be confirmed. The histology of lichen nitidus is very typical and described as the ‘claw and ball’ appearance:

Treatment of lichen nitidus

Usually no treatment is required, as lichen nitidus does not usually cause any symptoms and resolves within 12 months in two-thirds of cases. Post-inflammatory hyperpigmentation can persist for months, or in some cases, for years.

Treatment may be requested by patients with:

Treatments reported to have given some relief and/or resolution include:

In severe cases, systemic treatments may be considered, including:

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