LICHEN NITIDUS

Introduction:

Is chronic eruption consisting of multiple tiny discrete skin coloured papuples that are arranged in clusters.Progression from lichen nitidus to lichen planus has been reported. Few authours believe it may be a clincal manifestation of crohn's disease, however it is generally accepted that lichen nitidus is not associated with any systemic disease or abnormal laboratory findings.

Exhibits Koebner phenomenon.


Clinical Features:

Symptoms

Pruritis can occur but it is an uncommon feature.

Signs

Numerous, tiny, discrete,shiny skin colured uniform, pinhead-sized papules that occasionally exhibit central depression.
Lesions can coalesce to form plaques that can have psoriasiform appearance esp on elbows and knees
Papules can be hypopigmented in dark skin individuals,however occaionslly can be hyperpimented.

Location

Flexor aspect of upper extremities,genetalis,
chest,abdomen and dorsum of hands.
oral lesions are rare.
Nail involvement in about 10 % of patients.(same findings as LP)

Pathology

Infiltrate of lymphocytes, epitheloid cells and occaionally langhans giant cells is typically clutched by the surrounding hyperplastic rete ridges in a "ball and claw" pattern.
Lichenoid infiltrate closely apposes the epidermis.

Treatment

Treatment is mainly symtomatic.

First Line

Topical steriods
Anti histamines
Topical Calcineurim inhibitors

Second Line

Same as LP

Prognosis

Two thirds of patients resolve within a year.