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An Atlas of Lumps and Bumps, Part 40: Lichen Nitidus

Alexander K.C. Leung, MD1,2, Benjamin Barankin, MD3, Joseph M. Lam, MD4, Kin Fon Leong, MD5

Volume 64 - Issue 6 - June 2024

Lichen Nitidus

Lichen nitidus is an idiopathic chronic dermatosis characterized by minute, flesh-colored or hypopigmented, shiny papules commonly occurring on the abdomen, chest, genitalia, and extremities.1,2 Although the exact incidence is not known, lichen nitidus is a rare dermatosis. The majority of cases occur in children and young adults.3,4 The mean age of onset is around 8 years of age.5,6 The occurrence of lichen nitidus during infancy is extremely rare.1 The sex ratio is approximately equal.4,7 There is no racial predilection.5,7

Lichen nitidus is more common in patients with lichen planus, lichen spinulosus, lichen striatus, vitiligo, psoriasis vulgaris, neurofibromatosis type 1, and erythema nodosum.4,5,8,9 The condition has also been reported to occur following the use of certain medications (nivolumab, tremelimumab, mogamulizumab, ribavirin, interferon) and in patients after tattoos or trauma (Koebner phenomenon).4,7,10-12 Other conditions associated with lichen nitidus include HIV infection, Crohn disease, Niemann-Pick disease, Down syndrome, and Silver-Russell syndrome. 4,5,13-16 Familial lichen nitidus has rarely been reported.1,17,18 Leung and Ng reported identical twins with lesions of generalized lichen nitidus noted at two months of age.1 The familial occurrence of lichen nitidus suggests a genetic component. It is possible that the genetic predisposition renders individuals susceptible to some environmental factors that induce a cell-mediated response, resulting in lymphocyte accumulation forming the discrete papules seen in lichen nitidus.4

Clinically, lichen nitidus presents as minute (1 to 2 mm in diameter), discrete, flat-topped, shiny papules, usually arranged in groups (Figure 1).1,7,19,20  Occasionally, the lesions can be dome-shaped.20

fig. 1
Figure 1. Lichen nitidus presents as minute, discrete, flat-topped, shiny papules, usually arranged in groups

Although the lesions are often pink to tan brown or flesh-colored,4 they may be hypopigmented in dark-skinned individual (Figure 2).20 The lesions are usually asymptomatic but may be pruritic.20,21Sites of predilection include the chest, abdomen, genitalia, neck, and extremities.17,19,21 Rarely, the palms, soles, oral mucous membrane, and nails may be involved.4,17 Oral mucosal involvement often presents with flat, grayish papules on the oral mucosa while nail involvement may present with ridging, thickening/thinning, pitting, trachyonychia, and longitudinal grooving of the nail plate.22-24 The disorder is most often localized but can become extensive or generalized.1,2,19,25  Evidence of koebnerization, with grouping of the papules in a linear array, may be seen.20,21

fig. 2
Figure 2. The disorder is most often localized but can become extensive or generalized, with grouping of the papules in a linear array.

Several clinical variants have been recognized, namely, perforating lichen nitidus, linear lichen nitidus, confluent lichen nitidus, palmar/plantar lichen nitidus, hyperkeratotic and hypertrophic lichen nitidus, purpuric (hemorrhagic) lichen nitidus, actinic lichen nitidus, vesicular lichen nitidus, and follicular spinous lichen nitidus.26-32

The diagnosis of lichen nitidus is mainly clinical, based on its distinctive features. Typical dermoscopic features include smooth, white, well-circumscribed circles with a brown shadow.4,33 In vivo reflectance confocal microscopy typically shows enlarged, well-circumscribed dermal papillae which are highly refractile.34 

Lichen nitidus tends to resolve spontaneously within a few years.7 Transient post-inflammatory hyperpigmentation at the site of the condition may occur.7

AFFILIATIONS:
1Clinical Professor of Pediatrics, the University of Calgary, Calgary, Alberta, Canada
2Pediatric Consultant, the Alberta Children’s Hospital, Calgary, Alberta, Canada
3Dermatologist, Medical Director and Founder, the Toronto Dermatology Centre, Toronto, Ontario, Canada
4Associate Clinical Professor of Pediatrics, Dermatology and Skin Sciences, the University of British Columbia, Vancouver, British Columbia, Canada.
5Pediatric Dermatologist, the Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia

CITATION:
Leung AKC, Barankin B, Lam JM, Leong KF. An atlas of lumps and bumps, part 40: lichen nitidus. Consultant. 2024;64(6):e3. doi:10.25270/con.2024.06.000004

CORRESPONDENCE:
Alexander K. C. Leung, MD, #200, 233 16th Ave NW, Calgary, AB T2M 0H5, Canada (aleung@ucalgary.ca)

EDITOR’S NOTE:
This article is part of a series describing and differentiating dermatologic lumps and bumps. To access previously published articles in the series, visit: https://www.consultant360.com/resource-center/atlas-lumps-and-bumps.

References

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  2. Al-Mutairi N, Hassanein A, Nour-Eldin O, Arun J. Generalized lichen nitidus. Pediatr Dermatol. 2005;22(2):158-160. doi: 10.1111/j.1525-1470.2005.22215.x
  3. Farshi S, Mansouri P. Letter: Generalized lichen nitidus successfully treated with pimecrolimus 1 percent cream. Dermatol Online J. 2011;17(7):11.
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  9. Doğan S, Memis P, Ersoy-Evans S, Gokoz O, Tavil B, Çetin M. Generalized lichen nitidus associated with neurofibromatosis type 1 and juvenile myelomonocytic leukemia. Int J Dermatol. 2016;55(11):e592-e594. doi: 10.1111/ijd.13084
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  11. Li AW, Ko CJ, Leventhal JS. Generalized lichen nitidus-like eruption in the setting of mogamulizumab and tremelimumab. Eur J Dermatol. 2017;27(3):325-326. doi: 10.1684/ejd.2017.298.
  12. Shan SJ, Xia Z, Chen J, Xu TH, Xu XG, Li ZR, et al. Widespread lichen nitidus associated with tattoo. Eur J Dermatol. 2013;23(1):123-4. doi:10.1684/ejd.2012.1897.
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  15. Teixeira VB, Coutinho I, Cardoso JC, Tellhechea Ó. Generalized lichen nitidus in a boy with Niemann-Pick disease type B. An Bras Dermatol. 2013 Nov-Dec;88(6):977-8. doi:10.1590/abd1806-4841.20132829
  16. Wanat KA, Elenitsas R, Chachkin S, Lubinski S, Rosenbach M. Extensive lichen nitidus as a clue to underlying Crohn's disease. J Am Acad Dermatol. 2012;67(5):e218-20. doi:10.1016/j.jaad.2012.04.005
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  24. Tay EY, Ho MS, Chandran NS, Lee JS, Heng YK. Lichen nitidus presenting with nail changes--case report and review of the literature. Pediatr Dermatol. 2015;32(3):386-388. doi:10.1111/pde.12425
  25. Synakiewicz J, Polańska A, Bowszyc-Dmochowska M, Żaba RW, Adamski Z, Reich A, et al. Generalized lichen nitidus: a case report and review of the literature. Postepy Dermatol Alergol. 2016;33(6):488-490. doi:10.5114/ada.2016.63890
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  27. Ho JD, Al-Haseni A, Rosenbaum MT, Goldberg LJ. Hyperkeratotic and hypertrophic lichen nitidus. Dermatol Online J. 2017;23(10):13030/qt5t28j781.
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  30. Podder I, Mohanty S, Chandra S, Gharami RC. Isolated palmar lichen nitidus -A diagnostic challenge: First case from Eastern India. Indian J Dermatol. 2015;60(3):308-309. doi:10.4103/0019-5154.156398
  31. Singh S, Singh A, Mallick S, Arava S, Ramam M. Lichenoid pseudovesicular papular eruption on nose: A papular facial dermatosis probably related to actinic lichen nitidus or micropapular polymorphous light eruption. Indian J Dermatol Venereol Leprol. 2019;85(6):597-604. doi: 10.4103/ijdvl.IJDVL_347_18.
  32. Taneja N, Mehta N, Arava S, Gupta V. An unusual variant of lichen nitidus: Generalized follicular spinous with perifollicular granulomas. J Cutan Pathol. 2020;47(9):834-839. doi:10.1111/cup.13712
  33. Malakar S, Save S, Mehta P. Brown shadow in lichen nitidus: A dermoscopic marker! Indian Dermatol Online J. 2018;9(6):479-480. doi:10.4103/idoj.IDOJ_338_17
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