Lichen nitidus L44.1

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 23.08.2021

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Granuloma nitidum; Pinkus disease

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Pinkus 1907

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Chronic, asymptomatic, papular dermatosis with disseminated or generalized, approximately 0.1 cm large, skin-colored, lichenoid shining papules with initially lichenoid, later tuberculoid, dermal infiltrate.

No confirmed involvement of internal organs. An association of lichen nitidus and Crohn's disease is not confirmed (Stolze I et al. 2018).

A Koebner phenomenon can be observed.

In dark skin the papules appear hypopigmented.

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Unresolved, discussed are: atypical course of lichen planus (rather unlikely), miliary form of granuloma anulare or sui generis disease. Drug-induced cases of lichen nitidus have been documented in individual cases (ribavirin, tremelimumab), but are likely to be the exception.

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Predominantly occurring in children of pre-school and school age, less frequently in young adults or in middle age (20-40 years). Familial occurrence is extremely rare.

An increased occurrence in the African population is being discussed.

No gender preference.

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Bending surfaces of the forearms, neck, chest, back, back of the hands, penis, vulva. A variant described as"actinic lichen nitidus" occurs mainly in the facial area. Nail dystrophies are described in about 10% of patients. Oral mucosal involvement in the form of pale, grey papules is possible but a rarity. Palmo-plantar infestation is equally rare.

Clinical features
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Disseminated, also grouped, reddish-brownish on light skin, whitish on dark skin, barely 0.1 cm in size, slightly raised, pearlescent, centrally occasionally navelled, not itchy round or polygonal (not follicular) papules. Possible confluence and isomorphic irritation effect (Koebner phenomenon). On darker skin the efflorescences appear lighter than the surrounding skin, resulting in an inverse pattern (see figure).

A casuistically proven rarity is the linear (blaschkoid) lichen nitidus (Oiso N et al. 2016).

Lesional vesicles or haemorrhages are also rarely observed.

Furthermore, a perforating variant was described as a rarity.

Nail dystrophies are detectable: thickening of the nail plate, onychorrhexis; longitudinal stripes, pitting.

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Early stage: Interface dermatitis extending over several dermal papillae. Interstitial or also perivascular accentuated lymphocytic infiltrate with varying degrees of epidermotropy. Usually only discrete vacuolated degeneration of basal keratinocytes. Atrophy of the lesional epithelium. The keratinization is mostly orthokeratotic. Overall, the picture is not very specific.

Late stage: Increasing density of epithelioid cells, plasma cells and multinucleated giant cells of the Langerhans cell type (not to be confused with Langerhans cells, which are local histiocytes). This presents a granulomatous character.

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Informing the patient about the harmlessness of the findings. Blande nursing local therapy. In case of pronounced therapy desire and itching, local treatment with glucocorticoid creams and ointments such as 0.1% betamethasone (Betagalen, Betnesol) under occlusion.

Evidence-based studies are not available for the LN. PUVA therapy can be used for extensive clinical pictures.

Retinoids such as acitretin (neotigasone 10-20 mg/day p.o.) may be used on an experimental basis; there are anecdotal reports of this.

Individual healing attempts were made with tuberculostatics.

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Sporadic occurrence, chronic course. Healing after several years without atrophy is possible.

A variant is the lichen nitidus actinicus, also called "summertime actinic lichenoid eruption", which occurs after UV provocation. Predominantly affected are persons with dark skin type (Payette MJ et al. 2015).

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  1. Arizaga AT et al (2002) Generalized lichen nitidus. Clin Exp Dermatol 27: 115-117
  2. Bedi TR (1978) Summertime actinic lichenoid eruption. Dermatologica 157:115-125Gehring
    W et al (1989) Lichen nitidus of the palms. Nude Dermatol 15: 312-314
  3. Kubota Y et al (2002) Generalized lichen nitidus successfully treated with an antituberculous agent. Br J Dermatol 146: 1081-1083
  4. Oiso N et al (2016) Blaschkolinear lichen nitidus. Eur J Dermatol 26:100-101.
  5. Payette MJ et al (2015) Lichen planus and other lichenoid dermatoses: Kids are not just little people. Clin Dermatol 33:631-643.
  6. Pinkus F (1907) About a nodular skin eruption. Arch Dermatol Syphilol 85: 11-36
  7. Rudd ME et al (2003) An unusual variant of lichen nitidus. Clin Exp Dermatol 28: 100-102
  8. Sanders S et al (2002) Periappendageal lichen nitidus: report of a case. J Cutan catholic 29: 125-128
  9. Solano-López G et al (2014) Actinic lichen nitidus in a Caucasian European patient. J Eur Acad Dermatol Venereol 28:1403-1404
  10. Proud I et al (2018) Lichen nitidus and Lichen striatus. Dermatologist 69: 121-126
  11. Tay EYet al (2014) Lichen Nitidus Presenting with Nail Changes - Case Report and Review of the Literature. Pediatric Dermatol 32: 386-388


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Last updated on: 23.08.2021