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LICHEN NITIDUS

CLINICAL FEATURES. Lichen nitidus is a chronic inflammatory disease characterized by minute, shiny,

flat-topped, pale, reddish, yellowish red, or flesh-colored, exquisitely discrete, uniform papules,

rarely larger than the head of a pin. Usually there is no itching. Linear arrays of papules (Koebner

phenomenon) are common, especially on the forearms. Both psoralens and ultraviolet A, and oral

etretinete, have recently been reported to dear individual patients.

At the beginning lesions are localized and often remain so, in such cases being limited foals, chiefly

the penis and lower abdomen, the inner surfaces of the thighs, and the flexor aspects of the wrists

and forearms. Weiss and Cohen described two cases, and reported eight others, in Which the palms

and soles were involved.

In other cases the disease assumes a more wide-spread distribution and the elementary papules

become fused into erythematous, finely scaly patches. The reddish color varies with tints of yellow,

brown, or violet. This generalized type of lichen nitidus affects chiefly the groins and thighs, anklesand wrists, feet and hands, the submammary region in women, the folds of the neck, and the

extensor surfaces of the elbows. Minute, grayish, flat papules on the buccal mucous membrane have

been described.

The course of when nitidus is slowly progressive, with a tendency to remissions. The lesions may

remain stationary for years, but sometimes disappear spontaneously and entirely.

ETIOLOGY. The cause of lichen nitidus is unknown. Soon observers (ourselves not included) believe it

is merely a variety of lichen planus. On the boos of the absence of immunoglobulins at the dermal-

epidermal junction, Waisman and associates concluded that there is no relationship between lichen

nitidus and lichen planus. Clausen et al found, however, no ultrastructural changes that would

permit differentiation between lichen nitidus and lichen planus.

HISTOLOGY. Lichen nitidus has a characteristic histologic appearance. Solitary dermal papillae are

widened and contain a dense, discrete infiltrate composed of lymphocytes, histiocytes, and

melanophages. Multinucleate giant cells are often present, imparting a granulomatous appearance

to the infiltrate. The epidermal rote ridges on either side of the papilla form a clawlike collarette.

The overlying epidermis is attenuated and there is usually vacuolar alteration of its basal layer.

Banse-Kupin of al confirmed Bardach's earlier report of transepidermal elimination of the dense

inflammatory infiltrate in the dermal papilla in a case of perforating lichen nitidus.

DIFFERENTIAL DIAGNOSIS. Lichen nitidus is differentiated from flat warts by the small size, the

greater number, and the distribution of the lesions; from lichen planus by the absence of itching, the

color, and the distribution; and from lichen scrofulosorum by the darker coloring and follicular

character of the papules in lichen scrofulosorum, and by the fact that in lichen nitidus the histologic

changes occur immediately beneath the epidermis and show no basal inflammation.

TREATMENT. Little if any treatment is necessary. Topical application of corticosteroide is distinctly

helpful if pruritus is severe. As mentioned earlier. PUVA and etretinate have both been reported to

be effective. Ocampo et al reported success with astemizole, an H1-blocking antihistamine, in two

patients. Systemic steroids are rarely used but may be helpful in widespread cases.