Lichen Nitidus

Lichen Nitidus

Lichen nitidus is a relatively unusual benign skin condition usually seen in children. It is manifested by the onset of dozens to hundreds of tiny grid-like papules.  The flexor forearms and dorsal hands are favored areas, although it can be located almost anywhere.  In lighter skinned patients they are usually flesh colored or slightly reddish, but in darker skinned individuals they may be hyperpigmented (darker than normal skin) or hypopigmented (lighter than normal skin).  The papules often are found in tight groups, giving rise to the appearance of a plaque at the affected site.  There are a few recognized variants, including vesicular and actinic lichen nitidus.

Differential Diagnosis:
-Lichen planus
-Molluscum contagiosum
-Verruca plana

Diagnosis:
-Diagnosis is usually straightforward clinically to a seasoned dermatologist, but in the event the diagnosis is in question a biopsy is very helpful because the histologic features of lichen nitidus are distinctive.

Treatment:
-Treatment is not always required as the disorder often resolves spontaneously 
-If itching is present, a topcal steroid or topical calcineurin inhibitor is useful
-UV light has been reported to be helpful, except in cases of actinic lichen nitidus, of course
-In severe, recalcitrant cases there are reports of benefit from systemic agents such as prednisone, cyclosporine, systemic retinoids, and even itraconazole; however, potentially toxic agents such as these should be used only with extreme caution in a benign condition such as this.