Lichen Nitidus

Diagnosis: Lichen Nitidus

Skin-colored shiny papules on forearm with a foci of koebnerization

Clinical Presentation

Lichen Nitidus Skin-colored shiny papules on forearm with a foci of koebnerization

Clinical History

Asymptomatic, tiny, shiny, flat-topped papules in children or young adults. Forearms, trunk, genitalia. Koebner phenomenon may be present.

Treatment

Self-limited — observation and reassurance. If symptomatic: topical corticosteroids, phototherapy (NB-UVB). Widespread: acitretin, PUVA (rarely needed).

Differential Diagnosis

• Lichen planus • Keratosis pilaris • Flat warts (verruca plana) • Molluscum contagiosum • Lichen spinulosus • Papular eczema • Secondary syphilis

Key Learnings

• Tiny (1-2mm), shiny, flat-topped, flesh-colored papules — monomorphic • Most common in children and young adults • Often on forearms, trunk, and genitalia • Histology: "ball-and-claw" pattern — well-circumscribed granulomatous infiltrate within a widened dermal papilla, gripped by elongated rete ridges • Self-limited — resolves spontaneously in most cases • May koebnerize • Generalized lichen nitidus is uncommon but can occur

Tags: dermatologist, dermatology, kodachrome, Lichen Nitidus