What is Lichen Nitidus?
Lichen nitidus is a rare and chronic inflammatory condition of the skin characterized by the formation of multiple tiny papules referred as lichenoid eruptions. It is a benign skin condition that generally affects pre-school and school aged children.
The lichenoid eruptions in Lichen nitidus often occurs on the surface of the skin in the areas of the flexor of the forearms, back of the hands, chest, abdomen and the genitalia. The tiny lesions, however, may also occur in the other areas of the body and may involve the face.
Lichen nitidus is a rare skin condition that the frequency of its incidence internationally remains vague. No mortality or morbidity is being associated as lichen nitidus is generally a benign condition and causes no complications. The skin condition is known to affect both boys and girls although it has found to have a slight prevalence among girls. It can affect people worldwide without racial predilection. The disease is prevalent among pre-school and school aged children including young adults but can also occur in older adults.
Lichen nitidus is not a life-threatening disease that resolves on its own without the need for treatment. The incidence is not potential for skin cancer and seldom causes discomfort while it leaves without long-term or lifelong effect on the skin. Lichen nitidus was once associated with lichen planus believed to be a variant but is now deemed a separate disease.
Lichen Nitidus Symptoms
Lichen nitidus is hallmarked by the development of the tiny glistering papules that is skin-toned or may be hypopigmented in the individuals with dark skin. The affected area of the skin may also be noticed with slight scaling. Lichen nitidus is often asymptomatic although may get itchy. It is usually localized and seldom develops as generalized.
The tiny papules of lichen nitidus is referred to as lichen eruption and has various clinical variants such as:
- Generalized lichen nitidus rarely occurs in children and is an even rarer variant
- Hemorrhagic or purpuric lichen nitidus is characterized by an unusual eruption replicating a pigment purpuric papules and initially develop on top of the feet and around the ankle before it progresses to the legs until it become generalized
- Vesicular lichen nitidus is the blistering variant that is similar to a pompholyx and usually involves the palm of the hands
- Linear lichen nitidus is a variant of lichen nitidus that is arranged in line
- Keratodermic lichen nitidus involves the palms of the hands and soles of the feet and appears similar to fissuring in chronic eczema
- Perforated lichen nitidus is presented by umbilicated papules that usually develops in the forearms and hands
- Actinic lichen nitidus develops in the areas of the skin that are in constant exposure to the sun and is common among dark skinned individuals and the eruption of lesion is seasonal usually during the summer months
The papules or lesions of lichen nitidus is characterized by the following:
- The size of the papule is about 1mm to 2mm in diameter or similar to the size of a pinhead
- The shape of the lesion is round to polygonal
- The color of the papule is skin-tone and rarely yellowish or brownish while it may appear as hypopigmentation or hyperpigmentation in people with dark skin
- The top of the lesion is flat and the lesion appears shiny
- The lesion appears in clustered groups which may later merge to form a plaque
- The development of the lesion is usually localized and seldom occur as generalized
Lichen nitidus may also develop in the mouth and the papules are described as tiny and flat papules in gray-white color appearing inside the buccal mucosa. It develops on the tongue as white and hard plaques and resembles the appearance of lichen planus.
Lichen nitidus may also be seen with Koebner phenomenon which is not unusual. The lesion is rather arranged in linear down the scratch marks. The lesion of lichen nitidus may also involve the palm of the hand and sole of the foot which may develop in unilateral or bilateral or may occur as localized or in combination with other usual site of lichen nitidus.
Lichen Nitidus Causes
Lichen nitidus is more common among children and young adults, affecting both boys and girls. The disease is the result of an unusual inflammatory activity where the T-lymphocytes are involved. The incidence of lichen nitidus is also being linked with lichen planus although there has been no clear indication of the relationship between the two.
The exact cause of lichen nitidus remains unclear, although there are several diseases are being associated with the incidence of lichen nitidus.
The associated diseases include the following:
Lichen planus is an inflammatory skin condition characterized by the development of reddish or purplish patches and is crossed by fine white lines. This inflammatory skin condition is believed to be caused by viral infection and often develops in the mucus membrane of the mouth.
Crohn’s disease is an inflammatory disease involving the lining of the digestive tract. Skin problems are among the extraintestinal clinical features of the disease which may include lichen nitidus.
Atopic dermatitis is the most common form of dermatitis that often affects children although may also affect adults. It is a skin condition characterized by weeping and blistering skin patches.
Lichen nitidus usually requires no treatment. This skin condition often resolves on its own and leaves the skin without lifelong effect. It may, however, persist for several months to a year or several years. The treatment may be necessary if symptom of itchiness occurs and persists and if there is a generalized rash that involves the cosmetic areas of the body. Treatment may also be necessary if the condition is rather prolonged.
The treatment for lichen nitidus may include the following:
- Topical corticosteroid
Is Lichen Nitidus contagious?
Lichen nitidus is not a contagious disease. It is a self-limiting disease that cannot be spread or pass on to other people. Lichen nitidus is a benign and a chronic inflammatory skin condition that is generally harmless and resolve without treatment and leaves the skin without long-term effect.