Lichen nitidus

1 - ACKNOWLEDGEMENTS

Chapter written with the help of the EADV, the Fondation René Touraine and the Therapeutics in Dermatology

2 - OVERVIEW

Lichen nitidus is a skin condition that can cause an eruption of multiple, shiny, pinhead-sized bumps.

Lichen nitidus can happen in children and adults but it is more common in children and young adults.

Lichen nitidus is a benign disease with no associated complications. This condition usually clears up on its own without treatment.

3 - SYMPTOMS

Lichen nitidus usually appears as clusters of tiny, flesh-colored bumps on the skin with the following characteristics:

• Size: bumps can range from the size of a pinpoint to that of a pinhead (1-3mm).
• Color: bumps are usually skin-colored. They may look slightly pink in patients with lighter skin. In patient with darker skin, they may look lighter than the surrounding skin.
• Number: multiple to numerous bumps, they usually appear in clusters or groups.
• Location: bumps can appear anywhere on the body, but the most common locations are the inside of the forearms, back of the hands, chest, abdomen and genital areas, including the penis. They rarely occur on the palms, soles of the feet, inside of the mouth or fingernails.

Lichen nitidus usually does not cause itch, but in few patients the bumps may itch.

4 - CAUSES

In most cases, doctors do not know what causes lichen nitidus. The relationship between lichen nitidus and lichen planus (LP) has been debated, because both diseases can coexist in the same patient and share some similar clinical characteristics. However, most experienced doctors, as well as research studies, favor the separation of these two diseases based on both clinical characteristics (lesions of LP are larger, with a red or purple color and, usually, itchy) and biopsy results (medical procedure that involves taking a small piece of affected tissue for examination under a microscope). Rarely, cases of lichen nitidus were associated with atopic dermatis, inflammatory bowel disease and juvenile chronic arthritis.

5 - TREATMENT

Lichen nitidus does not need treatment in the most cases, since in the majority of patients the bumps are not itchy or bothersome and will most likely go away by itself over time.

In two-thirds of cases, lichen nitidus clears up on its own without treatment within a year.

There are some treatments that can help if lichen nitidus causes itching or if the patient is bothersome about the appearance of the bumps:

• Steroid ointments or creams that go on the bumps – these medicines help reduce inflammation and itching.
• Antihistaminic pills – these medicines may relieve itching.
• Medicines called calcineurin inhibitors, such as pimecrolimus (brand name: Elidel) and tacrolimus (brand name: Protopic) that go on the bumps
• Light therapy (Phototherapy) – For this treatment, it is used a machine that gives off a special type of light.

6 - TIPS FOR MANAGING

First, it is important to see a doctor to correctly diagnose lichen nitidus. Because other conditions can cause skin eruptions that may appear similar to lichen nitidus.

Second, lichen nitidus is a harmless condition that does not cause complications and it is not contagious.

Third, lichen nitidus will go away by itself within a year in most patients, and, no treatment is necessary.

Lastly, there are some treatment options available if lichen nitidus causes itching, or the appearance of the bumps worries the patient. However, the response to these treatments may be not predictable.