Lichen Nitidus

Diagnosis: Lichen Nitidus

Minute, shiny, flat-topped, pale, exquisitely discrete, uniform papules (some of them in linear array, as an expression of the Köbner phenomenon).

Clinical Presentation

Minute, shiny, flat-topped, pale, exquisitely discrete, uniform papules (some of them in linear array, as an expression of the Köbner phenomenon).

Clinical History

Submitted by Alaa Saad. Originally posted November 19, 2010.

Treatment

See case discussion.

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: lichen, nitidus, alaa saad