Definition

What is lichen nitidus?

Lichen nitidus is a condition in which small (pinhead size; 1-3 mm) shiny, skin colored, bumps or papules cover the skin surface, often appearing in groups or clusters.

How common is lichen nitidus?

Lichen nitidus is a rare skin condition. Although lichen nitidus may affect anyone, it typically develops in children and young adults. Please discuss with your doctor for further information.

Symptoms

What are the symptoms of lichen nitidus?

Lichen nitidus appears as clusters of tiny, glistening bumps (papules). Characteristics of the bumps include the following:

  • The bumps range in size from pinpoint to pinhead size.
  • They are flat topped and round.
  • Bumps are usually the same color as your skin. They may be slightly pink on people with lighter skin, or lighter than normal skin color on people with darker skin.
  • Lichen nitidus bumps commonly occur on the chest, abdomen, arms and genital areas, including the penis. They rarely occur on the palms, soles of the feet or fingernails. Lichen nitidus may clear up at one site on your body but then appear at another.
  • In rare cases, the bumps of lichen nitidus may itch, sometimes intensely. They may appear in a line where there’s a scratch, crease or constant pressure on the skin, such as a fold of skin on the abdomen or the crease of skin on the inside of the elbow or wrist.

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

See your doctor if tiny bumps or a rash-like condition appears on your skin for no apparent reason, such as a known allergic reaction or contact with poison ivy. Because a number of conditions can cause skin reactions, it’s best to get a prompt and accurate diagnosis.

Get immediate care if your skin condition is accompanied by other signs and symptoms, such as:

  • Fever
  • Itching
  • Pus or oozing from a rash

Causes

What causes lichen nitidus?

The cause of lichen nitidus is unknown. The papules that appear are the result of inflammation controlled by white blood cells called T lymphocytes. Normally, these cells work to heal disease or injury, such as a cut on your finger. Doctors and researchers don’t know what prompts T lymphocytes to be activated in lichen nitidus.

Risk factors

What increases my risk for lichen nitidus?

There are many risk factors for lichen nitidus, such as:

  • Lichen planus, an inflammatory condition usually characterized by patches of red or purple, flat-topped, itchy bumps on the skin or lacy white patches on the mucous membranes of the mouth
  • Atopic dermatitis (eczema), an inflammatory skin condition usually characterized by dry, itchy rashes on the face, inside the elbow, behind the knees, and on the hands and feet
  • Crohn’s disease, inflammation of the lining of your digestive tract, which can lead to abdominal pain, severe diarrhea and malnutrition
  • Juvenile rheumatoid arthritis, an inflammatory disease that causes persistent joint pain, swelling and stiffness
  • Tuberculosis, an infectious disease that most often affects the lungs

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is lichen nitidus diagnosed?

Although the clinical presentation will suggest the diagnosis, lichen nitidus usually requires a skin biopsy to be confirmed. The histology of lichen nitidus is very typical and described as the ‘claw and ball’ appearance:

  • Focal dense lymphohistiocytic infiltrate in the upper dermis very close to the epidermis.
  • Langhans giant cells are often present in the infiltrate.
  • Rete ridges of the epidermis are elongated and ‘clutch’ the infiltrate.
  • Red blood cells are seen just under the epidermis in the haemorrhagic/purpuric form.
  • Eosinophilic dermal material with some cell nuclei may be seen within the epidermis in the perforating variant.

How is lichen nitidus treated?

For most people, lichen nitidus lasts for a few months to a year. The condition usually clears up on its own without treatment. After it clears up, the appearance of the skin is usually normal with no scarring or permanent change to skin color.

If lichen nitidus causes itching or if you have concerns about your appearance or your child’s appearance, your doctor may prescribe one of the following treatments:

  • Corticosteroids may reduce inflammation associated with lichen nitidus. The side effects vary depending on whether it’s used as an ointment applied directly to the skin (topical) or taken as a pill (oral). Long-term use of topical corticosteroids can cause thinning of the skin, a lessening of the treatment effect and other skin problems. Long-term use of oral corticosteroids can cause weakening of the bones (osteoporosis), diabetes, high blood pressure and high cholesterol levels.
  • Retinoid is a synthetic version of vitamin A that can be a topical or oral treatment. The topical treatment doesn’t cause the side effects associated with corticosteroids, but it may irritate the skin. Because retinoid can cause birth defects, it shouldn’t be used by women who are pregnant or who might become pregnant. Your doctor can advise you on necessary precautions.
  • Other topical medications. A topical drug called tacrolimus (Protopic) helps to suppress the immune response and may be helpful for lichen nitidus. Possible side effects include stinging, burning and itching at the site where the medication is applied. This medication can’t be used in conjunction with phototherapy. Limit sun exposure while using tacrolimus and don’t use tanning beds during treatment.
  • Antihistamines act against a protein called histamine that is involved in inflammatory activity. An oral or topical antihistamine may relieve itching associated with lichen nitidus.
  • Phototherapy, a type of light therapy, may help clear up lichen nitidus. One type uses ultraviolet A (UVA) light, which penetrates deep into the skin. This therapy is usually used in combination with a drug that makes the skin more sensitive to UVA light. Another type uses narrow band ultraviolet B (UVB) light. It’s important to avoid sun exposure for a couple of days after having phototherapy. Also, you need to wear special UV-absorbing sunglasses for a couple of days to protect your eyes.

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage lichen nitidus?

Please discuss with your doctor for further information.

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: November 21, 2017 | Last Modified: November 21, 2017

Want to live your best life?
Get the Hello Doktor Daily newsletter for health tips, wellness updates and more.