Purpuric generalized lichen nitidus: an unusual eruption simulating pigmented purpuric dermatosis

BACKGROUND: Generalized haemorrhagic lichen nitidus is rare. To our knowledge, this form of presentation has only been reported once. OBJECTIVE: To describe a new case of generalized haemorrhagic lichen nitidus simulating a pigmented purpuric dermatosis. METHODS AND RESULTS: We document a 24-year-old man who presented with an 8-month history of a progressive non-pruritic, red-brown papular eruption on the dorsa of the feet, ankles and distal third of the legs. A diagnosis of Schamberg's progressive pigmentary dermatosis was made, and no treatment was prescribed. Two months later, the lesions had extended to the abdomen, groins, forearms, elbows and wrists. Biopsy of the skin of the right foot revealed lesions typical of lichen nitidus with subepidermal extravasation of red cells and capillary wall hyalinization. Macrophages and T lymphocytes were abundant in the infiltrate. CONCLUSION: Purpuric generalized lichen nitidus should be included in the differential diagnosis of pigmented purpuric dermatoses.     

Two cases of generalized lichen nitidus treated successfully with narrow-band UV-B phototherapy

BACKGROUND: Narrow-band ultraviolet (UV) phototherapy has not been used in the treatment of lichen nitidus. AIM: To report two cases of generalized lichen nitidus successfully treated with narrow-band UV-B phototherapy. METHODS: A 7-year-old girl presented with a persisting, asymptomatic, papular eruption refractory to topical steroid for 3 months. Another 10-year-old boy presented with an asymptomatic papular eruption present for 6 months. The histopathologies of both lesions were consistent with lichen nitidus. The lesions were treated with narrow-band UV-B phototherapy. RESULTS: The lesions of the patients were almost completely cleared after the 30th and the 17th irradiation, respectively. CONCLUSIONS: Narrow-band UV-B may be an effective alternative therapy for the treatment of generalized lichen nitidus unresponsive to common therapies.     

Lichen nitidus of the palms: a case with peculiar histopathologic features

Palmar involvement in lichen nitidus is infrequent. In such cases, the histopathologic findings of palmar lesions are usually identical to those of extrapalmar ones. We report on the case of a patient with multiple tiny papules located on the palms and elbows. A biopsy specimen from the elbow showed the typical features of lichen nitidus, but a biopsy from the palm disclosed an inflammatory infiltrate mostly disposed around the bases of rete ridges and composed of lymphocytes and histiocytes with some giant cells both in the dermis and in the epidermis. This location of the infiltrate is similar to that found in hypertrophic lichen planus, a combination of lichen planus and lichen simplex chronicus. We conclude that this histopathologic feature in palmar lichen nitidus could be the result of the superimposition of lichen nitidus on normal palmar skin, resulting in a picture resembling hypertrophic lichen planus.     

Generalized lichen nitidus

We report a 38-year-old man who presented with a generalized papular eruption that was clinically and histologically consistent with lichen nitidus. This patient's condition had been persistent for approximately 1 year; however, soon after assuming employment that entailed significant, regular sun exposure, the patient noted marked clearing of his lesions in sun-exposed areas. This case corroborates previous reports that suggest that generalized lichen nitidus can be successfully managed with ultraviolet light therapy.     

Pinpoint papular variant of polymorphous light eruption: clinical and pathological correlation

BACKGROUND: Polymorphous light eruption (PMLE) is the most common chronic idiopathic photodermatosis usually manifesting as a papular eruption along with several other morphological variants including a pinpoint papular variant. METHODS AND MATERIALS: Between June 1998 and August 2003, 10 PMLE patients presented to the Department of Dermatology at Henry Ford Hospital with complaints of a pruritic pinpoint papular eruption associated with sun exposure. In six patients skin biopsies were performed along with a detailed history and complete skin examination. We correlated the histology with the clinical course of disease corresponding to acute and subacute disease presentation. We also performed immunohistochemistry on three cases to study the immunophenotype in PMLE. RESULTS: The clinical, histologic and immunostain findings are summarized. Acute: Clinically pinpoint papules and vesicles, some with erythematous base, were seen. Histology showed focal vesicle formation, spongiosis, oedema, red blood cells extravasation, and superficial and deep perivascular and interstitial lymphocytic infiltrate with occasional eosinophils. Subacute: Clinically pinpoint papules with or without erythema were seen. Histology of the pinpoint lesion showed a nodular collection of lymphocytes and histiocytes with claw-like extension of epidermal rete ridges at the lateral boundaries of the lesion. Overlying epidermal atrophy with adjacent spongiosis, exocytosis, oedema and a superficial perivascular lymphocytic infiltrate and parakeratosis was also observed. The histologic differential diagnosis included lichen nitidus. Immunohistochemical stains revealed the following results: CD8, CD68 positive, CD4 variable (strongly positive to negative) and S-100 negative. CONCLUSION: (i) Pinpoint papular variant of PMLE is a distinct entity, which shows characteristic histology corresponding to the clinical course of the disease (acute and subacute). (ii) The histologic and immunophenotypic differential diagnosis of this variant during the subacute phase includes lichen nitidus.     

Periappendageal lichen nitidus: report of a case

BACKGROUND: The histology of lichen nitidus has been described previously but a follicular variant has not been emphasized. METHOD: We report a case of lichen nitidus with periappendageal inflammation resulting in histologic similarities to lichen striatus. RESULTS: This case extends the spectrum of histologic findings in lichen nitidus and shows overlap in the distribution of the inflammatory infiltrate in lichen nitidus and lichen striatus.     

皮损形态类似于光泽苔藓的朗格汉斯细胞组织细胞增生症一例

报道1例表现为光泽苔藓样皮损的朗格汉斯细胞组织细胞增生症。患儿女,19个月。因前胸、后背多发针尖大小丘疹伴多饮、多尿1个月余就诊。皮损临床表现为全身泛发性光泽苔藓样丘疹。垂体平扫+增强MRI提示：垂体后叶短T1信号消失。皮损组织病理显示表皮角化过度,真皮浅层密集组织细胞浸润,细胞核呈肾形,胞浆丰富。免疫组化：CD1a、S-100、CD68均阳性。结合临床、组织病理和免疫组化检查,诊断为朗格汉斯细胞组织细胞增生症。全身化疗后,皮损完全消退,目前仍在随访中。     

Palmoplantar lichen nitidus: a rare cause of palmoplantar hyperkeratosis

BACKGROUND: Lichen nitidus is a rare condition, which may be a cause of palmoplantar hyperkeratosis. We report two cases. CASE REPORTS: A 53 year-old woman presented with a dry and fissured palmoplantar hyperkeratosis. Histological examination of a biopsy showed the typical features of lichen nitidus. Significant improvement was obtained with acitretin. A few months later, multiple lichen nitidus papules appeared on the limbs and the abdomen. A 67 year-old woman was referred to us for a fissured, disabling palmoplantar hyperkeratosis refractory to topical steroids. Histological examination led to the diagnosis of lichen nitidus. Local PUVA therapy resulted in the cleaning of her lesions. Later, typical papules of lichen nitidus appeared on her elbows. DISCUSSION: Nineteen cases of palmoplantar localization of lichen nitidus have been described. The features are usually tiny yellow papules but sometimes a non-specific keratoderma resembling chronic eczema. Palmoplantar involvement of lichen nitidus may be isolated or associated with cutaneous lesions on unusual sites. Oral retinoids and local PUVA are effective treatments.     

Lichen nitidus with plasma cell infiltrate

The predominant cell types in the dermal infiltrate of lichen nitidus are lymphocytes and epithelioid cells. We report two cases of lichen nitidus in which numerous plasma cells were present in the dermal infiltrate.     

Segmental lichen aureus: a report of two cases treated with methylprednisolone aceponate

Two cases of segmental lichen aureus with a response to topical 0.1% methylprednisolone aceponate ointment are reported. A 9-year-old child and a 23-year-old man showed complete resolution of their lesions following treatment with the latter after 7 months and 4 months, respectively. Lichen aureus is a rare form of the pigmented purpuric dermatoses characterized by golden-brown and lichenoid macules and papules, most often on the lower extremities. Segmental presentations have seldom been described. Histology showed a lichenoid infiltrate with extravasation of red blood cells and haemosiderin deposition. The aetiology is unclear and treatment is disappointing. We report an uncommon segmental presentation of lichen aureus with resolution of the lesions after treatment with a topical corticosteroid.     

A very rare localization of a rare disease: palmar lichen nitidus

Lichen nitidus is an uncommon lichenoid dermatosis that could be defined as multiple, separated, shiny, pinpoint, pale to skin-colored papules. Palmoplantar lichen nitidus is a quite rare variant of lichen nitidus. It is hard to make a diagnosis of palmar lichen nitidus when there are no lesions elsewhere on the body. There are some dermoscopic features defined for both palmoplantar and non-palmoplantar lichen nitidus that might be useful to facilitate the diagnosis before histopathological examination. Herein, we report a case of a 24-year-old man diagnosed with isolated palmar lichen nitidus with dermoscopic features and histopathological confirmation.     

Lichen Nitidus Presenting with Nail Changes—Case Report and Review of the Literature

Lichen nitidus of the nail is rare and can precede the onset of skin lesions. Delayed diagnosis is common. We present an unusual case of lichen nitidus–associated nail changes that preceded the onset of skin lesions in a 4‐year‐old Indian girl. We also conduct a review of six other cases of lichen nitidus with nail involvement from the English‐language literature. Clues to the diagnosis of lichen nitidus include violaceous or pigmentary changes of the nail fold and subtle lichenoid papules on the affected digits. Lichen nitidus of the nails appears to be less severe than nail changes of lichen planus and is generally self‐limiting. Understanding the natural history of lichen nitidus of the nails will help physicians better counsel patients and their families.     

Inflammatory vitiligo-like macules that simulate hypopigmented mycosis fungoides

Two cases of an inflammatory vitiligo-like condition that simulated mycosis fungoides are reported. Both patients presented acquired hypopigmented macules sharply limited by an erythematous and papular border. The clinical aspect was suggestive of inflammatory vitiligo. Mycosis fungoides was suspected on skin specimens showing a dense band-like lymphocytic infiltrate with discrete nuclear atypias and marked exocytosis. This infiltrate was made of CD3 positive lymphocytes. CD8 positive lymphocytes were numerous in one case, few in the other. There was a loss of melanocytes in the lesional skin and absence of dominant T-cell clones in both cases. No repigmentation was observed after PUVA or local chemotherapy. The authors emphasized that erythematous and papular borders surrounding hypopigmented macules, CD8 positive lymphocytic infiltrate, absence of T-cell clonal rearrangement are helpful to rule out mycosis fungoides.     

Familial lichen nitidus

I report familial lichen nitidus in a 33-year-old father and his 3-year-old daughter. Histopathology of small papules in both cases revealed typical features of lichen nitidus. Immunohistochemical examination showed UCHL1-positivc, L-26-ncgarive lymphocytes and HAM56-positive histiocytes and multinucleated giant cells in the dermal infiltrate in both cases.     

Lichen nitidus presenting as palmoplantar hyperkeratosis and nail dystrophy

Four patients with lichen nitidus who presented with palmoplantar or nail lesions arc reported. In three cases palmoplantar hyperkeratosis was marked; these cases also had nail-plate lesions, but in all four, lesions of lichen nitidus at other sites were absent, sparse or asymptomatic.     

Lichen nitidus: electron microscopic and immunofluorescence studies

Skin biopsies from a patient suffering from lichen nitidus were studied by electron microscopy and immunofluorescence studies. Complete disintegration of the stratum basale in the central area of the lesion and signs of acantholysis in the border area were found. In the central part of the lesion the dermo-epidermal junction was severely damaged in most places. In the dermal infiltrate, macrophages and lymphocytes were found with a considerable representation of Sézary cells, not previously reported in lichen nitidus. The ultrastructural changes are identical with those found in lichen planus. No in vivo bound immunoglobulins, fibrinogen, or complement C3 were found.     

Lichen nitidus: a histologic and electron microscopic study.

A lesion of lichen nitidus in a 53-year-old man was examined by histology and electron microscopy. The histology showed typical features. The electron microscopy revealed primary changes in hydropic degeneration of basal cells which possibly indicated severe edema between the basal keratinocytes and in the subepidermal area. The basal keratinocytes themselves were not particularly altered, except for clustered micro-vacuolar structures in a small portion of the peripheral cytoplasm. In one of the eight blocks observed, the cytoplasmic process of a mast cell was found between the basal keratinocytes, indicating that mast cells may possibly infiltrate the epidermis in lichen nitidus. Scattered mast cells in the dermis were also noted. Thus primary pathologic changes of lichen nitidus may be induced by severe edema, which was accompanied by inflammatory cells including mast cells, in the region of the dermal-epidermal junction.     

Treatment of palmoplantar lichen nitidus with acitretin

We report a patient with lichen nitidus of the palms of the hands and the toes, whose skin lesions responded to treatment with acitretin.     

Micropapular sarcoidosis simulating lichen nitidus

A 28-year-old woman with sarcoidosis had military, skin-colored papules localized on the upper back. The lesions closely simulated lichen nitidus. Histologic examination of the papule demonstrated the naked granuloma encircled by epidermal collarettes in the papillary dermis. Therefore, the microscopic reaction pattern also resembled those of lichen nitidus. This case is a unique form of micropapular sarcoidosis in respect to the clinical appearance and microscopic changes.     

Generalized Lichen Nitidus Appearing Subsequent to Lichen Planus

A 27-year-old man was seen with multiple, small, shiny papules on his shoulders, upper arms, and trunk, and hyperpigmented violaceous plaques on his feet. The former was diagnosed as generalized lichen nitidus and the latter, as lichen planus. It is not likely that the coexistence of the two diseases in this patient is a fortuitous one, since generalized lichen nitidus is a very rare condition. The association of lichen nitidus and lichen planus suggests that lichen nitidus is closely related to lichen planus and that the two diseases may be different manifestations of essentially the same pathogenetic process.