What is Lichen Nitidus?

Lichen nitidus is a chronic inflammatory disease that affects the skin, causing the formation of papules, or raised lesions, called lichenoid eruptions. Often diagnosed in children and adolescents, lichen nitidus is benign and non-infectious. Most cases of this condition require no treatment and subside independently. Generally, the papules will fade without leaving lasting effects on the skin. Those who do seek treatment for this condition should be aware of the risk for potential side effects.

There is no definitive cause for the development of lichen nitidus. Papule formation frequently accompanies pre-existing inflammatory diseases, such as lichen planus and certain arthritic conditions. The conical skin lesions that characterize lichen nitidus form in response to localized inflammation.

Before a diagnosis may be confirmed, one’s complete medical history and symptoms are assessed. A visual examination of the affected area is performed and, in some cases, a skin biopsy may be conducted. Individuals presenting with moderate to severe lichenoid lesions may be referred to a dermatologist for further assessment and possible treatment.

The raised lesions associated with lichen nitidus have a characteristic presentation. Commonly no larger than the head of a pin, the flat lesions usually possess the same pigmentation as the surrounding skin. Generally, lesion development occurs on the upper torso and limbs, however, lesions may also form on other parts of the body. Rarely do lichenoid lesions cause itchiness or irritation.

Acute presentations of lichen nitidus may occur in the wake of a skin injury. Known as the Koebner phenomenon, these lesions usually adopt a linear pattern that forms in the area directly affected by injury. Named for the physician who first described the anomalous condition, Koebner phenomenon is most frequently diagnosed in individuals with pre-existing skin conditions, like lichen planus and psoriasis.

The risk for lichen nitidus-related complication is minimal. Only in cases where lesions induce itchiness is infection possible. Aggressive scratching can cause skin lacerations that may become vulnerable to bacteria and infection. Instances of skin inflammation accompanied by fever or oozing sores does necessitate medical attention. The most common complication associated with this chronic inflammatory disease is the impact it can have on one’s self-esteem.

Individuals who experience itchiness may be given anti-inflammatory medications, such as a corticosteroid or antihistamine, to alleviate skin irritation. The application of ultraviolet A (UVA) light therapy may also be used to minimize the appearance of lichenoid lesions; incidentally, light therapy can cause skin irritation and itchiness in the short term. Prior to pursuing treatment for lichen nitidus, individuals should discuss the potential for side effects that may range from nausea to a decrease in bone density over the long term, depending on treatment approach.