What Is Lichen Nitidus?
Medically reviewed by Susan Bard, MD
Lichen nitidus is a rare inflammatory skin condition with no known cause. It leads to the development of tiny, glistening bumps on various areas of the body. Usually, there are no other symptoms, but it can be itchy. The condition most often goes away without treatment after several months to a year.
The bumps are often the same color as the skin. However, they can present as lighter or darker than a person's skin tone or as various colors, including violet, yellow, or red-brown. This article discusses the types, symptoms, and treatment options for those with lichen nitidus.
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What Are the Symptoms of Lichen Nitidus?
The main feature of lichen nitidus is raised bumps. They typically appear on the torso, neck, forearms, abdomen, and genitals. However, they can affect any area of the body.
The following characteristics are typical of lichen nitidus bumps:
1–2 millimeters (mm) in diameter, roughly the size of a pinpoint
Round or shaped like a polygon
Mostly skin-colored but can also be yellow, red-brown, or violet
In people with darker skin tones, the bumps may present as hypo- or hyperpigmentation
Shiny with a flat top
Scaly appearance, in some cases
In rare occurrences, blisters and ulcers may form
The bumps form clusters, which can then morph into plaques
In some cases, they may form in a line along scratch marks or other sites of skin injury
The only symptom that sometimes appears in addition to the bumps is itching. However, not all cases of lichen nitidus will present with irritation.
In some cases, lichen nitidus can develop inside the mouth. When it does, people may experience:
Grey-white papules on the insides of their cheeks
White plaques on the tongue
Rare Symptoms of Lichen Nitidus
In some cases, the condition may affect the nails, causing symptoms such as:
Ridging on the nails
Nail splitting or detachment
Redness at the base of the nail
Nail thickening
Variations
Several variants of lichen nitidus have been identified, including:
Generalized: Can appear anywhere on the body.
Hemorrhagic/purpuric (with bruising or pinpoint dots due to bleeding): Forms on the tops of the feet and around the ankles. Over time, the bumps spread up the legs. Or, they can form on the palms.
Vesicular: Develops on the palms and can blister.
Actinic: Develops most often in people with darker skin tones after sun exposure.
Linear: Occurs when the bumps form a line instead of a cluster.
Keratoderma: Develops on the soles of the feet and palms of the hands. This type mimics eczema because it can also cause fissures or cracks in the skin.
Perforating: This form affects the hands and forearms. The bumps may appear as though they have tiny belly buttons (this condition is known as umbilication).
What Causes Lichen Nitidus?
The cause of lichen nitidus is unknown. However, older studies examining the condition found that specific cells in the immune system, T lymphocytes, may play a role. These cells are designed to help the body fight off infection and disease.
One older study published in 2005 found that these immune system cells are activated in people with lichen nitidus. This research suggests that this is what's behind the condition's inflammation and bumps. The reason for the T-lymphocyte activation has yet to be discovered.
Who Gets Lichen Nitidus the Most?
Lichen nitidus is most often diagnosed in children and adolescents. It can affect people of any sex and ethnicity. Because the cause is unknown, medical researchers have difficulty determining who is more at risk. It may have a hereditary component, but research is still ongoing.
Currently, other health disorders have been linked to an increased incidence rate of lichen nitidus, including Crohn’s disease, Down syndrome, atopic dermatitis (eczema), and human immunodeficiency virus (HIV).
Related: An Overview of Autoimmune Skin Conditions
How Is Lichen Nitidus Diagnosed?
Healthcare providers will begin the diagnostic process by physically examining the bumps, documenting symptoms, and gathering a health history. To definitively diagnose lichen nitidus, they may take a skin biopsy to look for microscopic characteristics of the condition, including:
Lymphocyte (white blood cell) infiltration in the area
Langhans giant cells (also called Langerhans cells), which are often present in the condition
Ridges that go into the underlying connective tissue (rete ridges) and are longer than usual
How Do You Treat Lichen Nitidus?
Treatment is rarely required, and there is no accepted cure for the condition. The bumps and other symptoms can go away in as little as one month or as much as one year, but sometimes for longer. Because the condition is not serious, the healthcare provider may reassure the affected person and not recommend treatment.
Treatments are available if the symptoms or cosmetic appearance are especially bothersome. The best treatment option depends on personal factors, such as what type of lichen nitidus you have, how you respond to treatments, and your healthcare provider's recommendations based on your overall health.
Some possible therapies for lichen nitidus include:
Topical or systemic corticosteroids to reduce inflammation levels
Immunosuppressant medications, including Protopic (tacrolimus)
Retinoids such as Soriatane (acitretin), especially if the hands and feet are affected
Phototherapy or exposure to sunlight, especially for generalized lichen nitidus
Photochemotherapy, which is exposure to UVA radiation after taking a medication that makes the skin more sensitive to light
After Effects of Lichen Nitidus
After the rash resolves, the skin may show post-inflammatory hyperpigmentation (darkened spots where the rash was). This can linger for months or longer.
Summary
Lichen nitidus is an inflammatory skin condition that causes small, shiny bumps on the body. Many people with the condition experience no symptoms besides the bumps, although it can also sometimes cause itching. It usually resolves without treatment in several months to a year.
The cause of it is unknown. Though the disorder is connected to inflammation, it is not yet considered an autoimmune disease. It is usually diagnosed in children and adolescents of any sex or race.
A skin biopsy may help to diagnose the condition. Treatment may prove unnecessary. If treatment is desired, light therapy, corticosteroids, retinoids, or immunosuppressants may address this.
Read the original article on Verywell Health.
