Skin nontumor
Lichenoid and interface reaction patterns
Lichen nitidus


Topic Completed: 5 May 2020

Minor changes: 5 May 2020

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PubMed Search: Lichen nitidus[TI] pathology full text[SB]

Chico J. Collie, M.B.B.S.
Jonathan D. Ho, M.B.B.S., D.Sc.
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Cite this page: Collie CJ, Ho JD. Lichen nitidus. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/skinnontumorlichennitidus.html. Accessed October 29th, 2020.
Definition / general
  • Uncommon, idiopathic, lichenoid disorder of the skin with characteristic clinical and histopathologic features
Essential features
  • Papular eruption most commonly seen in the young
  • Discrete lymphohistiocytic infiltrate expanding 1 - 4 dermal papillae
  • Epidermal collarette gives ball and claw appearance
  • Vacuolar interface change may be prominent
  • Multinucleated giant cells often present
  • Atypical clinical variants have classical histopathologic findings
ICD coding
  • ICD-10: L44.1 - Lichen nitidus
  • ICD-11: EA92 - Lichenoid dermatoses
Epidemiology
Sites
Pathophysiology
Etiology
Clinical features
Diagnosis
  • Classical clinical presentation
  • Histopathologic findings are diagnostic even in atypical variants
Prognostic factors
  • Majority resolve spontaneously
Case reports
Treatment
Clinical images

Contributed by Jonathan D. Ho, M.B.B.S., D.Sc.

Pinpoint koebnerized papules

Subtle papules

Microscopic (histologic) description
  • Discrete inflammatory cell infiltrate obscuring the dermoepidermal junction
  • Lichenoid infiltrate expands 1 - 4 dermal papillae
  • Epidermal collarette gives a ball and claw appearance
  • Variable admixture of lymphocytes and histiocytes with occasional giant cells
  • Basal layer vacuolation and colloid bodies may be prominent
  • Overlying hyperkeratosis with or without parakeratosis frequent
  • Epidermal atrophy may be noted
  • Melanophages prominent in richly pigmented individuals
  • Extravasated erythrocytes in purpuric variant (Dermatol Online J 2007;13:5)
  • Rarely, may have perifollicular distribution (Pediatr Dermatol 2013;30:e20)
Microscopic (histologic) images

Contributed by Jonathan D. Ho, M.B.B.S., D.Sc.

Expanded dermal papillae

Ball and claw appearance

Lymphohistiocytic infiltrate

Epidermal changes

PAS stain

Virtual slides

Images hosted on other servers:

Classical lichen nitidus

Immunofluorescence description
  • Immunofluorescence not used for diagnosis
  • Immunoglobulins typically absent
  • May have fibrinogen in a linear pattern at the dermoepidermal junction (Arch Dermatol 1973;107:200)
Positive stains
  • PAS highlights papillary dermal colloid bodies
Sample pathology report
  • Left knee, punch biopsy:
    • Lichen nitidus (see comment)
    • Comment: The specimen exhibits focal parakeratosis, focal epidermal atrophy, basal layer vacuolation with associated apoptotic keratinocytes and a subjacent lichenoid lymphohistiocytic infiltrate expanding 1 - 2 dermal papillae. There are scattered multinucleated giant cells, colloid bodies and occasional melanophages. These features are diagnostic of lichen nitidus.
Differential diagnosis
Board review style question #1



A 9 year old boy presents with an asymptomatic eruption of hypopigmented pinpoint papules involving the skin of his elbows, knees and penile shaft. The child is otherwise well. A punch biopsy reveals focal hyperkeratosis, epidermal atrophy, basal layer vacuolation and a discrete lymphohistiocytic infiltrate expanding a single dermal papilla and obscuring the dermoepidermal junction. What is the most likely diagnosis?

  1. Lichen nitidus
  2. Lichen planus
  3. Lichen scrofulosorum
  4. Lichen simplex chronicus
  5. Lichen striatus
Board review answer #1
A. Lichen nitidus

Comment Here

Reference: Lichen nitidus
Board review style question #2
Which of the following histopathologic features favors a diagnosis of lichen nitidus over lichen planus?

  1. Basal layer vacuolar change
  2. Broad band-like lymphocytic infiltrate with scattered colloid bodies
  3. Multinucleated giant cells within a focal lichenoid infiltrate
  4. Scattered melanophages
  5. Wedge shaped hypergranulosis
Board review answer #2
C. Multinucleated giant cells within a focal lichenoid infiltrate

Comment Here

Reference: Lichen nitidus
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