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Basics of onychopathology
Published in Archana Singal, Shekhar Neema, Piyush Kumar, Nail Disorders, 2019
Lichen nitidus predominantly affects children and young adults with multiple, very small, flat-topped, mostly skin colored papules, sometimes occurring in groups but not coalescing. Nail involvement is mainly seen as longitudinal ridging, pitting, or fine rippling.132,133 The nails tend to become fragile. Also, the proximal nail fold may develop small papules. Histopathology of lichen striatus of the nail fold shows small granulomas that are located in a dermal papilla, which becomes widened and finally gives the impression of the epidermal rete ridges embracing the granuloma. The granulomas consist of lymphocytes, histiocytes, and some giant cells. The overlying epidermis is thinned and parakeratotic. Often vacuolar changes of the basal layer and small areas of clefting are seen on top of the granuloma. Lesions in the matrix and nail bed mimic lichen planus with giant cells.134 The histological differential diagnosis is lichen planus.
Dermatoses affecting the genital area
Published in Shiv Shanker Pareek, The Pictorial Atlas of Common Genito-Urinary Medicine, 2018
Lichen nitidus is a rare skin condition which occasionally affects the mucous membranes and nails. The condition is characterised by skin-coloured micropapules which may resemble actinic lichen planus (that occurring on light-exposed skin). Lichen nitidus affects male and female children and young adults, but generalised variants more often affect females. In males, the micropapules are commonly present on the genitalia. The condition may co-occur with lichen planus.
Papulosquamous disorders
Published in Aimilios Lallas, Enzo Errichetti, Dimitrios Ioannides, Dermoscopy in General Dermatology, 2018
Aimilios Lallas, Enzo Errichetti
From a dermoscopic point of view, lichen nitidus is generally characterized by smooth, roundish, homogeneous, whitish areas (one for each papule) typically presenting sharply demarcated margins and often lacking physiological skin markings (Figure 1.82B).26 Lesions on the penis show a similar pattern, although normal skin furrows are often retained.26 Differently, lesions located on palmoplantar areas may reveal parallel linear scales as well as oval or elongated, well-defined depressions (pits) surrounded by ring-shaped, silvery white scales.26,27 This diverse pattern might depend on the thickness of stratum corneum, persistent mechanical stress, and more hyperkeratotic disease presentation in these areas.26,27
Generalized lichen nitidus in a 6-year-old girl with Down syndrome
Published in Baylor University Medical Center Proceedings, 2022
Joshua A. Peterson, Travis S. Dowdle, William D. Boothe, Brett A. Austin, Cloyce L. Stetson
Lichen nitidus is an uncommon inflammatory skin condition characterized by typically asymptomatic flesh-colored papules 1 to 2 mm in diameter. Lesions are usually localized to the trunk, upper limbs, and genitalia. Although lesions due to lichen nitidus are usually asymptomatic, some patients report pruritus, requiring treatment.1 Lichen nitidus tends to affect children and adolescents more than adults and does not appear to demonstrate a preference for any race or gender. Though the exact pathophysiology of lichen nitidus is unknown, it has been known to co-occur with lichen planus, erythema nodosum, segmental vitiligo, and lichen spinulosus.2 Several published case reports identify cases of generalized lichen nitidus in children with Down syndrome.3–9 Here, we document another case of generalized lichen nitidus in a child with Down syndrome and synthesize findings from relevant cases. We also share photographed improvement of lesions at 3-month follow-up, something not previously documented in children concurrently affected by lichen nitidus and Down syndrome.