Pathology of Lichen Nitidus - Dr Sampurna Roy MD

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Dermpath-India

Pathology of Lichen Nitidus

Dr Sampurna Roy MD

2022

Lichen nitidus is a rare benign chronic papular lesion of unknown etiology.

It was originally regarded as a variant of lichen planus but it is now considered a distinct entity.

Clinical presentation: Multiple, small flesh-coloured papules. These are 1-2 mm in diameter.

Clinical variants: Generalized, actinic, perforating , linear, vesicular etc.

Age: Usually present in children and young adult males.

Site: Upper extremities, chest, abdomen, genitalia. Rarely palms, soles and nails may be involved.

Microscopic features:

Dense, well circumscribed subepidermal infiltrate.

Limited to one or two adjacent dermal papilla.

Claw-like downgrowths of the rete ridges are present at the margins of the infiltrate, described as ("claw clutching a ball").

Inflammatory cells push against the undersurface of the epidermis.

Inflammatory infiltrate consists of lymphocytes, histiocytes, melanophages, plasma cells in some cases, a few epithelioid cells and occasional giant cells.

Differential diagnosis:

Disseminated granuloma annulare ;

Early lesion of lichen scrofulosorum (granulomas in lichen scrofulorum do not cause widening of the papillae) ;

Giant cell lichenoid dermatitis: a possible manifestation of sarcoidosis ;

Lichenoid and granulomatous dermatitis ;

Micropapular sarcoidosis simulating lichen nitidus.