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Pathology of Lichen Nitidus                     

Dr Sampurna Roy MD          



Path Quiz Case 76: History and images

Diagnosis: Lichen Nitidus




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.


Further reading:

Widespread lichen nitidus associated with tattoo.

Generalized lichen nitidus.

Extensive lichen nitidus as a clue to underlying Crohn's disease.

Generalized spinous follicular lichen nitidus with perifollicular granulomas.

Generalized Lichen nitidus associated with Down's syndrome: case report.

Facial lichen nitidus actinicus.

Generalized lichen nitidus in a Japanese girl.

Lichen nitidus and lichen spinulosus or spinous follicular lichen nitidus? A second case.





Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)






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