Actinic lichen nitidus

Arun C Inamadar¹ , SB Athanikar² , W Sampagavi² , BR Yelikar²

¹ Department of Skin, STD and Leprosy, SBMP Medical College, Bijapur 596 103, India
² Department of Pathology, STD and Leprosy, SBMP Medical College, Bijapur 596 103, India

Correspondence Address:
Arun C Inamadar
Department of Skin, STD and Leprosy, SBMP Medical College, Bijapur 596 103
India

Introduction

Lichen nitidus is characterised by the presence of pinpoint to pinhead sized papules which usually are asymptomatic, flesh-colored with flat and shiny surface.[1] Many clinical variants of lichen nitidus have been reported in the literature. We describe two children with distribution of lichen nitidus in sun exposed areas.

Case Report

Case 1. A 5-year-old boy presented with mildly pruritic papular eruption since one month. It began in the forehead and malar area, then spread over ′V′ area of the neck. His general health was normal. There was history of exacerbation of itching after exposure to sun. Examination revealed numerous skin colored dome shaped papules mainly on the sun exposed areas of the body. Koebner′s phenomenon was noted in the neck area. Palms, soles, nails and mucus membrane were without lesions. Routine laboratory studies were normal. Biopsy specimen showed well circumscribed lymphohistiocytic infiltrate in the elongated rete ridges [Figure - 1] and at places basal cell liquefaction and multinucleated giant cells [Figure - 2] suggestive of lichen nitidus.

Case 2. A 7-year-old child with skin lesions over exposed parts of the body presented to Dermatology department. History revealed mild pruritus of the lesions after exposure to sun light. Examination revealed pinhead sized flat papules, mainly discrete and at places confluent, over forehead malar, area of face, ′V′ area of neck and extensor surface of the forearm. Koebner′s phenomenon was observed over forearm and neck area. A clinical diagnosis of ′actinic′ lichen nitidus was made. Biopsy findings were suggestive of lichen nititus.

There was remission of the lesions after treatment with sun screen, mild strength topical steroids and astemizole 10mg once daily for 6 weeks.

Discussion

Reported clinical variants of lichen nitidus include-confluent, vesicular, haemorrhagic, palmar and plantar, spinous follicular, perforating, linear and generalised.[1]

Kanwar and Kaur have reported six children who had clinical and histologically proved lesions of lichen nitidus on sun exposed areas and termed it as Lichen nitidus actinicus′.[2] Recently Hussain[3] has reported nine patients of actinic lichen nitidus and concluded that the term summer time actinic lichenoid eruption[4] should be replaced with actinic LN, because the term actinic LN is descriptive and also reflects the parallelism between classic lichen planus (LP) and LN on the one hand, and actinic LN and actinic LP on the other. Koebner phenomenon was not observed in all his nine patients.[4] But both our cases had Koebner phenomenon, which is characteristic of lichen nitidus.

The distribution of the typical flesh colored shiny papules in a photo exposed fashion, Koebner′s phenomenon with characteristic histological findings have made us suggest that actinic LN, should be added to the list of clinical variants of LN.

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