Published on 19/03/2015 by admin
Filed under Dermatology
Last modified 22/04/2025
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Andrew L. Wright
Evidence Levels: A Double-blind study B Clinical trial ≥ 20 subjects C Clinical trial < 20 subjects D Series ≥ 5 subjects E Anecdotal case reports
Lichen nitidus is an uncommon idiopathic condition presenting with 1–2 mm diameter flat-topped or domed papules. They usually remain discrete, but may be grouped. They can occur on any part of the body, but mainly affect the forearms, penis, abdomen, chest, and buttocks. Palmar lesions may be hemorrhagic.
Lichen nitidus persists for long periods of time, but is generally asymptomatic and treatment may not be necessary. No large controlled clinical trials have been reported; most treatments are based on anecdotal reports.
In patients with localized disease, potent topical corticosteroids and topical tacrolimus can be successful in clearing lesions. For more extensive disease phototherapy (psoralen plus UVA (PUVA) and UVB) has been reported to be successful. Antihistamines, including astemizole and cetirizine, are reported to have cleared lesions. Generalized lesions have cleared with PUVA, UVB, and acitretin.
Biopsy
Wright S. Arch Dermatol 1984; 120: 155–6.
A 24-year-old woman with a 12-year history of extensive lesions cleared with 1 month’s treatment using 0.05% fluocinonide cream twice daily. No recurrence was noted at 12-month follow-up.
Park JH, Choi YL, Kim WS, Lee DY, Yang JM, Lee ES, et al. J Am Acad Dermatol 2006; 54: 545–6.
A 33-year-old man with a 3-year history of generalized disease was reported as almost clear after 28 treatments, and remained clear 11 months after cessation of therapy. A 10-year-old with generalized disease was reported as completely clear after 41 treatments, and was clear at the 6-month follow-up.
Kim YC, Shim SD. Int J Dermatol 2006; 45: 615–17.
A 7-year-old girl and a 10-year-old boy, both with generalized lichen nitidus, were treated with narrowband UVB phototherapy, receiving between 17 and 30 treatments maximum 9.5 J/cm2. Both were reported as almost clear at the end of treatment and remained clear for at least 11 months.
Dobbs CR, Murphy SJ. J Drugs Dermatol 2004; 3: 683–4.
A 32-year-old man with lichen nitidus confined to the penis was treated with twice-daily tacrolimus 0.1%. The lesion was reported to be clear after 4 weeks’ treatment, and had not relapsed after 4 months.
Ocampo J, Torne R. Int J Dermatol 1989; 28: 49–51.
Two patients treated with astemizole, a 65-year-old man with a 3-month history and a 48-year-old woman with a 4-month history, were either cleared or dramatically improved with 6–12 days of astemizole 10 mg daily.
Thio HB. Br J Dermatol 1993; 129: 342.
A 20-year-old woman with widespread disease responded to astemizole 10 mg daily, after relapsing following a successful course of PUVA. There was no recurrence of lesions at 2-year follow-up.
It should be noted that astemizole has been discontinued because of cardiotoxicity noted with certain drug interactions. It is presumed that safer antihistamines might also be valuable.
Randle HW, Sander HM. Int J Dermatol 1986; 25: 330–1.
A 29-year-old woman with an 8-month history of a generalized eruption was treated with PUVA three times weekly. Lesions cleared after 46 treatments (290 J) and remained clear 5 years later.
Aram H. Int J Dermatol 1988; 27: 117.
A 35-year-old woman with a 4-month history cleared with 8 weeks of etretinate 25 mg/50 mg on alternate days. Treatment was stopped 1 month later. There was no recurrence 5 months after completing the treatment.
Lucker GPH, Koopman RJJ, Steijlen PM, Van der Valk PG. Br J Dermatol 1994; 130: 791–3.
A 23-year-old man had a 14-month history of hand and foot involvement that failed to clear with acitretin 50 mg daily, but was reported to have improved significantly on 75 mg daily.
Lee YK, Choi KW, Lee CW, Kim KH. Korean J Dermatol 2007; 45: 1311–14.
A 16-year-old girl with generalized lichen nitidus was significantly improved with 8 weeks of cyclosporine 2 mg/kg/day.
Farshi S, Mansouri P. Dermatol Online J 2011; 17: 11.
Lesions were reduced and flattened following treatment twice daily for 8 weeks.
Libow LF, Coots NV. Cutis 1998; 62: 247–8.
A report of two cases showing partial clearance of lichen nitidus after 2 weeks of itraconazole 200 mg twice daily.
Kano Y, Otake Y, Shiohara T. J Am Acad Dermatol 1998; 39: 305–8.
This paper reports a patient treated with 0.1% dinitrochlorobenzene (DNCB) applied at 2-weekly intervals, following sensitization with 1% DNCB. The lesions were said to have cleared after 7 months of treatment, compared to a control area. 6 months after cessation of treatment lesions were said to be recurring in the treated area.
Sehgal VN, Jain S, Kumar S, Bhattacharya SN, Singh N. Australas J Dermatol 1998; 39: 60.
A 6-year-old boy with a 6-month history of generalized involvement showed complete regression/healing of lesions over a 4-week period of treatment with cetirizine dihydrochloride 5 mg daily and levamisole 50 mg on alternate days for 4 weeks.
Kubota Y, Kirya H, Nakayama J. Br J Dermatol 2002; 146: 1081–3.
A 10-year-old Japanese girl with a 2-year history of lichen nitidus showed almost complete clearance following a 6-month course of oral isoniazid.
Treatment of Skin Disease Comprehensive Therapeutic Strategies 4e
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Topical corticosteroids
UVB
Topical tacrolimus
Antihistamines
PUVA
Oral retinoids
Cyclosporine
Topical pimecrolimus
Itraconazole
Dinitrochlorobenzene
Cetirizine dihydrochloride, and levamisole
Isoniazid
