1/5. lichen nitidus of the palms: a case with peculiar histopathologic features.Palmar involvement in lichen nitidus is infrequent. In such cases, the histopathologic findings of palmar lesions are usually identical to those of extrapalmar ones. We report on the case of a patient with multiple tiny papules located on the palms and elbows. A biopsy specimen from the elbow showed the typical features of lichen nitidus, but a biopsy from the palm disclosed an inflammatory infiltrate mostly disposed around the bases of rete ridges and composed of lymphocytes and histiocytes with some giant cells both in the dermis and in the epidermis. This location of the infiltrate is similar to that found in hypertrophic lichen planus, a combination of lichen planus and lichen simplex chronicus. We conclude that this histopathologic feature in palmar lichen nitidus could be the result of the superimposition of lichen nitidus on normal palmar skin, resulting in a picture resembling hypertrophic lichen planus.- - - - - - - - - - ranking = 1keywords = ridge (Clic here for more details about this article) |
2/5. Generalized lichen nitidus.lichen nitidus is a rare chronic condition of unknown etiology. Generalized lichen nitidus is even rarer. We report here a 5-year-old girl who had multiple, asymptomatic, discrete, 1 to 2 mm flesh-colored, shiny, flat, papules on her face, upper limbs, and thighs with relative sparing of the trunk. Resolution of these papular lesions was followed by hyperpigmented macules in those areas. Histopathologic examination of a papular lesion revealed a localized granulomatous lymphohistiocytic infiltrate in an expanded dermal papilla with thinning of overlying epidermis and downward extension of the rete ridges at the lateral margin of the infiltrate, producing a typical "claw clutching a ball" picture, confirming our clinical diagnosis of lichen nitidus. The pigmented macules showed melanin pigmentation on histology. There was no response to oral astemizole treatment for 3 months. However, the lichen nitidus lesions resolved spontaneously without any further treatment over the next year, leaving behind a prominent pigmentary disturbance.- - - - - - - - - - ranking = 1keywords = ridge (Clic here for more details about this article) |
3/5. Condyloma with lichen nitidus.A 32-year-old black man presented with two separate eruptions on his penis (Figure). He has had a 10-year history of asymptomatic 1-3 mm shiny papules on the shaft of his penis. He also has had one asymptomatic verrucous brown plaque 1.5 cm in diameter on his penis. A small shave biopsy was performed for each process. The former showed lymphocytes and histocytes in the papillary dermis in a "ball-in-claw" relation to the rete ridges of the epidermis. The latter showed an acanthotic epidermis with papillomatosis. Diagnoses of lichen nitidus and condyloma acuminata were respectively made. As the shiny papules did not bother the patient, but he wanted to be rid of the verrucous plaque, only the latter was treated. Liquid nitrogen was applied to the plaque. The patient was also given podofilox 0.5% gel to apply to the condyloma overnight on Monday, Tuesday, and Wednesday, with a 4-day respite. This cycle was to be repeated for 3 more weeks. He was examined several more times and treated with cryotherapy and podofilox gel with the near disappearance of the condyloma over 4 months.- - - - - - - - - - ranking = 1keywords = ridge (Clic here for more details about this article) |
4/5. Perforating lichen nitidus.A 32-year-old man with no particular family history nor past history visited our clinic in September 1992, with papules that he claimed had developed approximately 3 years earlier. No subjective symptoms accompanied then. On examination, numerous, discrete, pinhead-sized or half-ricecorn-sized, flesh-colored papules were observed on the dorsolateral side of his left hand and fingers. No central dimple or scaling were noticed clinically (Fig. 1). Laboratory tests revealed no abnormal findings. The histopathology of the biopsied specimen showed a circumscribed nest of infiltrating cells closely attached to the epidermis (Fig. 2). These infiltrating cells consisted of mononuclear lymphoid cells and histiocytes. The overlying epidermis was stretched and atrophic. A transepithelial perforation channel existed in direct contact with the surface. Amorphous debris containing cell nuclei lay within the channel (Fig. 2). Lymphoid cells were also observed above the keratin layer overlying the channel. At the lateral margin of the infiltrate, rete ridges extended downward in the manner of a claw clutching a ball. In a periodic-acid-Schiff (PAS)-stained section, a basement defect was observed around the channel.- - - - - - - - - - ranking = 1keywords = ridge (Clic here for more details about this article) |
5/5. A case of generalized lichen nitidus with Koebner's phenomenon.A 12-year-old boy was seen in our department with a three year history of eruptions on his back consisting of normal colored or slightly reddish, pinhead-sized papules, which had gradually spread to his trunk within the previous year. Four days before the first visit, May 13, 1992, the eruption involved his entire extremities. On the back side of his lumbar region, Koebner's phenomenon was observed. He had received several medications for more than two years to treat this eruption in several hospitals, but none were effective. He was in good general health. Mantoux reaction was negative two months after BCG injection. Histopathologic features of the papules included focal epidermal hyperplasia and elongation of the rete ridges in a narrow area and a well demarcated dense lymphohistiocytic infiltrate on the papillar layer. Biscoclaurine alkaloids (20 mg/day) and Jumi-haidoku-to (TJ-6; 7.5 g/day) were administered to the patient after the biopsy. No topical ointments were applied. Two weeks after of these treatments, he reported moderate pruritus on the back. The eruption diminished rapidly within 2 weeks after the therapy began. Almost all the eruptions were cured within one year. Mantoux reaction developed 8 x 8 mm erythema two and half months after the treatment began, and it was significantly positive (23 x 30 mm) 6 months later.- - - - - - - - - - ranking = 1keywords = ridge (Clic here for more details about this article) |