Lichen Nitidus

Lichen nitidus is an uncommon skin disease that can be marked by the appearance of small, skin-colored, glossy irregularities on the surface of the skin.

It is caused by an abnormal inflammatory activity in skin cells. Although lichen nitidus may affect anyone, it is most frequent among children and young adults.

This inflammation usually clears up on its own without treatment and rarely causes discomfort. It is a non-infectious disease that won’t spread to other people.

These bumps can be characterized on the basis of following parameters:

• Size- Their size ranges from very minute to pin-head size.
• Shape- May is found as flat-topped or rounded bumps.
• Color- The bumps are usually same as the color of your skin. They may tend to be slightly pinkish on people with a lighter skin-tone, either lighter than the normal skin color on people with a darker skin-tone.
• Location- It usually occurs on the chest, abdomen, arms and genital areas, including the penis. Areas like palms, soles of the feet and fingernails are exceptions to this disease. Lichen nitidus may re-appear on any other site of your body after being cleared from the previous one.
• Itch- It happens in rare cases, that the bumps of lichen nitidus may lead to itching, sometimes an intense one. They may appear on areas such as a fold of skin on the abdomen or the crease of skin on the inner side of the elbow or wrist, usually where there's a scratch, crease or constant pressure on the skin.

Symptoms of lichen nitidus includes:

• The appearance of minute bumps on the surface of the skin.
• It is usually accompanied by fever.
• Itching is rare but if present, may be an intense one.

One should seek medical help if he/she encounters tiny bumps or a rash-like condition on the surface of their skin for no possible reason, such as a known allergic reaction or contact with poison ivy.

As a number of conditions can cause skin reactions, it's best to get an instant and accurate diagnosis.

The main cause of lichen nitidus is still unknown. The papules are a result of inflammation controlled by a type of white blood cells called T lymphocytes.

Under usual conditions, these cells work to heal a disease or wound, such as a cut on your finger.

Doctors and researchers are still unable to diagnose the cause of the activation/stimulation of T lymphocytes in a case of lichen nitidus.

One shall start by seeing their child's pediatrician or primary care doctor if their child or they themselves have the symptoms of lichen nitidus to receive a diagnosis.

The doctor may then refer the patient to a skin specialist (dermatologist).

The following are the probable questions to be asked to the doctor:

• What's the most likely cause of my symptoms?
• What tests do I need to undergo?
• How long can I expect this condition to last?
• What are the available treatments, and which ones do you recommend?
• What side effects can I expect from the treatments?
• Are there any restrictions on what types of products I use on my skin?
• Is there a generic alternative to the medicine you're prescribing me?
• Do you have any brochures or other printed materials I can take with me?
• What websites can I visit related to my condition?

The doctor or dermatologist shall make a diagnosis of lichen nitidus or any other skin condition based on the information provided about the symptoms and may carefully examine the skin abnormality.

He/she may use a magnifying glass to look at your skin or may take a small sample of tissue (biopsy) and look at it under a microscope.

Lichen nitidus usually clears up on its own without any treatment but can last for months.

After it clears up, the appearance of the skin usually gets back to normal without leaving any scar or permanent change to the skin color.

If lichen nitidus is accompanied by itching or if one has concerns about the appearance of their / their child’s skin, the doctor may prescribe one of the following treatments:

• Corticosteroids- Corticosteroids may reduce inflammation associated with lichen nitidus. Its side effects vary depending on whether it's used as an ointment directly onto the skin (topical) or taken as a pill (oral). The continuous use of topical corticosteroids can cause thinning of the skin, a lesser efficacy of the drug and other skin problems. The long-term use of oral corticosteroids can cause weakening of bones (osteoporosis), diabetes, high blood pressure and high cholesterol levels.

• Retinoid- It is a synthetic form of vitamin A that can be used as a topical or an oral treatment. The topical treatment is usually safe unlike corticosteroids, but it may irritate the skin. Since retinoid can cause birth-related defects; it shouldn't be used by pregnant women. The doctor may advise you bout other necessary precautions.

• Other topical medications- Tacrolimus (Protopic) is a topical drug that helps in suppressing the immune response and may be helpful for subsiding lichen nitidus. Its possible side effects include stinging, burning and itching at the site where the medication is applied. This medication can't be used in conjunction with phototherapy. Exposure to the sun should be limited while using tacrolimus and use of tanning beds during treatment is prohibited.

• Antihistamines- They act against a protein called histamine that is involved in an inflammatory activity. An oral or topical antihistamine may ease the itching associated with lichen nitidus.
• Phototherapy- It is a type of light therapy that may help in clearing up lichen nitidus. One type of photo therapy involves the use of ultraviolet A (UVA) light, which penetrates deep into the skin. This therapy is usually used in combination with a drug that makes the skin more sensitive to UVA light. While another type of photo therapy uses a narrow band ultraviolet B (UVB) light.

It's important to avoid sun exposure for a couple of days after having a phototherapy. Also, you need to wear special UV-absorbing sunglasses for a couple of days to protect your eyes.

There are several risks and complications associated with lechen nitidus.

Since lichen nitidus is rare, most information about the disorder is known through individual cases or small studies. It may usually be accompanied by other diseases. 

Links between lichen nitidus and other diseases aren't well-researched, but they may include:

• Lichen planus, an inflammatory condition usually characterized by patches of red or purple, flat-topped, itchy bumps on the skin or lacy white patches on the mucous membranes of the mouth.
• Atopic dermatitis (eczema), an inflammatory skin condition usually characterized by dry, itchy rashes on areas like the face, inner side of the elbow, behind the knees, and on the hands and feet.  
• Crohn's disease, inflammation of the lining of your digestive tract, which can lead to abdominal pain, severe diarrhea and malnutrition.
• Juvenile rheumatoid arthritis, an inflammatory disease that causes persistent joint pain, swelling and stiffness.
• Tuberculosis, an infectious disease that most often affects the lungs.
• Lichen nitidus is a harmless condition that doesn't result in long-term skin problems or medical complications.

However, the appearance of lichen nitidus may cause a person to be self-conscious or embarrassed.