64 Questions
What may lead to T-helper type 2 (Th2) cell polarization in lichen nitidus?
Cytokine milieu produced by the inflammatory infiltrate
Which conditions have been associated with lichen nitidus?
Atopic dermatitis, Crohn disease, and juvenile chronic arthritis
What has been reported about the genetic factors of lichen nitidus?
No genetic factors of the disease have been identified
What is the current understanding of the epidemiology of lichen nitidus?
It is more common in children and young adults
How is lichen nitidus currently regarded in terms of its pathophysiology?
As an idiopathic lichenoid tissue reaction with distinctive clinical and histologic features
What theory supports the formation of discrete inflammatory papules in lichen nitidus?
Stimulation of epidermal and dermal antigen-presenting cells by exogenous antigens and allergens
How do most clinicians and researchers view the relationship between lichen nitidus and lichen planus?
They favor the separation of these two diseases as distinct entities based on clinical, immunologic differences, and distinctive histologic changes
What is the role of Langerhans cells in the pathophysiology of lichen nitidus?
They activate a cell-mediated response and initiate lymphocyte accumulation in the skin
Where are the most frequent sites of predilection for lichen nitidus?
Trunk
What distinguishes palmar lichen nitidus from lichen planus?
Keratotic spicules on the central, palmar surfaces
Which phenomenon is observed in approximately 12% of cases of generalized lichen nitidus?
Koebner phenomenon
What is a potential site of involvement that is less common for lichen nitidus?
Nails
In which age group is palmoplantar involvement more common?
Older individuals
What is a common location for hemorrhagic-purpuric lesions in actinic lichen nitidus?
Palms and distal extremities
In which individuals does actinic lichen nitidus appear most commonly?
Dark-skinned individuals in areas of significant sun exposure
What is a distinguishing feature of actinic lichen nitidus compared to other frictional lichenoid eruptions?
Histologic features of lichen nitidus
What is the usual symptom presentation of lichen nitidus?
Usually asymptomatic with pruritus present in approximately 12% of cases
What is the classic histologic pattern seen in 90% of lichen nitidus cases?
The "ball and claw" pattern with involvement of up to three dermal papillae
What is the role of Langerhans cells in the majority of lichen nitidus cases?
They are S100+ and CD1+ cells
What distinguishes actinic lichen nitidus from other frictional lichenoid eruptions?
Presence of transepidermal elimination of the inflammatory infiltrate
What is a rare feature observed in about 10% of lichen nitidus cases?
Dyskeratotic cells and clefting at the dermal–epidermal junction
Where are predilection sites for hemorrhagic-purpuric lesions in actinic lichen nitidus?
Lower limbs and feet
What is a distinguishing feature of palmar lichen nitidus compared to lichen planus?
"Ball and claw" pattern in histologic examination
What is the typical duration of lichen nitidus in two thirds of patients?
1 year
Which of the following is a first-line treatment for lichen nitidus on the body?
Tacrolimus ointment
What type of lesions develop as older lesions of lichen nitidus resolve?
New lesions
For which subtype of lichen nitidus is acitretin a potential therapy?
Palmar disease
What is the first-line systemic agent for pruritus in lichen nitidus?
Oral antihistamines
Which medication has largely supplanted PUVA for generalized lichen nitidus?
Narrowband ultraviolet B
What should be considered when deciding on systemic treatments for lichen nitidus?
Potential harm of treatment
What type of disease warrants treatment in lichen nitidus?
Symptomatic and cosmetically disfiguring disease
Which therapy is most successful when combined with skin-directed therapies such as topical steroids or phototherapy?
Oral glucocorticoids
What is a rarely indicated systemic treatment for lichen nitidus?
Prednisone
Which condition may lead to T-helper type 2 (Th2) cell polarization in lichen nitidus?
Atopic dermatitis
What has been reported about the genetic factors of lichen nitidus?
No significant genetic association reported
What is the classic histologic pattern seen in 90% of lichen nitidus cases?
Lymphocyte, histiocytes, and foreign body or Touton-type giant cells forming a “ball and claw” pattern
Which cells predominate in the infiltrate of lichen nitidus cases?
T lymphocytes (CD4+ cells over CD8+)
What may be seen with clinical variants of lichen nitidus, such as palmar lesions?
Parakeratotic plug
In actinic lichen nitidus, where are purpuric or hemorrhagic lesions associated with capillary wall degeneration and red blood cell extravasation most likely to occur?
Areas of maximal sun exposure
What type of cells have been reported to predominate in the infiltrate of lichen nitidus?
T lymphocytes (CD4+ cells over CD8+)
Which features may be rarely observed in lichen nitidus cases?
Colloid bodies
What is the typical duration of lichen nitidus in two thirds of patients?
Less than 1 year
What is the first-line topical treatment for lichen nitidus?
Topical corticosteroids
What is the first-line systemic agent for pruritus in lichen nitidus?
Diphenhydramine
Which systemic therapy is rarely indicated in lichen nitidus and should be reserved for more symptomatic and cosmetically disfiguring disease?
Cyclosporine
What medication may hasten resolution of more extensive, generalized, or symptomatic lichen nitidus?
$0.3 mg/kg$ prednisone
Which therapy has largely supplanted PUVA for generalized lichen nitidus?
Narrowband ultraviolet B
For which subtype of lichen nitidus is acitretin a potential therapy?
$ ext{Hyperkeratotic palmar disease}$
What is a distinguishing feature of palmar lichen nitidus compared to lichen planus?
$ ext{Pruritus}$
What is a potential site of involvement that is less common for lichen nitidus?
Face
What should be considered when deciding on systemic treatments for lichen nitidus?
Potential harm of treatment vs. the relatively benign nature of lichen nitidus.
What is the role of Langerhans cells in the majority of lichen nitidus cases?
Causing granuloma formation.
What cells predominate in the infiltrate of lichen nitidus cases?
T lymphocytes
In lichen nitidus, what is the distinguishing feature of palmar lesions?
Deep parakeratotic plug
Which type of lesions are associated with capillary wall degeneration and red blood cell extravasation in lichen nitidus?
Purpuric or hemorrhagic lesions
What is the classic histologic pattern seen in 90% of lichen nitidus cases?
"Ball and claw" pattern
What is rarely seen in lichen nitidus cases, with only about 10% of cases showing this feature?
Colloid bodies
Where do perforating lesions tend to occur in lichen nitidus?
Areas of friction
What is the typical duration of lichen nitidus in two thirds of patients?
1 year
What is the first-line topical treatment for lichen nitidus?
Mid- to high-potency topical corticosteroids
Which therapy has largely supplanted PUVA for generalized lichen nitidus?
Narrowband ultraviolet B
Which systemic therapy is rarely indicated in lichen nitidus and should be reserved for more symptomatic and cosmetically disfiguring disease?
Low-dose oral glucocorticoids
What type of cells have been reported to predominate in the infiltrate of lichen nitidus cases?
Lymphocytes
What type of disease warrants treatment in lichen nitidus?
More symptomatic and cosmetically disfiguring disease
This quiz covers the epidemiology and characteristics of lichen nitidus, including its prevalence in different age groups, racial and sexual predilections, and its classification as an idiopathic lichenoid tissue reaction. It also touches on the debated relationship between lichen nitidus and lichen planus.
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