Epidemiology and Characteristics of Lichen Nitidus
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Questions and Answers

What may lead to T-helper type 2 (Th2) cell polarization in lichen nitidus?

  • Functioning cellular immunity
  • Cytokine milieu produced by the inflammatory infiltrate (correct)
  • Topical application of dinitrochlorobenzene
  • Genetic factors
  • Which conditions have been associated with lichen nitidus?

  • Vitiligo, alopecia areata, and urticaria
  • Psoriasis, eczema, and rosacea
  • Atopic dermatitis, Crohn disease, and juvenile chronic arthritis (correct)
  • Seborrheic dermatitis, acne, and molluscum contagiosum
  • What has been reported about the genetic factors of lichen nitidus?

  • Multiple genetic variants contributing to the disease
  • No genetic factors of the disease have been identified (correct)
  • Inheritance pattern following Mendelian genetics
  • Strong genetic linkage to specific alleles
  • What is the current understanding of the epidemiology of lichen nitidus?

    <p>It is more common in children and young adults</p> Signup and view all the answers

    How is lichen nitidus currently regarded in terms of its pathophysiology?

    <p>As an idiopathic lichenoid tissue reaction with distinctive clinical and histologic features</p> Signup and view all the answers

    What theory supports the formation of discrete inflammatory papules in lichen nitidus?

    <p>Stimulation of epidermal and dermal antigen-presenting cells by exogenous antigens and allergens</p> Signup and view all the answers

    How do most clinicians and researchers view the relationship between lichen nitidus and lichen planus?

    <p>They favor the separation of these two diseases as distinct entities based on clinical, immunologic differences, and distinctive histologic changes</p> Signup and view all the answers

    What is the role of Langerhans cells in the pathophysiology of lichen nitidus?

    <p>They activate a cell-mediated response and initiate lymphocyte accumulation in the skin</p> Signup and view all the answers

    Where are the most frequent sites of predilection for lichen nitidus?

    <p>Trunk</p> Signup and view all the answers

    What distinguishes palmar lichen nitidus from lichen planus?

    <p>Keratotic spicules on the central, palmar surfaces</p> Signup and view all the answers

    Which phenomenon is observed in approximately 12% of cases of generalized lichen nitidus?

    <p>Koebner phenomenon</p> Signup and view all the answers

    What is a potential site of involvement that is less common for lichen nitidus?

    <p>Nails</p> Signup and view all the answers

    In which age group is palmoplantar involvement more common?

    <p>Older individuals</p> Signup and view all the answers

    What is a common location for hemorrhagic-purpuric lesions in actinic lichen nitidus?

    <p>Palms and distal extremities</p> Signup and view all the answers

    In which individuals does actinic lichen nitidus appear most commonly?

    <p>Dark-skinned individuals in areas of significant sun exposure</p> Signup and view all the answers

    What is a distinguishing feature of actinic lichen nitidus compared to other frictional lichenoid eruptions?

    <p>Histologic features of lichen nitidus</p> Signup and view all the answers

    What is the usual symptom presentation of lichen nitidus?

    <p>Usually asymptomatic with pruritus present in approximately 12% of cases</p> Signup and view all the answers

    What is the classic histologic pattern seen in 90% of lichen nitidus cases?

    <p>The &quot;ball and claw&quot; pattern with involvement of up to three dermal papillae</p> Signup and view all the answers

    What is the role of Langerhans cells in the majority of lichen nitidus cases?

    <p>They are S100+ and CD1+ cells</p> Signup and view all the answers

    What distinguishes actinic lichen nitidus from other frictional lichenoid eruptions?

    <p>Presence of transepidermal elimination of the inflammatory infiltrate</p> Signup and view all the answers

    What is a rare feature observed in about 10% of lichen nitidus cases?

    <p>Dyskeratotic cells and clefting at the dermal–epidermal junction</p> Signup and view all the answers

    Where are predilection sites for hemorrhagic-purpuric lesions in actinic lichen nitidus?

    <p>Lower limbs and feet</p> Signup and view all the answers

    What is a distinguishing feature of palmar lichen nitidus compared to lichen planus?

    <p>&quot;Ball and claw&quot; pattern in histologic examination</p> Signup and view all the answers

    What is the typical duration of lichen nitidus in two thirds of patients?

    <p>1 year</p> Signup and view all the answers

    Which of the following is a first-line treatment for lichen nitidus on the body?

    <p>Tacrolimus ointment</p> Signup and view all the answers

    What type of lesions develop as older lesions of lichen nitidus resolve?

    <p>New lesions</p> Signup and view all the answers

    For which subtype of lichen nitidus is acitretin a potential therapy?

    <p>Palmar disease</p> Signup and view all the answers

    What is the first-line systemic agent for pruritus in lichen nitidus?

    <p>Oral antihistamines</p> Signup and view all the answers

    Which medication has largely supplanted PUVA for generalized lichen nitidus?

    <p>Narrowband ultraviolet B</p> Signup and view all the answers

    What should be considered when deciding on systemic treatments for lichen nitidus?

    <p>Potential harm of treatment</p> Signup and view all the answers

    What type of disease warrants treatment in lichen nitidus?

    <p>Symptomatic and cosmetically disfiguring disease</p> Signup and view all the answers

    Which therapy is most successful when combined with skin-directed therapies such as topical steroids or phototherapy?

    <p>Oral glucocorticoids</p> Signup and view all the answers

    What is a rarely indicated systemic treatment for lichen nitidus?

    <p>Prednisone</p> Signup and view all the answers

    Which condition may lead to T-helper type 2 (Th2) cell polarization in lichen nitidus?

    <p>Atopic dermatitis</p> Signup and view all the answers

    What has been reported about the genetic factors of lichen nitidus?

    <p>No significant genetic association reported</p> Signup and view all the answers

    What is the classic histologic pattern seen in 90% of lichen nitidus cases?

    <p>Lymphocyte, histiocytes, and foreign body or Touton-type giant cells forming a “ball and claw” pattern</p> Signup and view all the answers

    Which cells predominate in the infiltrate of lichen nitidus cases?

    <p>T lymphocytes (CD4+ cells over CD8+)</p> Signup and view all the answers

    What may be seen with clinical variants of lichen nitidus, such as palmar lesions?

    <p>Parakeratotic plug</p> Signup and view all the answers

    In actinic lichen nitidus, where are purpuric or hemorrhagic lesions associated with capillary wall degeneration and red blood cell extravasation most likely to occur?

    <p>Areas of maximal sun exposure</p> Signup and view all the answers

    What type of cells have been reported to predominate in the infiltrate of lichen nitidus?

    <p>T lymphocytes (CD4+ cells over CD8+)</p> Signup and view all the answers

    Which features may be rarely observed in lichen nitidus cases?

    <p>Colloid bodies</p> Signup and view all the answers

    What is the typical duration of lichen nitidus in two thirds of patients?

    <p>Less than 1 year</p> Signup and view all the answers

    What is the first-line topical treatment for lichen nitidus?

    <p>Topical corticosteroids</p> Signup and view all the answers

    What is the first-line systemic agent for pruritus in lichen nitidus?

    <p>Diphenhydramine</p> Signup and view all the answers

    Which systemic therapy is rarely indicated in lichen nitidus and should be reserved for more symptomatic and cosmetically disfiguring disease?

    <p>Cyclosporine</p> Signup and view all the answers

    What medication may hasten resolution of more extensive, generalized, or symptomatic lichen nitidus?

    <p>$0.3 mg/kg$ prednisone</p> Signup and view all the answers

    Which therapy has largely supplanted PUVA for generalized lichen nitidus?

    <p>Narrowband ultraviolet B</p> Signup and view all the answers

    For which subtype of lichen nitidus is acitretin a potential therapy?

    <p>$ ext{Hyperkeratotic palmar disease}$</p> Signup and view all the answers

    What is a distinguishing feature of palmar lichen nitidus compared to lichen planus?

    <p>$ ext{Pruritus}$</p> Signup and view all the answers

    What is a potential site of involvement that is less common for lichen nitidus?

    <p>Face</p> Signup and view all the answers

    What should be considered when deciding on systemic treatments for lichen nitidus?

    <p>Potential harm of treatment vs. the relatively benign nature of lichen nitidus.</p> Signup and view all the answers

    What is the role of Langerhans cells in the majority of lichen nitidus cases?

    <p>Causing granuloma formation.</p> Signup and view all the answers

    What cells predominate in the infiltrate of lichen nitidus cases?

    <p>T lymphocytes</p> Signup and view all the answers

    In lichen nitidus, what is the distinguishing feature of palmar lesions?

    <p>Deep parakeratotic plug</p> Signup and view all the answers

    Which type of lesions are associated with capillary wall degeneration and red blood cell extravasation in lichen nitidus?

    <p>Purpuric or hemorrhagic lesions</p> Signup and view all the answers

    What is the classic histologic pattern seen in 90% of lichen nitidus cases?

    <p>&quot;Ball and claw&quot; pattern</p> Signup and view all the answers

    What is rarely seen in lichen nitidus cases, with only about 10% of cases showing this feature?

    <p>Colloid bodies</p> Signup and view all the answers

    Where do perforating lesions tend to occur in lichen nitidus?

    <p>Areas of friction</p> Signup and view all the answers

    What is the typical duration of lichen nitidus in two thirds of patients?

    <p>1 year</p> Signup and view all the answers

    What is the first-line topical treatment for lichen nitidus?

    <p>Mid- to high-potency topical corticosteroids</p> Signup and view all the answers

    Which therapy has largely supplanted PUVA for generalized lichen nitidus?

    <p>Narrowband ultraviolet B</p> Signup and view all the answers

    Which systemic therapy is rarely indicated in lichen nitidus and should be reserved for more symptomatic and cosmetically disfiguring disease?

    <p>Low-dose oral glucocorticoids</p> Signup and view all the answers

    What type of cells have been reported to predominate in the infiltrate of lichen nitidus cases?

    <p>Lymphocytes</p> Signup and view all the answers

    What type of disease warrants treatment in lichen nitidus?

    <p>More symptomatic and cosmetically disfiguring disease</p> Signup and view all the answers

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