Epidemiology and Characteristics of Lichen Nitidus

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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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