Lichen nitidus unusual site and atypical morphology

An 11-year-old boy presented with asymptomatic lesions on the right sole for 3 months. There was no preceding trauma. There was a negative history of topical application. On examination, there were multiple discrete and confluent hyperpigmented and skin-colored pin-point papules with pits on the plantar crease extending from the medial aspect of the right plantar region to the midline just below the forefoot [Figure 1]. Pitted keratolysis and plantar punctuate warts were the differentials considered. Skin biopsy from the plantar lesion revealed a mononuclear infiltrate just below the epidermis with the rete pegs “clutching” the infiltrate resembling a “claw clutching a ball,” diagnostic of lichen nitidus [Figure 2]. The patient was treated with clobetasol–salicylic acid ointment (3%), and the lesions resolved. Rare presentations of lichen nitidus are involvement of the palms and soles, generalized lesions, linear, Blaschkoid pattern, hemorrhagic, purpuric, and mucosal involvement. We are reporting one more morphology – pits. The thick stratum corneum and pressure effect on the plantar region due to shearing forces may cause the typical morphology of dermatosis to be modified in the plantar region.^[1]

Close

Figure 1:

Multiple discrete and confluent hyperpigmented papules and pits on plantar region.

Export to PPT

Close

Figure 2:

Skin biopsy showing hyperkeratosis, irregular acanthosis with rete pegs “clutching” mononuclear infiltrate in the upper dermis, H and E × 100.

Export to PPT