Lichen nitidus with koebnerization

A 10-year-old girl presented with multiple slightly pruritic lesions over upper limbs, neck, and trunk. On examination, there were multiple shiny flat-topped hypopigmented to mildly violaceous papules few present in linear pattern exhibiting Koebner phenomenon (black arrow) distributed over above mentioned sites [Figure 1]. Dermoscopy [Figure 2] demonstrates multiple, white, and well-defined circular areas (black arrow) with whitish scales (yellow arrow) along with central brown shadow (red arrow) within white circular areas which are a dermoscopic marker and alleviate the need for biopsy in children.

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Figure 1:

Multiple shiny flat-topped hypopigmented to mildly violaceous papules few present in linear pattern exhibiting Koebner (black arrow) phenomenon over upper limbs, trunk, and neck.

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Figure 2:

Dermoscopy (DermLite DL4; 3Gen; San Juan Capistrano, California, USA, noncontact polarized mode, ×10 magnification) showed multiple, white, and well-circular areas (black arrow) with whitish scales (yellow arrow), along with central brown shadow (red arrow) within white circular areas.

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Lichen nitidus is a benign skin condition characterized by the presence of tiny, flat-topped, and skin-colored papules.^[1] Typical histology includes “claw and ball appearance.”^[1] The differential diagnosis for this condition includes lichen planus, verruca, lichen spinulosus and phrynoderma, and keratosis pilaris.^[2]

Treatment options include topical corticosteroids; topical calcineurin inhibitors may be prescribed to reduce inflammation and itching. Phototherapy and oral medications such as steroids, acitretin, low-dose cyclosporine, and itraconazole may also be considered in more severe or widespread cases.^[2]