An unusual variant of lichen nitidus: Generalized follicular spinous with perifollicular granulomas

Abstract

Several unusual variants of lichen nitidus are described in the literature. Spinous follicular lichen nitidus with perifollicular granulomas is one such variant characterized by generalized follicular as well as nonfollicular keratotic papules, which show perifollicular granulomas on histopathology as well as a lichenoid granulomatous tissue reaction typical of lichen nitidus. Owing to its atypical clinical and histopathologic manifestations, it raises several clinical possibilities and can be a diagnostic challenge. We report this rare variant of lichen nitidus in a 19‐year‐old female, and discuss its clinical and histopathological differential diagnosis.

Generalized Purpuric Lichen Nitidus in a 32-Year-Old Filipino Male with Acute Myeloid Leukemia: Case Report

“…She was later managed with oral prednisolone and dapsone, which resulted in significant clearance of skin lesions. 20 The use of natural sunlight therapy for lichen nitidus was reported in a six-year-old male patient by Berman, Truong, and Cheng in 2019. He was previously managed with topical corticosteroids for several months without any improvement.…”

A very rare localization of a rare disease: palmar lichen nitidus

“…1 The most commonly involved sites are flexor areas of upper extremities, hand dorsums, trunk, and genitalia. 2 LN located solely at palms presenting as hyperkeratotic pitted papules and plaques have been rarely reported. 3 It is hard to make a diagnosis of palmar LN when there are no lesions elsewhere on the body.…”

“…The histopathological main features of LN are well-circumscribed infiltration of lymphocytes, macrophages, Langerhans giant cells, and multinucleated epithelioid histiocytes in the papillary dermis surrounded by the elongated epidermal rete ridges. 1 , 2 This subepidermally located lymphohistiocytic infiltrate surrounded by acanthosis, the parakeratotic epidermis is the so-called “ball-in-clutch” or “ball-in-claw” appearance. 5 There were similar histopathological findings in the case here reported.…”

Adnexotropic Variants of the Interface Dermatitides: A Review

“…In addition, a specific clinical variant of LN has been described whereby the papules had a spinous follicular appearance. On histopathology, in addition to the classical LN findings, a granulomatous infiltrate around hair follicles was noted [20][21][22]. The presence of these perifollicular granulomas led authors to emphasize that this clinical variant may be misread as lichen scrofulosorum [20].…”