Clinical Images  |   October 2019
Lichen Nitidus
Author Notes
  • From the Naval Medical Center San Diego in California (Drs Jordan, Green, and Sulit) and the Uniformed Services University of the Health Sciences School of Medicine in San Diego (Dr Sulit). Dr Jordan is a first-year resident, and Dr Green is a dermatopathology fellow. Disclaimer: The views expressed herein are those of the authors and do not necessarily reflect the official policy or position of the Department of the United States Navy, the Department of Defense, or the US Government. 
  • Financial Disclosures: None reported. 
  • Support: None reported. 
  •  *Address correspondence to Alys S. Jordan, DO, 34800 Bob Wilson Dr, San Diego, CA 92134-1098. Email:
Article Information
Emergency Medicine / Imaging / Clinical Images
Clinical Images   |   October 2019
Lichen Nitidus
The Journal of the American Osteopathic Association, October 2019, Vol. 119, 704. doi:
The Journal of the American Osteopathic Association, October 2019, Vol. 119, 704. doi:
A 25-year-old man presented with a 5-year history of small asymptomatic bumps on his extremities and trunk. He denied any oral lesions or nail changes. Examination revealed multiple 1- to 2-mm monomorphic, hypopigmented, shiny papules symmetrically distributed on the neck, trunk, elbows, hands (image A and image B), popliteal fossae, dorsal feet, and ankles. A 4-mm punch biopsy found a “ball” of lichenoid and granulomatous inflammation with occasional giant cells in the papillary dermis, cupped laterally by “claw-like” extensions of acanthotic epidermal rete, consistent with lichen nitidus. 
Lichen nitidus typically presents as multiple, flesh-colored, tiny, shiny papules found on flexor surfaces of the upper extremities, genitalia, and anterior trunk.1,2 Similar to lichen planus and psoriasis, lichen nitidus can develop in areas of trauma to the skin, which is known as the Koebner phenomenon.3 The diagnosis of lichen nitidus is usually clinical, but a punch biopsy of a representative papule should be performed if the diagnosis is in question or if there is a lack of response to empiric treatments. Lichen nitidus typically self-resolves after a few months to a year. However, if the lesions persist or are symptomatic, treatment options are aimed at reducing associated inflammation.4,5 
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