A 6-Year-Old Girl with Papules on Her Abdomen

Differential Diagnosis

• Keratosis pilaris
• Lichen nitidus
• Lichen planus
• Atopic dermatitis

Diagnosis

This patient was diagnosed with lichen nitidus, a rare, benign, chronic, cutaneous eruption characterized by the presence of small, discrete, uniform, often skin-colored or glistening papules that present in clusters or linear arrays. It most commonly affects children and young adults, although it can be found in patients of any age.

Learnings/What to Look for

• Lichen nitidus may be generalized or focal, but it is commonly found on the chest, abdomen, flexor surfaces of the upper extremities, dorsal hands, and anogenital region (including the shaft and glans of the penis)
• Patients may complain of pruritus over affected areas, although these micropapules are typically asymptomatic
• It is typically not associated with laboratory abnormalities
• While the etiology of lichen nitidus is inflammatory, the cause is unknown
• Medication-related cases (following administration of nivolumab, tremelimumab, mogamulizumab, and interferon alpha) and familial forms have been reported
  
  

Pearls for Urgent Care Management

• Lichen nitidus is chronic and persistent, but most patients ultimately clear spontaneously over the course of several months without residual skin changes or medical complications

Acknowledgment: Image and case presented by VisualDx (www.VisualDx.com/JUCM).