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BACKGROUND: Facial papules are a feature of several clinical conditions and may present both diagnostic and therapeutic challenges. AIM: To describe a grouped papular eruption on the nose and adjoining cheeks that has not been well characterized previously. MATERIALS AND METHODS: A series of consecutive patients with a papular eruption predominantly involving nose and cheeks were evaluated, treated and followed up prospectively at tertiary care centers. Demographic details, clinical features, histopathology and response to treatment were recorded. RESULTS: There were five men and six women (mean age 29.9 ± 6.9 years) who had disease for a mean duration of 17.3 ± 11.1 months. All patients presented with a predominantly asymptomatic eruption of monomorphic, pseudovesicular, grouped, skin colored to slightly erythematous papules prominently involving the tip of nose, nasal alae, philtrum and the adjoining cheeks. A total of 15 biopsies from 11 patients were analyzed and the predominant finding was a dense, focal lymphoid infiltrate restricted to the upper dermis with basal cell damage and atrophy of the overlying epidermis. The eruption ran a chronic course from several months to years. LIMITATIONS: Direct immunofluorescence could not be performed except in one case. Immunohistochemical stains for CD4 and CD8 could not be done owing to nonavailability. Phototesting was undertaken in one patient only. CONCLUSION: Small grouped papules on the nose and adjoining skin with a lichenoid histopathology appear to represent a distinct clinicopathological entity. It may be related to actinic lichen nitidus/micropapular variant of polymorphous light eruption.

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Lichen nitidus is a benign inflammatory dermatosis that typically presents in a localized distribution. We present the rare case of a 6-year-old boy with a 1-year history of generalized lichen nitidus with limited access to narrowband ultraviolet B phototherapy. Over the course of a summer, he had complete and lasting resolution of generalized lichen nitidus after daily natural sunlight exposure. This case demonstrates a rare variant of lichen nitidus and a practical treatment alternative to in-office phototherapy.

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Lichen nitidus is a rare, chronic dermatosis which occurs more often in children than in adults. It presents with tiny, monomorphous, lichenoid, mostly asymptomatic papules in regional or disseminated distribution which show a pathognomonic histological pattern. The pathogenesis is unclear; however, immunologic phenomena and genetic factors are under discussion. In rare cases, an association with other dermatoses and systemic diseases has been described. Moreover, medical treatments have been incriminated as triggers. Considering the self-limited course in mostly young patients, treatment must be thoroughly weighed. Possible therapeutic options include topical corticosteroids and calcineurin inhibitors as well as oral antihistamines, corticosteroids and narrow-band ultraviolet B phototherapy. Lichen striatus is an acquired, usually asymptomatic dermatosis occurring mostly in preschool children. The characteristic feature is the arrangement of small, flat, light red- to skin-colored papules along the lines of Blaschko. Therefore, a postzygotic mutation of epidermal progenitor cells induced to express new surface antigens by trigger factors as infections, vaccinations or trauma with consecutive immune reaction is assumed. Nail involvement of the affected limb can rarely occur. Lichen striatus usually heals without scarring within several months, so that therapies with severe side effects are obsolete. Mild topical corticosteroids or calcineurin inhibitors may be used, especially if patients exceptionally suffer from pruritus. A postinflammatory hypopigmentation can persist for months to years.

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Lichenoid dermatoses, a group of inflammatory skin conditions with characteristic clinical and histopathologic findings, range from common to rare. Classic lichen planus typically presents as pruritic, polygonal, violaceous flat-topped papules and plaques; many variants in morphology and location also exist. Other lichenoid dermatoses share similar clinical presentations and histopathologic findings. These include lichenoid drug eruption, lichen planus-like keratosis, lichen striatus, lichen nitidus, and keratosis lichenoides chronica. Epidemiologic characteristics vary among each lichenoid disorder. While classic lichen planus is considered a disease of adults, other lichenoid dermatoses may be more common in younger populations. The literature contains an array of reports on the variations in presentation and successful management of lichen planus and lichenoid dermatoses among diverse populations. Familiarity with the characteristics of each lichenoid dermatosis, rare or common within each patient population, is key to accomplishing timely recognition and effective management.

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Transepidermal elimination and/or perforation of the epidermis is seen in a variety of conditions but has only rarely been reported in association with lichen nitidus. We describe a case of lichen nitidus with the unique finding of epidermal perforation, a feature that made the usual straightforward diagnosis of lichen nitidus much more difficult.

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Lichen nitidus (LN) is a rare skin disorder presenting with multiple, small and bright papules located on the chest, abdomen, penis glans and upper extremities. It usually presents with limited involvement; however, it can present as generalized involvement. There is no consensus on treatment. Corticosteroid, astemizole, phototherapy has been used; however, the results are controversial. A 15-year-old male with clinical and histopathological diagnosis of LN was treated with narrow-band ultraviolet B (NB-UVB). The lesions completely regressed with post-inflammatory hypopigmentation on the second month of the therapy (25 sessions). We believe that NB-UVB is an effective treatment on generalized LN.

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El liquen nitidus es una dermatosis de origen desconocido caracterizada por pequeñas pápulas brillantes, color piel normal, del tamaño de la cabeza de un alfiler, asintomáticas o ligeramente pruriginosas, que se localizan principalmente en antebrazos,abdomen, glúteos y genitales. Presentamos dos casos, uno de ellos generalizado. En ambos pacientes se indicaron corticoides tópicos y emolientes; con buena respuesta.Se realiza una revisión de esta patología y sus posibilidades terapéuticas

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El liquen nitidus es una dermatosis de origen desconocido caracterizada por pequeñas pápulas brillantes, color piel normal, del tamaño de la cabeza de un alfiler, asintomáticas o ligeramente pruriginosas, que se localizan principalmente en antebrazos,abdomen, glúteos y genitales. Presentamos dos casos, uno de ellos generalizado. En ambos pacientes se indicaron corticoides tópicos y emolientes; con buena respuesta.Se realiza una revisión de esta patología y sus posibilidades terapéuticas (AU)

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El liquen nitidus es una dermatosis de origen desconocido caracterizada por pequeñas pápulas brillantes, color piel normal, del tamaño de la cabeza de un alfiler, asintomáticas o ligeramente pruriginosas, que se localizan principalmente en antebrazos,abdomen, glúteos y genitales. Presentamos dos casos, uno de ellos generalizado. En ambos pacientes se indicaron corticoides tópicos y emolientes; con buena respuesta.Se realiza una revisión de esta patología y sus posibilidades terapéuticas (AU)

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We report a 38-year-old man who presented with a generalized papular eruption that was clinically and histologically consistent with lichen nitidus. This patient's condition had been persistent for approximately 1 year; however, soon after assuming employment that entailed significant, regular sun exposure, the patient noted marked clearing of his lesions in sun-exposed areas. This case corroborates previous reports that suggest that generalized lichen nitidus can be successfully managed with ultraviolet light therapy.

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El liquen nitidus fue descrito por Pinkus en 1907.Se caracteriza por múltiples y pequeñas pápulas de 1-2 mm, rosadas que afectan habitualmente brazos, pene, tórax, abdomen. Las lesiones son asintomáticas o ligeramente pruriginosas y la asociación con enfermedades sistémicas es rara.La relación con el liquen plano aún es controvertida. La biopsia cutánea muestra un infiltrado linfohistiocitario bien delimitado en dermis papilar que se encuentra rodeado por elongación de crestas epidérmicas. Los tratamientos son variables e incluyen el uso de UVA-UVB, retinoides, corticosteroides, antihistamínicos, ciclosporina. Presentamos tres casos, dos diseminados y con lesiones queratodérmicas palmares, que tenían características clínicas e histológicas de liquen nitidus (AU)

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