Indian Journal of Pathology and Microbiology

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Year
: 2010  |  Volume : 53  |  Issue : 1  |  Page : 162--163

Perforating lichen nitidus


B Vijaya, Sunila, GV Manjunath 
 JSS Medical College, Mysore, Karnataka-570 011, India

Correspondence Address:
B Vijaya
JSS Medical College, Mysore, Karnataka-570 011
India




How to cite this article:
Vijaya B, Sunila, Manjunath G V. Perforating lichen nitidus.Indian J Pathol Microbiol 2010;53:162-163


How to cite this URL:
Vijaya B, Sunila, Manjunath G V. Perforating lichen nitidus. Indian J Pathol Microbiol [serial online] 2010 [cited 2021 Jan 26 ];53:162-163
Available from: https://www.ijpmonline.org/text.asp?2010/53/1/162/59215


Full Text

 Introduction



Lichen nitidus is an uncommon, usually asymptomatic chronic eruption characterized by the presence of multiple, small, flesh colored papules two to three mm in diameter. [1] Perforation in lichen nitidus is a rare phenomenon. The lesions frequently appear as a localized eruption affecting predominantly the upper extremities, chest, abdomen and genitalia of children and young adult males. Histopathological examination of the papule shows a dense well circumscribed sub epidermal infiltrate sharply delimited to one or two adjacent dermal papillae. Claw like acanthotic rete ridges which appear to grasp the infiltrate are present. Perforation in lichen nitidus is a rare phenomenon. [2],[3],[4],[5]

 Case Report



A 14-year-old adolescent female presented with asymptomatic lesions over the dorsum of the hand and feet since six months. There was no associated pain or itching in the lesions. Clinical examination showed lichenoid, skin colored, shiny papules over the right index finger, knuckles and dorsum of the feet. A skin biopsy of the papule from right index finger with umbilication was performed.

Histopathologic examination revealed a dense well circumscribed infiltrate in the papillary dermis composed of lymphocytes and histiocytes. Acanthotic rete ridges partially encircling the infiltrate were observed. These features were diagnostic of lichen nitidus. A transepidermal perforation channel in direct contact with the surface was observed. The perforation channel showed eosinophilic material admixed with sparse inflammatory cells. [Figure 1]

Above the perforation there was a thin layer of degenerated keratinocytes with overlying thin orthokeratotic layer. The adjacent epidermis showed hyperkeratosis and hypergranulosis. The adjacent papilla also showed lymphohistiocytic infiltrate. However, no well defined epitheliod cells or langhans type of giant cells were seen. No foreign material was seen amidst the infiltrate by polaroscopic examination.

 Discussion



Very few cases of lichen nitidus with perforation has been reported in English literature. For the first time, Bardach [2] observed transepidermal elimination in a case of generalized lichen nitidus. Later a few more cases were reported. [3],[4],[5] The papules which display perforation histologically may or may not show central dimpling on gross observation. [4],[5] This case showed an umbilicated papule which was also observed in the case reported by Tae. [5] The underlying infiltrate perforating the epidermis has been observed in earlier reported cases. In the present case perforation channel contained eosinophilic material admixed with inflammatory infiltrate. Overlying the perforation channel, a thin atrophic layer of keratinocytes was seen with orthokeratosis. Itami et al. [4] reported a case of perforation in lichen nitidus in which the perforating channel was in direct contact with the surface and contained amorphous material with cell nuclei.

Perforation is a nonspecific cutaneous reaction pattern occurring in the course of many unrelated disorders. Apart from primary perforating disorders which include Kyrle's disease, reactive perforating collagenoses, elastosis perforans serpiginosa and perforating folliculitis there are many other unrelated disorders which may show secondary transepithelial perforation. Secondary perforation has been observed in granuloma annulare, calcinosis cutis, and chondrodermatitis nodular helices, lichen nitidus and so on. When he described the first case of lichen nitidus with perforation, Bardach [2] put forth a hypothesis that any disturbance in dermoepidermal interaction with alterations of epidermal cell kinetics is an explanation for this rare phenomenon of transepithelial perforation. The perforation in the present case could possibly be due to transepithelial elimination of the eosinophilic material admixed with inflammatory cells. Polaroscopic examination may help to rule out any possibility of the presence of foreign material which could have initiated the perforation. The distinctive histopathological feature of perforation in lichen nitidus substantiates its inclusion in secondary perforating dermatoses. Lichen nitidus is an uncommon, usually asymptomatic chronic eruption characterized by the presence of multiple, small, flesh colored papules two to three mm in diameter. [1] Perforation in lichen nitidus is a rare phenomenon. The lesions frequently appear as a localized eruption affecting predominantly the upper extremities, chest, abdomen and genitalia of children and young adult males. Histopathological examination of the papule shows a dense well circumscribed sub epidermal infiltrate sharply delimited to one or two adjacent dermal papillae. Claw like acanthotic rete ridges which appear to grasp the infiltrate are present. Perforation in lichen nitidus is a rare phenomenon. [2],[3],[4],[5]

A 14-year-old adolescent female presented with asymptomatic lesions over the dorsum of the hand and feet since six months. There was no associated pain or itching in the lesions. Clinical examination showed lichenoid, skin colored, shiny papules over the right index finger, knuckles and dorsum of the feet. A skin biopsy of the papule from right index finger with umbilication was performed.

Histopathologic examination revealed a dense well circumscribed infiltrate in the papillary dermis composed of lymphocytes and histiocytes. Acanthotic rete ridges partially encircling the infiltrate were observed. These features were diagnostic of lichen nitidus. A transepidermal perforation channel in direct contact with the surface was observed. The perforation channel showed eosinophilic material admixed with sparse inflammatory cells. [Figure 1]

Above the perforation there was a thin layer of degenerated keratinocytes with overlying thin orthokeratotic layer. The adjacent epidermis showed hyperkeratosis and hypergranulosis. The adjacent papilla also showed lymphohistiocytic infiltrate. However, no well defined epitheliod cells or langhans type of giant cells were seen. No foreign material was seen amidst the infiltrate by polaroscopic examination.

Very few cases of lichen nitidus with perforation has been reported in English literature. For the first time, Bardach [2] observed transepidermal elimination in a case of generalized lichen nitidus. Later a few more cases were reported. [3],[4],[5] The papules which display perforation histologically may or may not show central dimpling on gross observation. [4],[5] This case showed an umbilicated papule which was also observed in the case reported by Tae. [5] The underlying infiltrate perforating the epidermis has been observed in earlier reported cases. In the present case perforation channel contained eosinophilic material admixed with inflammatory infiltrate. Overlying the perforation channel, a thin atrophic layer of keratinocytes was seen with orthokeratosis. Itami et al. [4] reported a case of perforation in lichen nitidus in which the perforating channel was in direct contact with the surface and contained amorphous material with cell nuclei.

Perforation is a nonspecific cutaneous reaction pattern occurring in the course of many unrelated disorders. Apart from primary perforating disorders which include Kyrle's disease, reactive perforating collagenoses, elastosis perforans serpiginosa and perforating folliculitis there are many other unrelated disorders which may show secondary transepithelial perforation. Secondary perforation has been observed in granuloma annulare, calcinosis cutis, and chondrodermatitis nodular helices, lichen nitidus and so on. When he described the first case of lichen nitidus with perforation, Bardach [ 2] put forth a hypothesis that any disturbance in dermoepidermal interaction with alterations of epidermal cell kinetics is an explanation for this rare phenomenon of transepithelial perforation. The perforation in the present case could possibly be due to transepithelial elimination of the eosinophilic material admixed with inflammatory cells. Polaroscopic examination may help to rule out any possibility of the presence of foreign material which could have initiated the perforation. The distinctive histopathological feature of perforation in lichen nitidus substantiates its inclusion in secondary perforating dermatoses.

References

1Lapins NA, Willoughby C, Helwig EB. Lichen nitidus. A study of forty three cases. Cutis 1978;21:634-7.
2Bardach H. Perforating lichen nitidus. J Cutaneous Pathology 1981;8:111-6.
3Banse-kupin l, Morales A, Kleinsmith D A. perforating lichen nitidus. J Am Acad Dermatol 1983;9:452-6.
4Itami A, Ando I, Kukita A. Perforating lichen nitidus. Int J Dermatol 1994;33:382-4.
5Tae Young Yoon, June Woo KIM, Mi Kyeong KIM. Two cases of perforating lichen nitidus. The journal of Dermatology 2006;33:278-80.