Generalized Lichen Nitidus Successfully Treated with Cyclosporine
Year: 2025
Type: article
Abstract: Dear Editor, Lichen nitidus (LN) is a chronic inflammatory skin disease of unknown etiology, characterized by multiple, discrete, 1–2-mm, skin-colored papules with flat, shiny surfaces, commonly occurring on the flexor surface of the upper limbs, genitalia, chest, abdomen, and dorsum of the hands.[1] Children and young adults are primarily affected. Pruritus, usually minimal or absent in localized forms, may be prominent in the generalized variety.[2] The histology shows a dense, sharply circumscribed infiltrate composed of lymphocytes, epithelioid cells, and Langhans giant cells in a typical “ball-in-claw” configuration. LN variants include the linear, spinous, follicular, generalized, actinic, and perforating types.[3] We report a case of generalized lichen nitidus in a 15-year-old boy, successfully treated with cyclosporine. A 15-year-old boy presented with itchy, generalized, shiny, tiny papules for the last 4 years. The lesions first appeared on the neck and progressed to involve the other body parts, including face within 3–4 months. The lesions were associated with moderate pruritus. Cutaneous examination revealed generalized, discrete shiny 1–2 mm papules on the trunk, extremities, abdomen, genitalia, and face [Figure 1a and 1b]. Koebnerisation was noted on the trunk. Nails showed longitudinal striations and ridging. There was no mucosal involvement. Patient’s general health was good. Histopathology showed circumscribed, lymphohistiocytic infiltrate in the papillary dermis, consistent with a diagnosis of lichen nitidus [Figure 2]. Based on clinical examination and histopathological findings, a diagnosis of lichen nitidus, generalized variety, was considered.Figure 1: (a) Generalized, discrete shiny 1-2 mm sized papules on the face, trunk, extremities, and abdomen. (b) Shiny papules on entire backFigure 2: Histopathology showed circumscribed, lymphohistiocytic cellular infiltrate in the papillary dermis (H and E, 100X)Owing to the generalized nature of the disease, the patient was given oral prednisolone 20 mg daily for 2 weeks, along with a moisturizer and antihistamine (tab levocetirizine 5 mg at night time). Partial improvement was seen in skin lesions and itching. However, recurrence of the lesions was observed after withdrawal of oral steroid. Oral cyclosporine (4 mg/kg/day) was then initiated. The patient responded well, with complete improvement in itching and resolution of skin lesions in a month [Figure 3a and 3b]. The patient has remained in remission with cyclosporine dose of 2 mg/kg/day for the past 2 months.Figure 3: (a) Complete disappearance of lesions with post-inflammatory hypopigmentation on the face, extremities and trunk. (b) Resolution of lesions on the backLichen nitidus is generally asymptomatic and self-limiting and usually does not require any treatment. Topical steroids and calcineurin inhibitors have been used in localized forms. The generalized variety of lichen nitidus is quite rare and is usually associated with pruritus, requiring treatment to alleviate itching and for cosmetic reasons. The treatment of generalized LN is challenging. Narrow band ultraviolet therapy (NBUVB), psoralen and ultraviolet A therapy (PUVA), acitretin, and cyclosporine have been used with variable success.[2] Cyclosporine is a well-known immunosuppressive drug that has been proven effective in the treatment of autoimmune diseases of the skin, such as psoriasis, alopecia areata, and autoimmune bullous diseases. We found only 3 previous reports of generalized lichen nitidus successfully treated with cyclosporine in the English literature [Table 1].[4-6] We used cyclosporine (4 mg/kg/day initial dose) in our case with an excellent response in a month. Cyclosporine can be a promising therapeutic option for a fast resolution of skin lesions and control of associated pruritus in patients with generalized involvement.Table 1: Studies on cyclosporine in generalized lichen nitidusDeclaration of patient consent The authors certify that they have obtained all appropriate parent consent forms. In the form a parent has given their consent for his images and other clinical information to be reported in the journal. The parent understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Use of artificial intelligence (AI) The preparation of this manuscript was carried out entirely by the authors without the use of artificial intelligence technologies.
Authors: Laxman Kumar, Lalit Kumar Gupta, Manisha Balai, Nirmal Chouhan
Institution: Rabindranath Tagore Medical College
Language: English
Subfield: Dermatology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4414084159