Generalized Lichen Nitidus Successfully Treated with Narrow-band UVB Phototherapy : Two Cases Report

Abstract

Lichen nitidus (LN) is an uncommon chronic inflammatory skin disease composed of numerous, tiny, shiny, flesh-colored papules that are predominantly observed on the chest, abdomen, glans penis and upper extremities. The distribution of LN is most often localized, but in some cases it can become generalized. Because LN tends to be asymptomatic and presents spontaneous resolution within several years, it usually does not require treatment except in symptomatic, persistent and generalized cases. We describe a 28-yr-old man and a 7-yr-old boy with generalized LN where both cases improved with narrow-band ultraviolet B (NB-UVB) phototherapy plus topical steroid ointment. Both patients noted improvement within the first three treatments and showed almost complete resolution after 18 and 20 treatments, respectively. NB-UVB phototherapy may be an effective alternative therapy for the treatment of generalized LN, even for those patients in their childhood.

Pediatric generalized lichen nitidus treated with natural sunlight therapy

“…Published reports on pediatric GLN describe multiple treatment approaches but do not demonstrate a clear consensus on a standard treatment strategy. Successful treatments described include NB‐UVB phototherapy with or without topical steroids, topical calcineurin inhibitors, acitretin, and isolated instances of success with isotretinoin, isoniazid, or biscoclaurine alkaloids with jumi‐haidoku‐to (an alternative herbal detoxifying agent) …”

“…Of the reported pediatric cases, five were successfully treated with narrowband phototherapy, one of which additionally included topical steroids, demonstrating some promise in this treatment regimen . There are also a few reports of both pediatric and adult cases of GLN where treatment involved natural sunlight, including a 19‐year‐old girl who experienced improvement of symptoms using corticosteroids and moderate sun exposure and one report of a 6‐year‐old patient with a multiyear history of LN, which went into remission after summer sun exposure .…”

Generalized lichen nitidus: Successful treatment with systemic isotretinoin

“…[3] Medical treatment should be considered if the lesions are persistent and diffuse or if they cause itching or cosmetic discomfort in the patient. Topical and systemic steroids, ultraviolet A and B treatment, and immunotherapy with dinitrochlorobenzene or dinitrocyclopropenon are currently being used to combat this disease along with agents such as retinoids, selective H1 antagonist, itraconazole, and isoniazid.…”

Phototherapy and photochemotherapy in childhood dermatoses

“…Mycosis fungoides (topical PUVA) [17] Lymphomatoid papulosis (bath PUVA) [18] Keratosis lichenoides chronica (bath PUVA) [19] Vitiligo (bath PUVA) [20] Urticaria pigmentosa/systemic mastocytosis [21] Generalized Schamberg's disease [22] Generalized granuloma annulare (bath PUVA) [23] Pansclerotic morphea (UVA) [24] Pansclerotic morphea [25,26] Cutaneous graft versus host disease (bath PUVA) [27] Palmoplantar keratoderma (bath PUVA) [28] Atopic dermatitis [29] BBUVB Psoriasis [16,30] Atopic dermatitis [16] Pityriasis lichenoides chronica [16] NBUVB Vitiligo [31,32] Psoriasis [33,34] Atopic dermatitis [33] Mycosis fungoides [35] Keratosis lichenoides chronica [36] Lichen nitidus [37] UVA1 (not discussed) Morphea, low-dose UVA1, combined with calcipotriol [38] Disabling pansclerotic morphea [39] Lichen sclerosus et atrophicus, low dose [40] Chronic graft versus host disease [41,42] Hypopigmented mycosis fungoides [43] been proven and, in comparison to BBUVB, it elicits faster clearance of lesions, fewer episodes of erythema and longer remission. However, large studies on phototherapy in childhood psoriasis are rare.…”