Purpuric Generalized Lichen nitidus: An Unusual Eruption Simulating Pigmented Purpuric Dermatosis

Abstract

Background: Generalized haemorrhagic lichen nitidus is rare. To our knowledge, this form of presentation has only been reported once. Objective: To describe a new case of generalized haemorrhagic lichen nitidus simulating a pigmented purpuric dermatosis. Methods and Results: We document a 24-year-old man who presented with an 8-month history of a progressive non-pruritic, red-brown papular eruption on the dorsa of the feet, ankles and distal third of the legs. A diagnosis of Schamberg’s progressive pigmentary dermatosis was made, and no treatment was prescribed. Two months later, the lesions had extended to the abdomen, groins, forearms, elbows and wrists. Biopsy of the skin of the right foot revealed lesions typical of lichen nitidus with subepidermal extravasation of red cells and capillary wall hyalinization. Macrophages and T lymphocytes were abundant in the infiltrate. Conclusion: Purpuric generalized lichen nitidus should be included in the differential diagnosis of pigmented purpuric dermatoses.

Angioma Serpiginosum with Extensive Lesions Associated with Retinal Vein Occlusion

“…Angiokeratoma corporis diffusum is an X-linked disorder and shows by electron microscopy electron-dense material in the lysosomes of endothelial cells [11] . Histopathologically, pigmented purpura shows hemosiderin deposition, extravasation of erythrocytes and inflammation [12] , and generalized hemorrhagic lichen nitidus shows a typical cellular, dense, focal infiltrate involving the papillary dermis [13] . Clinically, unilateral nevoid telangiectasia and portwine stain can be distinguished [14,15] .…”

Oral lichen nitidus case report

“…It is unclear why there is variation, but it is noted that cutaneous lesions can be variable in appearance. Cutaneous LN lesions are predominately skin‐colored but in some cases can present red/brown in color 7 or even hemorrhagic 8 in appearance. Therefore, the red erythematous papules in this case could parallel this redder cutaneous variant.…”

Generalized Purpuric Lichen Nitidus in a 32-Year-Old Filipino Male with Acute Myeloid Leukemia: Case Report

“…3 It is chronic, occasionally pruritic, and usually localized on the trunk, face, extremities, and genitalia. 5 The classic variant is distinguished by multiple 1-2mm smooth round skincolored papules. 2 In 1927, Civatte presented the similarities between lichen nitidus and lichen planus regarding configuration and morphology and their histopathologic findings of lymphohistiocytic infiltrate.…”