Facial actinic lichen nitidus successfully treated with hydroxychloroquin: a case report

Abstract

Lichen nitidus is an unusual condition with chronic evolution. It arises as multiple tiny, shiny papules with a flat surface. Many clinical variants have been reported. We describe a new case of facial actinic lichen nitidus. Our patient responded rapidly to corticosteroids and hydroxychloroquine. A 23-year-old woman with photodistributed eruptions recurring during the summer with improvement during the winter presented to our institution. Clinical exam revealed pinhead sized flat and flesh-colored papules on her face. Koebner phenomenon was not observed. Palms, soles, nails, and mucosa were normal. Histologic examination of a cutaneous biopsy showed a well circumscribed lymphohistiocytic infiltrate in the papillary dermis in a "claw clutching a ball" pattern suggestive of lichen nitidus. The diagnosis of actinic lichen nitidus was made. Treatment included photoprotection, topical corticosteroids once daily for 6 weeks, and hydroxychloroquine for 6 months. Remission of lesions was obtained after 4 weeks. Actinic lichen nitidus is rare. The true prevalence of this disease and the effectiveness of its various therapies is difficult to evaluate because it is usually asymptomatic and resolves without squelae.