Lichen Nitidus Diagnosis & Treatment in London

Understanding Lichen Nitidus

Lichen nitidus is an uncommon inflammatory skin disorder first described over a century ago. It presents as multiple tiny papules that may be flesh-coloured, pink, or slightly shiny. These papules are usually 1–2 mm in size and often appear grouped in patches.

Causes and Mechanisms

The exact cause of lichen nitidus is not known. The condition is thought to involve an abnormal immune response that leads to inflammation in the skin. Some studies suggest links with:

• Lichen planus – sometimes both conditions occur in the same patient.
• Atopic dermatitis or eczema – shared immune pathways may be involved.
• Autoimmune processes – abnormal immune recognition of skin structures.

Clinical Features

Lichen nitidus typically appears as:

• Tiny, flat-topped papules 1–2 mm in diameter.
• Colour ranging from skin-tone to pink or brown depending on skin type.
• Shiny surface, sometimes with fine scaling.
• Common sites: chest, forearms, hands, abdomen, genital region.

Most cases are asymptomatic, but some individuals may experience mild itching.

Diagnosis

Diagnosis is clinical, based on characteristic appearance. Dermoscopy may show a central depression with surrounding elevation. In uncertain cases, a skin biopsy confirms diagnosis by showing a “ball-and-claw” pattern of inflammatory cells around dermal papillae.

Management and Treatment

Since lichen nitidus is harmless and self-limiting, treatment is often not required. However, management options include:

• Topical corticosteroids: Reduce inflammation and itching.
• Topical calcineurin inhibitors: Used in sensitive areas such as the face or genitals.
• Phototherapy: Narrowband UVB may be helpful in widespread cases.
• Antihistamines: For symptomatic itch relief.

Most cases resolve within months to years without scarring.

Living with Lichen Nitidus

Although harmless, lichen nitidus can cause cosmetic concern or anxiety, especially when affecting visible or intimate areas. At Skinhorizon Dermatology London, we provide reassurance, treatment when needed, and ongoing support to help patients manage the condition with confidence.

Your first visit — what to expect

1. Consultation: Medical history and symptom review.
2. Examination: Full skin assessment to confirm diagnosis.
3. Discussion: Reassurance and treatment options tailored to severity.
4. First steps: Start topical therapy if required, or monitoring plan.
5. Follow-up: Review progress and adapt management as necessary.

Reviewed by: Dr Mohammad Ghazavi, Consultant Dermatologist
Skinhorizon Clinic, 4 Clarendon Terrace, Maida Vale, London W9 1BZ
Last reviewed: 21 August 2025