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Year : 2018  |  Volume : 9  |  Issue : 6  |  Page : 479-480  

Brown shadow in lichen nitidus: A dermoscopic marker!

1 MD, DCH, Medical Director, Rita Skin Foundation, Kolkata, West Bengal, India
2 DNB, Consultant, Rita Skin Foundation, Kolkata, West Bengal, India

Date of Web Publication5-Nov-2018

Correspondence Address:
Sushrut Save
1/204, Yashodhan Apts., 4 Bungalows, J.P. Road, Andheri (W), Mumbai - 400 053
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/idoj.IDOJ_338_17

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How to cite this article:
Malakar S, Save S, Mehta P. Brown shadow in lichen nitidus: A dermoscopic marker!. Indian Dermatol Online J 2018;9:479-80

How to cite this URL:
Malakar S, Save S, Mehta P. Brown shadow in lichen nitidus: A dermoscopic marker!. Indian Dermatol Online J [serial online] 2018 [cited 2021 Dec 6];9:479-80. Available from: https://www.idoj.in/text.asp?2018/9/6/479/245007

A 35-year-old male presented with asymptomatic multiple papular lesions over both forearms. Physical examination revealed multiple white-colored, flat-topped papules [Figure 1]. Based on the characteristic morphology of the lesions, a clinical diagnosis of lichen nitidus was established.
Figure 1: Multiple white-colored flat-topped papules distributed bilaterally over forearms

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Dermoscopy (DermLite III; 3Gen; Polarized, 10×) of the lesions revealed multiple, white, well-circumscribed circular areas, 1–2 mm in diameter with a smooth surface [Figure 2]a. An indistinct brown shadow was reflected through each of these white circles [Figure 2]b.
Figure 2: (a) Dermoscopy demonstrates multiple, white, well-circumscribed, circular areas with a smooth surface along with an indistinct brown shadow reflected through these white circles (b) Magnified dermoscopic image of (a) demonstrating the brown shadow (black arrow) (DermLite III; 3Gen; Polarized, 10×)

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Histopathology revealed a circumscribed subepidermal dense focal lymphohistiocytic infiltrate along with occasional Langhans giant cells, flanked by collarettes of epidermal acanthosis on either side, which gave a “ball-in-clutch” appearance confirming the diagnosis of lichen nitidus. The overlying epidermis showed evidence of acanthosis and focal parakeratosis [Figure 3].
Figure 3: Histopathology shows subepidermal foci of lymphohistiocytic infiltrate, encircled by acanthotic epidermal collarettes with parakeratosis of overlying stratum corneum (H and E stain 10×)

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The presence of multiple well-demarcated white circles on dermoscopy are known to correspond to epidermal acanthosis on histopathology.[1],[2] An interesting observation made was the presence of a brownish shadow inside each of these white circles, which is in fact a reflection of the underlying dense foci of lymphocytes and epithelioid cells in the dermal papilla. This deduction concurs with the observation of the “peripilar sign” in cases of early androgenetic alopecia, wherein the superficial perifollicular lymphocytic infiltrate is seen as a brown halo around the hair follicles.[3],[4] Hence, in lichen nitidus, the epidermal acanthosis corresponds to white circles and the central brownish shadow reflected through the white circles corresponds to the inflammatory infiltrate enveloped by the acanthotic rete ridges.

This particular finding on dermoscopy establishes a strong dermoscopic and histopathological correlation in lichen nitidus, which enables us to differentiate it from other conditions mimicking it, such as pityriasis versicolor and lichen sclerosus et atrophicus.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

   References Top

Chen W, Schramm M, Zouboulis CC. Generalized lichen nitidus. J Am Acad Dermatol 1997;36:630-1.  Back to cited text no. 1
Ankad BS, Beergouder SL. Pityriasis lichenoides et varioliformis acuta in skin of color: New observations by dermoscopy. Dermatol Pract Concept 2017;7:27-34.  Back to cited text no. 2
Vazquez-Lopez F, Manjon-Haces JA, Maldonado-Seral C, Raya-Aguado C, Perez-Oliva N, Marghoob AA. Dermoscopic features of plaque psoriasis and lichen planus: New observations. Dermatology 2003;207:151-6.  Back to cited text no. 3
Deloche C, De Lacharrière O, Misciali C, Piraccini BM, Vincenzi C, Bastien P, et al. Histological features of peripilar signs associated with androgenetic alopecia. Arch Dermatol Res 2004;295:422-8.  Back to cited text no. 4


  [Figure 1], [Figure 2], [Figure 3]


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