Case Letter
Axillary papules: an uncommon location of lichen nitidus
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"aff0005" ] ] ] 1 => array:3 [ "nombre" => "Paulo Ricardo" "apellidos" => "Criado" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:4 [ "nombre" => "Nilton Gioia" "apellidos" => "Di Chiacchio" "email" => array:1 [ 0 => "dichiacchiong@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Faculdade de Medicina do ABC, São Paulo, SP, Brazil" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Hospital do Servidor Público Municipal de São Paulo, São Paulo, SP, Brazil" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 675 "Ancho" => 900 "Tamanyo" => 154585 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Higher magnification showing the lymphohistiocytic infiltrate in a broadened dermal papila, (Hematoxylin & eosin, ×200).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Lichen nitidus is a relatively rare, chronic, papulosquamous cutaneous disease that is characterized by multiple flesh-coloured shiny, dome-shaped papules, with sizes from 1 to 2 mm, often referred as pinhead-like papules.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The crop of the lesions often is asymptomatic; moreover, it sometimes may associate with pruritus.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> This uncommon condition was described for the first time by Pinkus in 1901.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The skin is the primary site involved but the mucous membranes and nails also might be affected.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">No racial or sex predilection is reported, although the majority of cases appear to arise in children and young adults.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4</span></a> There are located and generalized forms of lichen nitidus, sometimes described under clinical variants: familiar, actinic, confluent, vesicular, hemorrhagic, palmo-plantaris, mucous, spinulosus and follicularis, keratodermic, perforating or linear.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,5</span></a> The lesions are located preferentially on the flexor surface of the arms, wrists, on the abdomen and genitalia, though they can become disseminated.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> We are adding to the indexed literature the second case of lichen nitidus exclusively located on both axillae.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The patient is a 26-year-old Caucasian man who was seen for evaluation of asymptomatic lesions on the both axillae; the lesions had been present more than 4-years and showed insidious emergence. He denied previous treatment on the lesions or any medication intake preceding the crop of the lesions. On his dermatological exam, discrete or grouped skin-colored, shiny, firm, monomorphic round, and dome-topped papules of 1-to 3-mm in diameter were observed on both axillae (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">A skin biopsy was performed from these lesions, and that displayed a lymphohistiocytic infiltrate in a broadened dermal papilla, with a descending growth of the rete ridges surrounding the dermal inflammatory infiltrate in a “ball-and-claw” manner (<a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2 and 3</a>). The overlying epidermis was noted to be unremarkable, and there was no evidence of spongiosis or exocytosis.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The patient was treated with the combination of dexchlorpheniramine 2 mg and betamethasone 0.25 mg t.i.d per os for 10-days, and after thatt he was virtually clear of lesions.</p><p id="par0030" class="elsevierStylePara elsevierViewall">There is only one report of lichen nitidus on axillae.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Our patient displayed lesions only in this area, emphasizing the peculiar aspect of our report. Once considered as a tuberculoid reaction, lichen nitidus is currently regarded as a disorder of unknown origin. The differential diagnosis includes lichen planus, psoriasis, verruca plana and keratosis pilaris.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4</span></a> Rare cases of lichen nitidus associated with atopic dermatitis, Crohn disease, Down´s syndrome and juvenile chronic arthritis have been reported.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3</span></a> The first clinical hypothesis in this case was Fox-Fordyce disease due the presence of popular lesions on the axillae. The final diagnosis was established on histopathological basis.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Due to the rare clinical presentation of lichen nitidus exclusively located on the both axillae, the clinicians must alert to the necessity of performing cutaneous biopsy to confirm this diagnosis. The histological study of the biopsy showed characteristic findings of lichen nitidus, including lymphohistiocytic infiltrate in an expanded dermal papilla with thinning of overlying epidermis and downward extension of the rete ridges at the lateral margin of the infiltrate, producing a typical "claw clutching a ball" picture.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In two-thirds of patients the lesions resolve spontaneously after months to 1 year. Topical glucocorticoids can be useful in localized forms.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In this case, the patient was successfully treated with the combination of dexchlorpheniramine 2 mg and betamethasone 0.25 mg t.i.d per os for 10-days.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The authors would like to highlight the rarity of the presentation of this case and the importance of considering the lichen nitidus as a differential diagnosis of papular lesions in the axillae, itchy or not.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0055" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors’ contributions</span><p id="par0060" class="elsevierStylePara elsevierViewall">Walter Belda Junior: Statistical analysis; approval of the final version of the manuscript; design and planning of the study; drafting and editing of the manuscript; collection, analysis, and interpretation of data; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Paulo Ricardo Criado: Statistical analysis; approval of the final version of the manuscript; design and planning of the study; drafting and editing of the manuscript; collection, analysis, and interpretation of data; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Nilton Gioia Di Chiacchio: Statistical analysis; approval of the final version of the manuscript; design and planning of the study; drafting and editing of the manuscript; collection, analysis, and interpretation of data; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors’ contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-01-14" "fechaAceptado" => "2020-04-11" "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Belda Jr W, Criado PR, Di Chiacchio NG. Axillary papules: an uncommon location of lichen nitidus. An Bras Dermatol. 2021;96:381–3.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Faculdade de Medicina do ABC, São Paulo, SP, Brasil.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 681 "Ancho" => 905 "Tamanyo" => 85359 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Right axilla presenting discrete and grouped skin-colored, shiny, firm, monomorphic round, and dome-topped papules of 1-to 3-mm.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 675 "Ancho" => 900 "Tamanyo" => 160605 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Infiltrate in a broadened dermal papilla, with a descending growth of the rete ridges surrounding the dermal inflammatory infiltrate in a “ball-and-claw” manner, (Hematoxylin & eosin, ×40).</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 675 "Ancho" => 900 "Tamanyo" => 154585 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Higher magnification showing the lymphohistiocytic infiltrate in a broadened dermal papila, (Hematoxylin & eosin, ×200).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Generalized lichen nitidus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.T. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 19 | 7 | 26 |
| 2024 October | 109 | 80 | 189 |
| 2024 September | 141 | 101 | 242 |
| 2024 August | 155 | 127 | 282 |
| 2024 July | 142 | 119 | 261 |
| 2024 June | 109 | 106 | 215 |
| 2024 May | 99 | 79 | 178 |
| 2024 April | 100 | 99 | 199 |
| 2024 March | 103 | 88 | 191 |
| 2024 February | 89 | 82 | 171 |
| 2024 January | 78 | 50 | 128 |
| 2023 December | 65 | 78 | 143 |
| 2023 November | 89 | 79 | 168 |
| 2023 October | 71 | 90 | 161 |
| 2023 September | 68 | 70 | 138 |
| 2023 August | 56 | 42 | 98 |
| 2023 July | 75 | 30 | 105 |
| 2023 June | 60 | 40 | 100 |
| 2023 May | 68 | 27 | 95 |
| 2023 April | 61 | 26 | 87 |
| 2023 March | 90 | 57 | 147 |
| 2023 February | 57 | 42 | 99 |
| 2023 January | 49 | 35 | 84 |
| 2022 December | 47 | 45 | 92 |
| 2022 November | 67 | 58 | 125 |
| 2022 October | 104 | 66 | 170 |
| 2022 September | 49 | 56 | 105 |
| 2022 August | 45 | 56 | 101 |
| 2022 July | 56 | 62 | 118 |
| 2022 June | 49 | 74 | 123 |
| 2022 May | 44 | 56 | 100 |
| 2022 April | 64 | 68 | 132 |
| 2022 March | 68 | 85 | 153 |
| 2022 February | 37 | 39 | 76 |
| 2022 January | 61 | 77 | 138 |
| 2021 December | 71 | 68 | 139 |
| 2021 November | 47 | 58 | 105 |
| 2021 October | 62 | 82 | 144 |
| 2021 September | 67 | 67 | 134 |
| 2021 August | 62 | 80 | 142 |
| 2021 July | 73 | 60 | 133 |
| 2021 June | 143 | 118 | 261 |
| 2021 May | 107 | 107 | 214 |
| 2021 April | 286 | 415 | 701 |
| 2021 March | 35 | 44 | 79 |
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