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Table of Contents
CORRESPONDENCE
Year : 2021  |  Volume : 39  |  Issue : 3  |  Page : 161-162

Pediatric generalized lichen nitidus successfully treated with narrow-band ultraviolet B phototherapy: A case report


Department of Dermatology, Cathay General Hospital, Taipei, Taiwan

Date of Submission02-Feb-2021
Date of Decision30-Jun-2021
Date of Acceptance20-Jul-2021
Date of Web Publication20-Sep-2021

Correspondence Address:
Dr. Yu Yu
No. 280, Sec. 4, Renai Road, Taipei 106
Taiwan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ds.ds_33_21

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How to cite this article:
Yang YT, Yu Y. Pediatric generalized lichen nitidus successfully treated with narrow-band ultraviolet B phototherapy: A case report. Dermatol Sin 2021;39:161-2

How to cite this URL:
Yang YT, Yu Y. Pediatric generalized lichen nitidus successfully treated with narrow-band ultraviolet B phototherapy: A case report. Dermatol Sin [serial online] 2021 [cited 2021 Nov 28];39:161-2. Available from: https://www.dermsinica.org/text.asp?2021/39/3/161/326271



Dear Editor,

Lichen nitidus (LN) is a typically self-limiting inflammatory disease and most patients require no treatment. However, in patients with generalized LN, a rare subtype with a more variable course, treatment is often warranted. We report a pediatric case of generalized LN who had a significant treatment response to narrow-band ultraviolet B (NBUVB) phototherapy.

A 6-year-old boy presented with abrupt onset, persistent “goose bumps” for 8 months. He was overall healthy without any inherited disorders. Personal history and family history were insignificant. The lesions developed after an upper respiratory tract viral illness and were mostly asymptomatic with only occasional itch. Physical examination revealed numerous generalized-distributed, pinpoint- to pinhead-sized, flat-topped, shiny, and skin-colored papules on the face, chest, abdomen, back, buttocks, genital area, upper and lower limbs [Figure 1]a and [Figure 1]b. A diagnosis of generalized LN was made upon typical clinical presentation. Initially, the patient was treated with a mixture of pimecrolimus 1% cream and urea 10% cream for 1 month, with suboptimal treatment response. We, therefore, decided to include NBUVB phototherapy into his treatment plan. The NBUVB phototherapy was administered twice weekly in an ultraviolet (UV) irradiation cubicle (HOUVA II; National Biological Corp., Beachwood, OH, USA.) equipped with 24 UVB lamps (TL100W/01 311NB UVB; Philips Company, Eindhoven, the Netherlands). The starting dose was 100 mJ/cm2 with increments of 20 mJ/cm2 per treatment session and a maximum dose of 500 mJ/cm2. The patient's genital areas had been protected by clothing during NBUVB phototherapy. After 6 phototherapy sessions, moderate improvement of the skin lesions was observed. The topical regimen was shifted to a mixture of hydrocortisone 1% ointment and urea 10% cream. After another 18 phototherapy sessions combined with topical medication, he had significant improvement of the skin lesions [Figure 1]c and [Figure 1]d. The phototherapy was stopped after 24 sessions, and no relapse of the disease was noted afterward.
Figure 1: (a) Numerous monomorphic, round, and skin-colored papules over trunk and limbs. (b) Individual papules are flat with glistening surface and occasional central depression. (c and d) After 24 narrow-band ultraviolet B phototherapy sessions, the patient had significant improvement of the skin lesions.

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LN is an inflammatory skin eruption with a clinical presentation of multiple, shiny, skin-colored, pinhead-sized, and dome-shaped papules, generally localized in the genital area, upper limbs, and trunk.[1] LN is most commonly seen in children and young adults and affects both genders equally. The etiology and pathogenesis remain unidentified.[2] Typical LN is self-limited and thus requires no treatment unless symptomatic. However, generalized LN has a more variable course, and treatment may be offered to improve cosmetic outcomes and quality of life. Many treatment modalities have been used to treat LN, including systemic and topical corticosteroids, topical calcineurin inhibitors, antihistamines, retinoids, low-dose cyclosporine, antifungals, anti-tuberculous agents, and dinitrochlorobenzene (DNCB). UV therapy, including oral psoralen plus UV-A (PUVA), UV-A/UV-B, and exposure to intense sunlight, have also been reported as effective therapy.[2],[3],[4] However, many of the above-mentioned treatments are either contraindicated or unsuitable in the very young population (e.g., retinoids, PUVA, and DNCB).

Several publications reported treatment success in generalized LN with NBUVB therapy, with or without add-on topical corticosteroid.[4],[5],[6] The exact mechanism of NBUVB remains unknown. Studies have shown that effector T-cell activation is inhibited by UVB exposure, which consequently resulted in diminished cell-mediated response.[7] The photoimmunologic effects on cell-mediated immunity are presumed to play a major role in diseases such as psoriasis, atopic dermatitis, and lichen planus, in which T-cell hyperactivity predominates. As LN is often postulated as a cell-mediated response to exogenous antigens and allergens, the inhibitory effect on cell-mediated immunity of NBUVB may provide a plausible explanation on the efficacy of NBUVB in patients with generalized LN.

Previous publications reported that patients with generalized LN had noticeable improvement after 3–17 sessions of NBUVB and complete resolution after 18–30 sessions of NBUVB, which is comparable with this case. The treatment response was observed in both pediatric and adult patients.[4],[5],[6] No adverse reaction was noted in the reports, but it should be kept in mind that the long-term safety of using NBUVB in pediatric patients is not well-established.

It is possible that the resolution in this patient is part of the natural course of the disease as spontaneous resolution occurs in the majority of patients with LN. However, the degree of improvement of areas covered by clothing during phototherapy was significantly less than that of other body parts [Figure 2]. This finding supports the therapeutic effect of NBUVB on this patient.
Figure 2: Treatment response of the clothing-protected areas such as (a) the groins, the proximal thighs, and (b) the buttocks were not as significant as that of other body parts.

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In summary, this case report presents a pediatric case of generalized LN successfully treated with NBUVB and topical medications. Our experience may provide insights regarding the use of NBUVB in pediatric patients with generalized LN.

Declaration of patient consent

The authors certify that they have obtained appropriate patient's guardian consent form. In the form, the guardian has given the consent for the child's images and other clinical information to be reported in the journal. The guardian understands that the child's name and initial will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kundak S, Çakır Y. Pediatric lichen nitidus: A single-center experience. Pediatr Dermatol 2019;36:189-92.  Back to cited text no. 1
    
2.
Berman H, Truong A, Cheng CE. Pediatric generalized lichen nitidus treated with natural sunlight therapy. Pediatr Dermatol 2019;36:690-2.  Back to cited text no. 2
    
3.
Al-Mutairi N, Hassanein A, Nour-Eldin O, Arun J. Generalized lichen nitidus. Pediatr Dermatol 2005;22:158-60.  Back to cited text no. 3
    
4.
Kim YC, Shim SD. Two cases of generalized lichen nitidus treated successfully with narrow-band UV-B phototherapy. Int J Dermatol 2006;45:615-7.  Back to cited text no. 4
    
5.
Do MO, Kim MJ, Kim SH, Myung KB, Choi YW. Generalized lichen nitidus successfully treated with narrow-band UVB phototherapy: Two cases report. J Korean Med Sci 2007;22:163-6.  Back to cited text no. 5
    
6.
Park JH, Choi YL, Kim WS, Lee DY, Yang JM, Lee ES, et al. Treatment of generalized lichen nitidus with narrowband ultraviolet B. J Am Acad Dermatol 2006;54:545-6.  Back to cited text no. 6
    
7.
Krutmann J, Morita A, Elmets CA. Mechanisms of photo (chemo) therapy. In: Krutmann J, Hönigsmann H, Elmets CA, Bergstresser PR, editors. Dermatological Phototherapy and Photodiagnostic Methods. Berlin, Heidelberg: Springer; 2001. p. 54-68.  Back to cited text no. 7
    


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