Dermatology, Flat-Topped Papules, Lichen Nitidus, Teledermatology



  1. Jacob, Sharon E.
  2. Juhasz, Margit


ABSTRACT: Teledermatology is a term to describe the provision of dermatologic medical services through telecommunication technology. This is a case of flat-topped grouped papules on the fingers.


Article Content

In the store-and-forward teledermatology modality, there is a transfer of patient medical information electronically (including history and visual data) obtained in one location to a provider who is in another location (Roman & Jacob, 2015). The construct of the TeleDermViewPoint column is such that cases are presented in a standardized teledermatology reader format reflective of an actual teledermatology report (Table 1).

Table 1 - Click to enlarge in new windowTABLE 1 Teledermatology Viewpoint: Column Template



Chief complaint: presenting for the diagnosis of lesions on the fingers.


History of present illness: A 19-year-old woman presents with a rash on her fingers. Prior treatment: none. Her primary symptoms: none. Prior biopsy: none. She has no personal history of skin cancer. Other significant laboratory/study findings: none.


Image Quality Assessment

Fully satisfactory.



One image was provided (Figure 1), which demonstrates multiple, discrete, uniform 1- to 2-mm, shiny, skin-colored flat-topped grouped polygonal papules, without obvious secondary change, on the proximal interphalangeal space of digit.

Figure 1 - Click to enlarge in new windowFIGURE 1. A proximal interphalangeal space of the digit showing multiple, skin-colored, flat-topped papules.

Interpretation of Images

The presented lesions are consistent in morphology and distribution with the diagnosis of lichen nitidus.



Skin Care and Treatment Recommendations

Lichen nitidus is a benign skin condition that does not require treatment. Occasionally, it is associated with mild pruritus, and the patient may benefit from the application of a midpotency topical steroid (such as triamcinolone 0.1% ointment) twice daily with wean to off over several weeks.



Type of Visit

As this lesion is benign and asymptomatic, this patient should return to the primary care provider for continued monitoring and reassurance.


Clinical Pearl

Lichen nitidus is a benign chronic skin condition presenting with asymptomatic flat-topped, skin-colored papules. Histologically, a dense lymphocytic infiltrate can be appreciated in the upper dermis termed the "claw and ball" appearance. This condition is most often found in children and young adults on the forearms, dorsal hands, trunk, penis, and buttocks; less commonly, lesions are found on the palms/soles and buccal mucosa (including the tongue and hard palate). Ten percent of patients may exhibit nail changes including, but not limited to, pitting, linear ridges, and onychoschisis. Lichen nitidus may also exhibit the so-called Koebner phenomenon, in which lesions appear on previously traumatized skin. Additional therapeutic options include steroid-sparing agents (such as calcineurin inhibitors), topical retinoids, and light therapy (narrow-band ultraviolet B phototherapy, photochemotherapy) (Pickert, 2012; Rallis, Verros, Moussatou, Sambaziotis, & Papadakis, 2007).




Pickert A. (2012). Concise review of lichen planus and lichenoid dermatoses. Cutis, 90(3), E1-E3. [Context Link]


Rallis E., Verros C., Moussatou V., Sambaziotis D., Papadakis P. (2007). Generalized purpuric lichen nitidus. Report of a case and review of the literature. Dermatology Online Journal, 13(2), 5. [Context Link]


Roman M., Jacob S. E. (2015). Teledermatology: Virtual access to quality dermatology care and beyond. Journal of Dermatology Nurses' Association, 6(6), 285-287. [Context Link]