Am Fam Physician. 2005 Aug 15;72(4) Online.
to the editor: The "Photo Quiz"1 in the January 1, 2005, issue of American Family Physician was a nice quiz about an uncommonly diagnosed condition: lichen nitidus. I would like to add to the discussion of the differential diagnosis. Lichen nitidus is one of only a few skin conditions that exhibit the Koebner phenomenon. Other skin conditions that exhibit the Koebner phenomenon are: juvenile rheumatoid arthritis (systemic form),2 lichen planus, molluscum contagiosum, pityriasis lichenoides et varioliformis acuta,3 psoriasis, vitiligo,4 and warts.
Asking the patient about areas of trauma, and then looking for clustered or linear distribution of isomorphic lesions may be a major clue in the diagnosis of these disorders.
Thank you for an interesting discussion.
1. Pielop JA, Hsu S. Tiny, skin-colored papules on the arms and hands [Photo Quiz]. Am Fam Physician 2005;71:343-4.
2. Williams G, Katcher M. Primary care dermatology module: nomenclature of skin lesions. Tutorial C: patterns and distribution. University of Wisconsin-Madison. Accessed online May 24, 2005, at: http://www.pediatrics.wisc.edu/education/derm/tutc/koebner.html.
3. Inamdar AC, Palit A. Koebner phenomenon in PLEVA. Indian J Dermatol Venereol Leprol 2003;69:226.
4. Lahiri K, Malakar S. Vitiligo and lichen planus in striae: is it Koebner phenomenon? Indian J Dermatol Venereol Leprol 2004;70:375.
editor’s note: This letter was sent to the authors of "Tiny, skin-colored papules on the arms and hands" [Photo Quiz], who declined to reply.
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