In vivo imaging of lichen nitidus with confocal laser scanning microscopy.

A 33-YEAR-OLD MAN, A 20-YEAR-OLD WOMAN, AND a 10-year-old boy with the clinical diagnosis of lichen nitidus (Figure 1A, Figure 2A, and Figure 3A, respectively) underwent imaging with confocal laser scanning microscopy (CLSM) (Vivascope 1500; Lucid-Tech Inc, Henrietta, New York). The mosaic CLSM images (Figure 1B, Figure 2B, and Figure 3B [3 3 mm, 2 2 mm, and 2 2 mm, respectively]) revealed round, enlarged, well-circumscribed dermal papillae. The basal cell layer over the top of the dilated dermal papilla was poorly refractile, possibly because of the depletion of melanocytic cells. The enlarged dermal papillae were heavily laden with individual highly refractive cells, consistent with melanophages and, possibly, mononuclear cells. These findings appear to be a repeatable CLSM pattern for lichen nitidus. Histologically, these lesions revealed a focal well-circumscribed infiltrate of lymphocytes and histiocytes closely attached to the epidermis as well as rete ridges on the margins of the granuloma, which were elongated to create the “claw clutching a ball” image (Figure 1C, Figure 2C, and Figure 3C).