Pediatric emergency medicine trisk 1816 1816

Lichen Nitidus Lichen nitidus is characterized by tiny, pinpoint, flat-topped, skin-colored papules ( Fig 88.12 ) The papules are often grouped and are found in scratch lines (i.e., the Koebner phenomenon) Although any skin surface may be involved, the trunk and genitalia are common sites The lesions are often asymptomatic but may occasionally itch The lesions persist for variable periods and generally not respond to therapy PLAQUES Annular Plaques Granuloma Annulare Granuloma annulare is believed to be an idiosyncratic response to trauma and looks to many like tinea corporis (“ringworm”) without the scale This skin change may begin as a skin-colored or violaceous papule that clears centrally as the margins advance, or it may appear as a group of papules arranged in a ringlike configuration ( Fig 88.13 ) The central portion of the lesion is often dusky or hyperpigmented The key point on physical examination is the lack of scaling This physical finding distinguishes granuloma annulare from tinea corporis The border is firm on palpation, unlike tinea corporis The rings can be cm in diameter or larger FIGURE 88.11 Lichen striatus