Consultant360Penile Lesions in a Healthy 3-Year-Old Boy

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A rare case of penile lichen nitidus in a 3-year-old boy presents key diagnostic and management insights for pediatric dermatological conditions. This case study examines the characteristic presentation, differential diagnosis, and treatment approach for this chronic inflammatory condition that predominantly affects children and young adults.

Key Points:

• The patient presented with asymptomatic, flesh-colored papules (1-2 mm in diameter) isolated to the lateral dorsum of the penis, with a 3-4 week onset and no associated symptoms or systemic manifestations. The diagnosis was made through clinical presentation alone.
• Differential diagnoses included pearly penile papules (typically appearing as dome-shaped papules in ring distribution at coronal sulcus), sebaceous hyperplasia (characterized by yellow/greasy appearance), and lichen planus (typically systemic with violaceous, flat-topped papules and associated symptoms).
• The pathophysiology likely involves immunologic mechanisms, with hypersensitivity triggering Langerhans cells and T-cell activation. Correlations exist with conditions including Down syndrome, HIV, Crohn disease, Niemann-Pick disease, and nivolumab treatment.
• Management typically requires no intervention, as the condition is self-limiting and resolves within months to a year. Postinflammatory hyperpigmentation may occur but typically resolves within months.
• For persistent or generalized cases, treatment options include topical/systemic corticosteroids, photochemotherapy, antihistamines, topical calcineurin inhibitors, and immunotherapy with dinitrochlorobenzene or diphenylcyclopropene.

HCN Medical Memo
Although lichen nitidus often presents as a diagnostic challenge, its characteristic appearance and typically benign course allow for conservative management in most cases. Regular monitoring and patient education remain cornerstone approaches.

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