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Fever, abdominal distension and hepatomegaly

Generalised lichen nitidus Lichen nitidus is an uncommon dermatosis of unknown aetiology that affects mainly children and young adults. It is characterised by multiple asymptomatic flesh-coloured small papules with a glistening appearance, usually located on the trunk, upper limbs and genitalia. Multiple clinical variants have been described, including vesicular, haemorrhagic, linear, actinic and generalised, the last one being a rare subtype. Histopathologic examination is essential for correct diagnosis, highlighting the importance of a high index of clinical suspicion. Differential diagnosis includes keratosis pilaris, lichen planus, follicular eczema, verruca plana, pityriasis rubra pilaris, lichen simplex chronicum, prurigo nodularis, psoriasis and papular mucinosis. The classic form is usually self-healing within months and resolves without sequelae, but the course of the generalised type is unpredictable. Multiple treatments have been proposed, depending on patient’s symptoms or aesthetic reasons, including topical tacrolimus, topical and oral corticosteroids, phototherapy and retinoids, among others. In our case, given the asymptomatic presentation and the young age of the patient, a conservative attitude was adopted. The patient applied a 10% urea emollient in a daily basis, with progressive clearing and resolution of the lesions after 6 months.