Lichen nitidus after hepatitis B vaccine

A 27‐year‐old man presented to our clinic with an asymptomatic papular eruption all over his body. The eruption first began after hepatitis B vaccination (Engerix B) and increased with the second vaccination which was given 1 month after the first. His medical history and systemic examination were normal. Physical examination revealed numerous, flesh‐colored or pink, 1–2 mm papules, with a flat, shiny surface, predominantly on the trunk and arms, and grouped in some areas. The face, nails, and oral mucosa were spared. Laboratory investigation revealed normal values of the routine hematologic and biochemical tests. Antistreptolysin O (ASO), C‐reactive protein (CRP), venereal disease research laboratory (VDRL) test, anti‐human immunodeficiency virus (anti‐HIV), chest X‐ray, and ultrasonography were normal. Anti‐hepatitis A virus immunoglobulin M (anti‐HAV IgM), anti‐hepatitis B core total (anti‐HBc total), and anti‐hepatitis C virus (anti‐HCV) were negative. Anti‐hepatitis A virus immunoglobulin G (anti‐HAV IgG) was positive; 10 mm erythema and induration were detected in the purified protein derivative (PPD) test. During the following period, spontaneous resolution of the lesions was observed. When the hepatitis B vaccine was given to the patient again after several months, however, the same types of lesion re‐occurred and spread rapidly all over his body. Again, physical examination revealed numerous, flesh‐colored or pink, 1–2 mm papules, with a flat, shiny surface, on the trunk, arms, and penis (Fig. 1). Laboratory investigations revealed normal hematologic and biochemical values. Anti‐hepatitis B surface antigen (anti‐HBsAg) was > 150 IU/mL. Histopathologic examination of skin biopsy material taken from the regio antebrachii revealed, in the dermis, a granuloma formation of lymphocytes, histiocytes, and plasma cells which was surrounded by rete ridges and covered with focal parakeratotic epidermis (Fig. 2). 1 Numerous, flesh‐colored to pink papules with a flat, shiny surface 2 Granuloma formation with histiocytes, lymphocytes, and plasma cells in the dermis (hematoxylin and eosin, × 40) During the following period, spontaneous resolution of the lesions began and, with the addition of topical corticosteroid, the improvement increased. During the 1‐year follow‐up period after complete resolution of the lesions, no further exacerbation was detected.