Derm Dx: A factory worker with an itchy rash on the wrists and ankles - Clinical Advisor

Derm Dx: A factory worker with an itchy rash on the wrists and ankles

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A 42-year-old man presents with an itchy rash affecting his wrists and ankles. The eruption began approximately 6 weeks previously. He works in a manufacturing plant and was diagnosed at their health clinic with contact dermatitis. Treatment with mometasone cream has proven ineffectual. He is otherwise in good health and takes no oral medications. Examination reveals scattered erythematous papules, many manifesting a white superficial coating. 

 

Wickham striae are the fine lacy lines that frequently accompany lichen planus. They are named after the French dermatologist Louis Frédéric Wickham.1 Lichen planus most commonly occurs on the wrists and ankles and may involve the genitalia and mucous membranes...

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Wickham striae are the fine lacy lines that frequently accompany lichen planus. They are named after the French dermatologist Louis Frédéric Wickham.1 Lichen planus most commonly occurs on the wrists and ankles and may involve the genitalia and mucous membranes as well. The typical clinical manifestations are erythematous to violaceous polygonal papules with sharp borders. These are usually pruritic. The pathogenesis is thought to involve an immunologic response to an exogenous antigen, which may be viral, bacterial, or drug-related.2,3

Wickham striae provide a clue to diagnosis and are most commonly observed in oral lesions. Histopathology reveals epidermal orthohyperkeratosis and circumscribed wedge-shaped hypergranulosis.2 Their appearance under the dermatoscope is also characteristic.4

Stephen Schleicher, MD, is an associate professor of medicine at the Geisinger Commonwealth School of Medicine in Scranton, Pennsylvania, and an adjunct assistant professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. He practices dermatology in Hazleton, Pennsylvania.

References

  1. Steffen C, Dupree ML. Louis-Frédéric Wickham and the Wickham’s striae of lichen planus. Skinmed. 2004;3:287-289.
  2. Wagner G, Rose C, Sachse MM. Clinical variants of lichen planus. J Dtsch Dermatol Ges. 2013;11:309-319.
  3. Lehman JS, Tollefson MM, Gibson LE. Lichen planus. Int J Dermatol. 2009;48:682-694.
  4. Lallas A, Kyrgidis A, Tzellos TG, et al. Accuracy of dermoscopic criteria for the diagnosis of psoriasis, dermatitis, lichen planus and pityriasis rosea. Br J Dermatol. 2012;166:1198-1205.
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