Derm Dx: Linear dermatosis that follows the lines of Blaschko - Clinical Advisor

Derm Dx: Linear dermatosis that follows the lines of Blaschko

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A 3-year-old Hispanic male is brought in by his mother for evaluation of scattered papules on his abdomen, which had previously been diagnosed clinically as insect bites. His mother also points out a rash on the child’s right leg that has been present for approximately 4 weeks. She observes him scratching the site periodically. Examination reveals linear bands of slightly hypopigmented papules. No similar lesions are noted elsewhere.

Lichen striatus is an uncommon self-limited linear dermatosis. The condition is diagnosed based on appearance and its characteristic pattern, which follows the lines of Blaschko.1 Blaschko lines represent pathways of epidermal cell migration and proliferation during the development of the...

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Lichen striatus is an uncommon self-limited linear dermatosis. The condition is diagnosed based on appearance and its characteristic pattern, which follows the lines of Blaschko.1 Blaschko lines represent pathways of epidermal cell migration and proliferation during the development of the fetus.1

Lichen striatus is primarily a disease of young children and has rarely been reported in adults.2,3 There is no sex or racial predilection, and the etiology is unknown. The most commonly accepted hypothesis is that lichen striatus is the result of abnormal keratinocyte clones that arise by somatic mutation and then are distributed along the lines of Blaschko during embryonic migration.4 Atopy may be a predisposing factor.

 

Lichen striatus is a self-limiting disorder, which typically resolves within 3 to 12 months. Emollients and topical steroids may be used to treat excessive dryness and pruritus. A recent report showed improvement after treatment with a combination of a topical retinoid and a topical steroid.5 Photodynamic therapy using methyl aminolevulinic acid6 and topical calcineurin inhibitors7,8 have also been reported to promote resolution of the disorder.

Michael Stas, DPM, is a podiatry-dermatology fellow at St. Luke’s University Hospital in Bethlehem, Pennsylvania, and at the DermDox Dermatology Center in Hazleton, Pennsylvania. Stephen Schleicher, MD, is an associate professor of medicine at the Commonwealth Medical College 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. Taieb A, el Youbi A, Grosshans E, Maleville J. Lichen striatus: a Blaschko linear acquired inflammatory skin eruption. J Am Acad Dermatol. 1991;25:637-642.
  2. Hofer T. Lichen striatus in adults or ‘adult blaschkitis’? There is no need for a new naming. Dermatology. 2003;207:89-92.
  3. Taniguchi Abagge K, Parolin Marinoni L, Giraldi S, et al. Lichen striatus: description of 89 cases in children. Pediatr Dermatol. 2004;21:440-443.
  4. Happle R. Mosaicism in human skin. Understanding the patterns and mechanisms. Arch Dermatol. 1993;129:1460-1470.
  5. Youssef SM, Teng JM. Effective topical combination therapy for treatment of lichen striatus in children: a case series and review. J Drugs Dermatol. 2012;11:872-875.
  6. Park JY, Kim YC. Lichen striatus successfully treated with photodynamic therapy. Clin Exp Dermatol. 2012;37:570-572.
  7. Fujimoto N, Tajima S, Ishibashi A. Facial lichen striatus: successful treatment with tacrolimus ointment. Br J Dermatol. 2003;148:587-590.
  8. Campanati A, Brandozzi G, Giangiacomi M, Simonetti O, Marconi B, Offidani AM. Lichen striatus in adults and pimecrolimus: open, off-label clinical study. Int J Dermatol. 2008;47:732-736.
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