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Lichen striatus is a common childhood eruption, but only rare reports link cutaneous manifestations and onychodystrophy. We report a case of lichen striatus and onychodystrophy in a 12-year-old girl, only the eighth such patient in the dermatologic literature. Nail changes may precede the rash of lichen striatus and should be considered in the differential diagnosis of isolated nail dystrophy in children.
Lichen striatus is a self-limiting inflammatory condition of unknown etiology in which the lesions follow the lines of Blaschko. We report a series of 61 cases of this condition in children, describing the clinical features, age distribution, and season of onset. The preponderance of cases in the preschool-age group and onset in the spring and summer months support the hypothesis of an environmental agent, possibly an infection, in the etiology of the condition.
Nail involvement in lichen striatus is nearly always accompanied by skin lesions. A case of childhood lichen striatus involving the thumb nail is presented.
The possible relationship between lichen striatus and atopy was studied. Twenty-six patients with typical lichen striatus were studied, and 22 (84.6%) had a positive history of atopic disorders. This might indicate that the pathogenesis of lichen striatus has a close relationship to that of atopic disorders.
Lichen striatus (LS) is a self-limiting linear papular dermatosis of unknown etiology seen mostly in children. We report LS occurring in two pairs of siblings: two sisters who had LS at an interval of 6 months and a brother and sister who had the dermatosis contemporaneously after an episode of flulike fever. In all four patients family history was positive for atopy. LS is frequently associated with atopic diseases. The abnormal immune status of patients with atopy may be a predisposing factor in the induction of LS. In our patients the simultaneous occurrence of LS in siblings after a flulike fever appears to corroborate the hypothesis that a viral infection is a possible candidate, as other authors have proposed. The rarity of familial cases of LS is, in our opinion, due to the exceptional confluence of difference sporadic events (atopy, viral infection caught at a specific period of life such as childhood, and a genetic predisposition) simultaneously present in the same patient.
To analyze the clinical features, response to treatment, and follow-up of lichen striatus and any associated symptoms or disease, we designed a retrospective study involving 115 affected children at the Pediatric Dermatology Unit of the Department of Dermatology of the University of Bologna, Bologna, Italy. Between January 1989 and January 2000 we diagnosed lichen striatus in 37 boys and 78 girls (mean age 4 years 5 months). We studied their family history and the season of onset, morphology, distribution, extent, duration, histopathology, and treatment of their lichen striatus. We found that family history was negative in all our patients except for two pairs of siblings. The majority of children had the disease in the cold seasons; precipitating factors were found in only five cases. The most frequently involved sites were the limbs, with no substantial difference between upper and lower limb involvement. When lichen striatus was located on the trunk and face, it always followed Blaschko lines; in seven children the bands on the limbs appeared to be along the axial lines of Sherrington. In 70 cases, lichen striatus was associated with atopy. The mean duration of the disease was 6 months and relapses were observed in five children, and in one instance the disease had a prolonged course. Only a few case study series of lichen striatus in children have been reported and ours is the largest to date. The etiology of lichen striatus remains unknown in the majority of our patients. The confirmed association with atopy observed in our patients may be a predisposing factor. It has generally been accepted that lichen striatus follows the lines of Blaschko, and this distribution is a sign of both a topographic and a pathogenetic concept. In patients where lichen striatus is along axial lines, a locus minoris resistentiae, we suppose that this distribution may only be an illusory phenomenon in instances in which the trigger factor prefers this route, consisting of several successive Blaschko lines, but appearing as a single band.
A case of lichen striatus with transepidermal elimination of clusters of necrotic keratinocytes is reported. On the basis of the morphologic findings, we suggest that transepidermal elimination may be a mechanism of healing in some cutaneous lichenoid eruptions.
Lichen striatus is an uncommon, self-limited eruption of unknown etiology. What role genetic or environmental influences play in its pathogenesis is unclear. We report two nonrelated, adopted children living in the same household who simultaneously developed lichen striatus.
A 2-year-old boy experienced lichen striatus localized to the left half of the body. Some weeks later he developed a peculiar form of eruptive psoriasis limited to the right half of the body. To our knowledge, unilateral eruptive psoriasis has never been described in the literature. The coincidence in this young patient of lichen striatus and this unusual form of psoriasis arising in so short a period of time leads us to hypothesize a common trigger factor.
We describe a very rare case of bilateral lichen striatus on the lower extremities with a history of more than ten years. Histopathologically, the lesions demonstrated a lichenoid tissue reaction with foci of spongiosis and perivascular inflammatory cell infiltration. In addition, the finding of lymphocytic infiltrations around the eccrine duct was observed. They were treated successfully with topical application of corticosteroid ointment. To the best of our knowledge, no other lichen striatus case has been reported with bilateral distribution and such long-term persistence.
Three phases of lichenoid reactions are defined: 1) the primary phase, 2) the established phase; and 3) the senescent phase. Lichen striatus is characterized by a primary pattern that may be apparent in the epidermis, the hair follicles, and rarely the sweat glands and ducts. Focal areas of established lichenoid reaction, that are indistinguishable from lichen planus, are common. They usually are confined to the tips of elongated rete ridges. Established lichenoid patterns are occasionally present in hair follicles and are indistinguishable from those seen in lichen planopilaris. Eccrine hidradenitis, a feature of lichen striatus, is rarely seen in lichen planus. Lichen planus may be an adaptive epidermal response to a clone of aggressive lymphocytes and, as such, may be a manifestation of auto-immunity. In lichen striatus, senescent lichenoid patterns resemble those seen in lichen nitidus.
Four cases of lichen striatus (L.S.) with nail involvement were studied and the four cases published previously reviewed. There are several types of nail dystrophy: fraying, longitudinal ridging, splitting and shredding, onycholysis, and total nail loss. All of them are transient and can be explained by the pathologic changes observed, particulary the transitory disruption of the basal layer. Lichen striatus must be differentiated from systematized eruptions such as lichen planus (the simultaneous occurrence of L.S. and lichen planus is extremely rare and the resemblance of one dermatosis to the other can be so pronounced that a differential diagnosis is difficult) linear localized neurodermatitis, linear psoriasis (almost always associated with more typical lesions of psoriasis elsewhere on the body), linear keratosis follicularis (histologically typical of Darier's disease) and linear epidermal nevus which occasionaly does not appear at birth but later in life and may present nail involvement. In some cases, however, clinical similarity of the inflammatory linear verrucose epidermal nevus to lichen striatus is striking.
A 58-year-old Japanese woman with lichen striatus had asymptomatic multiple erythemato-papular plaques in arranged linear or band-like patterns over the right half side of her chest, back, and the right upper and lower extremities, following Blaschko's lines. A biopsy specimen demonstrated a dermoepidermal interface inflammation with a lichenoid lymphoid cell infiltrate into the upper and middle dermis. All lesions spontaneously cleared within 2 months. Lichen striatus in an adult should be differentiated from other acquired erythemato-papular dermatoses which may follow Blaschko's lines. Its histopathological features may mimic those of lichen planus, but it can be distinguished because of its consistent distribution on Blaschko's lines, not only in children but also in adults.
The authors describe eight patients with Lichen Striatus: history, clinical description and pathologic findings are discussed. Particularly, the histologic picture of Lichen Striatus is not uniform and changes, as it seems, with the "oldness" of the lesion.
We report four children with linear eruptions on the nose, with overlapping features of lichen striatus and linear cutaneous lupus erythematosus. However, linear lupus erythematosus has rarely been reported, and lichen striatus, although classically linear, rarely affects the face. The linear distribution of lesions from the glabella to the ala nasi may represent distribution following Blaschko's lines.
Lichen striatus (LS) is a benign, self-limited, linear, inflammatory dermatosis of unknown etiology that usually affects children. We analyzed 89 cases in regard to age of appearance, sex, race, symptoms, seasonal incidence, localization of lesions and affected side of the body, and presence of atopy. Lesions predominated on the inferior limbs, with no preponderance of any age, and were asymptomatic in the majority of the instances. There was no difference in the incidence of LS in regard to the season of the year. A possible association of lichen sclerosus with atopy and pruritus was observed.
Two case reports of lichen striatus with nail dystrophy are presented herein. Review of the literature suggests a more protracted course for the cutaneous eruption if there is nail involvement. Biopsy is important to differentiate this condition from other linear lesions that may interfere with normal nail growth.
An illustrative case report and a series of 18 well-documented cases of lichen striatus are presented. The mean age at diagnosis was 3 years (6 months to 14 years; median 2 years). The lesions were predominantly distributed on the trunk in 33% of cases and on the limbs in the remaining two thirds (upper limb: 48%; lower limb: 19%). Pruritus was noted in only 1 of 18 cases. Six cases were associated with clinical features of atopy and/or minor signs of atopic dermatitis (e.g., pityriasis alba). Two cases were considered to be clinically associated with lesions consistent with psoriasis. The mean duration was 9.5 months (4 weeks to 3 years; median 6 months). In one patient, two relapses occurred in 4 years. Hypochromic sequelae were noted in 50% of cases. Lichen striatus is the most common acquired self-limited linear eruption in childhood that follows Blaschko's lines. A new acronym is proposed to emphasize the developmental background of the disease: BLAISE for Blaschko linear acquired inflammatory skin eruption.