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What Is This Skin Eruption?
A 36-year-old African American woman presented with an 18-month history of an itchy linear eruption on the anterior side of the right lower shin. It appeared as small slightly hypopigmented to skin-colored papules coalescing into linear plaque (Figure 1). No scaling and excoriations were seen. Fingernails and toenails were not affected.
What is Your Diagnosis?
Turn to page 2 for an answer and more details.
Diagnosis: Lichen Striatus
Lichen striatus is an uncommon, acquired, self-limited, linear papulosquamous disorder. It typically presents with sudden onset of flat-topped, erythematous or hyperpigmented, often scaly papules distributed along the Blaschko lines. The condition is predominantly seen in children. Rare familial cases have been described in the literature.1-3 Cases following infection, vaccinations, insect bite, and administration of interferon and etanercept (Enbrel) therapy have also been documented.4-8
Clinical Presentation
Lichen striatus presents as solitary, mostly unilateral eruption composed of hyperkeratotic hypopigmented and hyperpigmented papules9 (Figure 1). The most frequent location is the trunk, followed by the extremities, but cases of facial lesions are known. Lichen striatus may be pruritic.10 Nail involvement has been described with the longitudinal fissuring being the most common presentation.11 Nail involvement may appear before the typical skin eruption and sometimes is an isolated finding; it usually resolves spontaneously.12
Dermoscopy is rarely used for the diagnostic purpose; linear white structures resembling Wickham striae and scar-like depigmentation were described in a case from Coto-Segura and colleagues.13
Histopathology
Lichen striatus is usually diagnosed clinically, based on the typical features described above. A biopsy may be performed, if diagnosis is in question. Prototypical histopathologic findings in lichen striatus are superficial and deep lymphohistiocytic infiltrate with lichenoid or patchy lichenoid changes (Figures 2-5). Deep infiltrate usually surrounds eccrine glands and/or hair follicles (Figures 2 and 5). Other common features include spongiosis, exocytosis of lymphocytes.14
Because the presence of periadnexal infiltrates is important for the establishment of the diagnosis, shallow shave biopsies that lack eccrine glands or hair follicles may miss pertinent findings and lead to erroneous conclusions. Due to epidermotropism and syringotropism, some lichen striatus cases histopathologically may mimic mycosis fungoides; thus, clinical information is essential.15 Dermal lymphocytes in lichen striatus express CD4 and CD7, while epidermal lymphocytes are mostly CD8+.14,16
Differential Diagnosis
The most common differential diagnoses of lichen striatus and their distinguishing features are described in the Table. Rare entities that may present as linear eruption and mimic lichen striatus include linear morphea and lichen sclerosus.17,18
The term blashkitis is somewhat controversial and is not accepted by all dermatologists. Dermatologists are using this term in different settings and there is no unifying concept. Some authors use blashkitis for any case of lichen striatus in adults.19 Others consider it to be a different entity based on the fact that it is mainly pruritic and has mostly spongiotic changes without prominent necrotic keratinocytes.20
Pathogenesis
The exact etiology of lichen striatus is unknown. Genetic mosaicism or loss of heterozygosity in the skin may play a role.21 It is proposed that the aberrant clone is activated by a trigger (trauma, infection, etc.) and initiates T cell-mediated inflammatory process.14,16
Associated Diseases and Syndromes
Association of lichen striatus with atopic dermatitis is most common.9 Other rare associations include pityriasis lichenoides chronica, lichen nitidus, and lichen sclerosus.22-24
Management
Common treatment modalities for lichen striatus include topical steroids and topical pimecrolimus and tacrolimus.10,11 In children, 308-nm excimer laser treatment has been shown to improve residual hypopigmentation.25 Despite these therapeutic options, however, patients with lichen striatus should be reassured that their condition is self-resolving, benign, and nonscarring; treatment is often unnecessary.
Our Patient
Our patient was previously applying triamcinolone 0.1% ointment for 4 weeks. She was instructed to continue topical treatment with hydrocortisone 2.5% ointment as needed for symptomatic relief. At 6-month follow-up visit in our clinic, the eruption was partially resolving with flattened papules and areas of hyperpigmentation (Figure 6).
Conclusion
Lichen striatus is an inflammatory condition presented with linear papular eruption usually along the Blaschko lines. The condition is more frequently seen in children, but rare adult cases as well familial cases have been reported. Histopathology of lichen striatus is characterized by lichenoid lymphocytic infiltrate as well as deeper infiltrate around the sweat glands. Although the condition is usually self-limited, topical corticosteroids and calcineurin inhibitors may be used. Prognosis is usually favorable, and the condition resolves in the majority of cases.
Ms Siegel is with the University of Massachusetts Medical School in Worcester, MA.
Dr Gallitano is with the department of dermatology at SUNY Downstate Medical Center in Brooklyn, NY.
Dr Alapati is the department of dermatology at the Veterans Hospital in Brooklyn, NY.
Dr Kazlouskaya is with the department of dermatology at SUNY Downstate Medical Center in Brooklyn, NY.
Disclosure: The authors report no relevant financial relationships.
References
1. Peramiquel L, Baselga E, Dalmau J, Roe E, del Mar Campos M, Alomar A. Lichen striatus: clinical and epidemiological review of 23 cases. Eur J Pediatr. 2006;165(4):267-269.
2. Karempelis PS, Cely SJ, Davis LS. Lichen striatus in a mother and son. Int J Dermatol. 2014;53(7):e366.
3. Racette AJ, Adams AD, Kessler SE. Simultaneous lichen striatus in siblings along the same Blaschko line. Pediatr Dermatol. 2009;26(1):50-54.
4. Ishikawa M, Ohashi T, Yamamoto T. Lichen striatus following influenza infection. J Dermatol. 2014;41(12):1133-1134.
5. Unal E, Balta I, Bozkurt O. Lichen striatus: after a bite by bumblebee. Cutan Ocul Toxicol. 2015;34(2):171-172.
6. Lora V, Kanitakis J, Latini A, Cota C. Lichen striatus associated with etanercept treatment of rheumatoid arthritis. J Am Acad Dermatol. 2014;70(4):e90-e92.
7. Zaki SA, Sanjeev S. Lichen striatus following BCG vaccination in an infant. Indian Pediatr. 2011;48(2):163-164.
8. Mask-Bull L, Vangipuram R, Carroll BJ, Tarbox MB. Lichen striatus after interferon therapy. JAAD Case Rep. 2015;1(5):254-256.
9. Patrizi A, Neri I, Fiorentini C, Bonci A, Ricci G. Lichen striatus: clinical and laboratory features of 115 children. Pediatr Dermatol. 2004;21(3):197-204.
10. 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(7):732-736.
11. Kim M, Jung HY, Eun YS, Cho BK, Park HJ. Nail lichen striatus: report of seven cases and review of the literature. Int J Dermatol. 2015;54(11):1255-1260.
12. Tosti A, Peluso AM, Misciali C, Cameli N. Nail lichen striatus: clinical features and long-term follow-up of five patients. J Am Acad Dermatol. 1997;36(6 Pt 1):908-913.
13. Coto-Segura P, Costa-Romero M, Gonzalvo P, Mallo-Garcia S, Curto-Iglesias JR, Santos-Juanes J. Lichen striatus in an adult following trauma with central nail plate involvement and its dermoscopy features. Int J Dermatol. 2008;47(12):1324-1325.
14. Zhang Y, McNutt NS. Lichen striatus. Histological, immunohistochemical, and ultrastructural study of 37 cases. J Cutan Pathol. 2001;28(2):65-71.
15. Wang L, Chen F, Liu Y, Gao T, Wang G. Lichen striatus with syringotropism and hyperplasia of eccrine gland cells: a rare phenomenon that should not be confused with syringotropic mycosis fungoides. J Cutan Pathol. 2016;43(11):927-931.
16. Gianotti R, Restano L, Grimalt R, Berti E, Alessi E, Caputo R. Lichen striatus--a chameleon: an histopathological and immunohistological study of forty-one cases. J Cutan Pathol. 1995;22(1):18-22.
17. Muñoz Garza FZ, Manubens Mercadè E, Roè Crespo E, Puig Sanz L, Baselga Torres E. Linear morphea mimicking lichen striatus in its early presentation. Pediatr Dermatol. 2016;33(1):e23-e26.
18. Kumar P, Jha AK, Mallik SK, Raihan M. Bilateral zosteriform extragenital lichen sclerosus. Skinmed. 2014;12(2):123-125.
19. Tejera-Vaquerizo A, Ruiz-Molina I, Solís-Garcia E, Moreno-Giménez JC. [Adult blaschkitis (lichen striatus) successfully treated with topical tacrolimus]. Actas Dermosifiliogr. 2009;100(7):631-632.
20. Keegan BR, Kamino H, Fangman W, Shin HT, Orlow SJ, Schaffer JV. “Pediatric blaschkitis”: expanding the spectrum of childhood acquired Blaschko-linear dermatoses. Pediatr Dermatol. 2007;24(6):621-627.
21. Lipsker D, Cribier B, Girard-Lemaire F, Flori E, Grosshans E. Genetic mosaicism in an acquired inflammatory dermatosis following the lines of Blaschko. Arch Dermatol. 2000;136(6):805-807.
22. Erpolat S, Yenidunya S. Lichen striatus and pityriasis lichenoides chronica in an 11-year-old girl: an etiologic relationship? J Pak Med Assoc. 2015;65(9):1011-1113.
23. Cho EB, Kim HY, Park EJ, Kwon IH, Kim KH, Kim KJ. Three cases of lichen nitidus associated with various cutaneous diseases. Ann Dermatol. 2014;26(4):505-509.
24. Taniguchi Abagge K, Parolin Marinoni L, Giraldi S, Carvalho VO, de Oliveira Santini C, Favre H. Lichen striatus: description of 89 cases in children. Pediatr Dermatol. 2004;21(4):440-443.
25. Bae JM, Choo JY, Chang HS, Kim H, Lee JH, Kim GM. Effectiveness of the 308-nm excimer laser on hypopigmentation after lichen striatus: A retrospective study of 12 patients. J Am Acad Dermatol. 2016;75(3):637-639.
A 36-year-old African American woman presented with an 18-month history of an itchy linear eruption on the anterior side of the right lower shin. It appeared as small slightly hypopigmented to skin-colored papules coalescing into linear plaque (Figure 1). No scaling and excoriations were seen. Fingernails and toenails were not affected.
What is Your Diagnosis?
Diagnosis: Lichen Striatus
Figure 1. Small skin-colored papules
in linear distribution.
Lichen striatus is an uncommon, acquired, self-limited, linear papulosquamous disorder. It typically presents with sudden onset of flat-topped, erythematous or hyperpigmented, often scaly papules distributed along the Blaschko lines. The condition is predominantly seen in children. Rare familial cases have been described in the literature.1-3 Cases following infection, vaccinations, insect bite, and administration of interferon and etanercept (Enbrel) therapy have also been documented.4-8
Clinical Presentation
Lichen striatus presents as solitary, mostly unilateral eruption composed of hyperkeratotic hypopigmented and hyperpigmented papules9 (Figure 1). The most frequent location is the trunk, followed by the extremities, but cases of facial lesions are known. Lichen striatus may be pruritic.10 Nail involvement has been described with the longitudinal fissuring being the most common presentation.11 Nail involvement may appear before the typical skin eruption and sometimes is an isolated finding; it usually resolves spontaneously.12
Dermoscopy is rarely used for the diagnostic purpose; linear white structures resembling Wickham striae and scar-like depigmentation were described in a case from Coto-Segura and colleagues.13
Histopathology
Lichen striatus is usually diagnosed clinically, based on the typical features described above. A biopsy may be performed, if diagnosis is in question. Prototypical histopathologic findings in lichen striatus are superficial and deep lymphohistiocytic infiltrate with lichenoid or patchy lichenoid changes (Figures 2-5). Deep infiltrate usually surrounds eccrine glands and/or hair follicles (Figures 2 and 5). Other common features include spongiosis, exocytosis of lymphocytes.14
Figure 2. Patchy lichenoid infiltrate with periadnexal involvement.
Figures 3 and 4. Focal epidermotropism and superficial fibrosis of the dermis, features mimicking mycosis fungoides.
Figure 5. Lymphocytic infiltrate around eccrine glands.
Because the presence of periadnexal infiltrates is important for the establishment of the diagnosis, shallow shave biopsies that lack eccrine glands or hair follicles may miss pertinent findings and lead to erroneous conclusions. Due to epidermotropism and syringotropism, some lichen striatus cases histopathologically may mimic mycosis fungoides; thus, clinical information is essential.15 Dermal lymphocytes in lichen striatus express CD4 and CD7, while epidermal lymphocytes are mostly CD8+.14,16
Differential Diagnosis
The most common differential diagnoses of lichen striatus and their distinguishing features are described in the Table. Rare entities that may present as linear eruption and mimic lichen striatus include linear morphea and lichen sclerosus.17,18
The term blashkitis is somewhat controversial and is not accepted by all dermatologists. Dermatologists are using this term in different settings and there is no unifying concept. Some authors use blashkitis for any case of lichen striatus in adults.19 Others consider it to be a different entity based on the fact that it is mainly pruritic and has mostly spongiotic changes without prominent necrotic keratinocytes.20
Pathogenesis
The exact etiology of lichen striatus is unknown. Genetic mosaicism or loss of heterozygosity in the skin may play a role.21 It is proposed that the aberrant clone is activated by a trigger (trauma, infection, etc.) and initiates T cell-mediated inflammatory process.14,16
Associated Diseases and Syndromes
Association of lichen striatus with atopic dermatitis is most common.9 Other rare associations include pityriasis lichenoides chronica, lichen nitidus, and lichen sclerosus.22-24
Management
Common treatment modalities for lichen striatus include topical steroids and topical pimecrolimus and tacrolimus.10,11 In children, 308-nm excimer laser treatment has been shown to improve residual hypopigmentation.25 Despite these therapeutic options, however, patients with lichen striatus should be reassured that their condition is self-resolving, benign, and nonscarring; treatment is often unnecessary.
Our Patient
Our patient was previously applying triamcinolone 0.1% ointment for 4 weeks. She was instructed to continue topical treatment with hydrocortisone 2.5% ointment as needed for symptomatic relief. At 6-month follow-up visit in our clinic, the eruption was partially resolving with flattened papules and areas of hyperpigmentation (Figure 6).
Figure 6. At 6-month follow-up visit,
the eruption was partially resolving with
flattened papules and areas of hyperpigmentation.
Conclusion
Lichen striatus is an inflammatory condition presented with linear papular eruption usually along the Blaschko lines. The condition is more frequently seen in children, but rare adult cases as well familial cases have been reported. Histopathology of lichen striatus is characterized by lichenoid lymphocytic infiltrate as well as deeper infiltrate around the sweat glands. Although the condition is usually self-limited, topical corticosteroids and calcineurin inhibitors may be used. Prognosis is usually favorable, and the condition resolves in the majority of cases.
Ms Siegel is with the University of Massachusetts Medical School in Worcester, MA.
Dr Gallitano is with the department of dermatology at SUNY Downstate Medical Center in Brooklyn, NY.
Dr Alapati is the department of dermatology at the Veterans Hospital in Brooklyn, NY.
Dr Kazlouskaya is with the department of dermatology at SUNY Downstate Medical Center in Brooklyn, NY.
Disclosure: The authors report no relevant financial relationships.
References
1. Peramiquel L, Baselga E, Dalmau J, Roe E, del Mar Campos M, Alomar A. Lichen striatus: clinical and epidemiological review of 23 cases. Eur J Pediatr. 2006;165(4):267-269.
2. Karempelis PS, Cely SJ, Davis LS. Lichen striatus in a mother and son. Int J Dermatol. 2014;53(7):e366.
3. Racette AJ, Adams AD, Kessler SE. Simultaneous lichen striatus in siblings along the same Blaschko line. Pediatr Dermatol. 2009;26(1):50-54.
4. Ishikawa M, Ohashi T, Yamamoto T. Lichen striatus following influenza infection. J Dermatol. 2014;41(12):1133-1134.
5. Unal E, Balta I, Bozkurt O. Lichen striatus: after a bite by bumblebee. Cutan Ocul Toxicol. 2015;34(2):171-172.
6. Lora V, Kanitakis J, Latini A, Cota C. Lichen striatus associated with etanercept treatment of rheumatoid arthritis. J Am Acad Dermatol. 2014;70(4):e90-e92.
7. Zaki SA, Sanjeev S. Lichen striatus following BCG vaccination in an infant. Indian Pediatr. 2011;48(2):163-164.
8. Mask-Bull L, Vangipuram R, Carroll BJ, Tarbox MB. Lichen striatus after interferon therapy. JAAD Case Rep. 2015;1(5):254-256.
9. Patrizi A, Neri I, Fiorentini C, Bonci A, Ricci G. Lichen striatus: clinical and laboratory features of 115 children. Pediatr Dermatol. 2004;21(3):197-204.
10. 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(7):732-736.
11. Kim M, Jung HY, Eun YS, Cho BK, Park HJ. Nail lichen striatus: report of seven cases and review of the literature. Int J Dermatol. 2015;54(11):1255-1260.
12. Tosti A, Peluso AM, Misciali C, Cameli N. Nail lichen striatus: clinical features and long-term follow-up of five patients. J Am Acad Dermatol. 1997;36(6 Pt 1):908-913.
13. Coto-Segura P, Costa-Romero M, Gonzalvo P, Mallo-Garcia S, Curto-Iglesias JR, Santos-Juanes J. Lichen striatus in an adult following trauma with central nail plate involvement and its dermoscopy features. Int J Dermatol. 2008;47(12):1324-1325.
14. Zhang Y, McNutt NS. Lichen striatus. Histological, immunohistochemical, and ultrastructural study of 37 cases. J Cutan Pathol. 2001;28(2):65-71.
15. Wang L, Chen F, Liu Y, Gao T, Wang G. Lichen striatus with syringotropism and hyperplasia of eccrine gland cells: a rare phenomenon that should not be confused with syringotropic mycosis fungoides. J Cutan Pathol. 2016;43(11):927-931.
16. Gianotti R, Restano L, Grimalt R, Berti E, Alessi E, Caputo R. Lichen striatus--a chameleon: an histopathological and immunohistological study of forty-one cases. J Cutan Pathol. 1995;22(1):18-22.
17. Muñoz Garza FZ, Manubens Mercadè E, Roè Crespo E, Puig Sanz L, Baselga Torres E. Linear morphea mimicking lichen striatus in its early presentation. Pediatr Dermatol. 2016;33(1):e23-e26.
18. Kumar P, Jha AK, Mallik SK, Raihan M. Bilateral zosteriform extragenital lichen sclerosus. Skinmed. 2014;12(2):123-125.
19. Tejera-Vaquerizo A, Ruiz-Molina I, Solís-Garcia E, Moreno-Giménez JC. [Adult blaschkitis (lichen striatus) successfully treated with topical tacrolimus]. Actas Dermosifiliogr. 2009;100(7):631-632.
20. Keegan BR, Kamino H, Fangman W, Shin HT, Orlow SJ, Schaffer JV. “Pediatric blaschkitis”: expanding the spectrum of childhood acquired Blaschko-linear dermatoses. Pediatr Dermatol. 2007;24(6):621-627.
21. Lipsker D, Cribier B, Girard-Lemaire F, Flori E, Grosshans E. Genetic mosaicism in an acquired inflammatory dermatosis following the lines of Blaschko. Arch Dermatol. 2000;136(6):805-807.
22. Erpolat S, Yenidunya S. Lichen striatus and pityriasis lichenoides chronica in an 11-year-old girl: an etiologic relationship? J Pak Med Assoc. 2015;65(9):1011-1113.
23. Cho EB, Kim HY, Park EJ, Kwon IH, Kim KH, Kim KJ. Three cases of lichen nitidus associated with various cutaneous diseases. Ann Dermatol. 2014;26(4):505-509.
24. Taniguchi Abagge K, Parolin Marinoni L, Giraldi S, Carvalho VO, de Oliveira Santini C, Favre H. Lichen striatus: description of 89 cases in children. Pediatr Dermatol. 2004;21(4):440-443.
25. Bae JM, Choo JY, Chang HS, Kim H, Lee JH, Kim GM. Effectiveness of the 308-nm excimer laser on hypopigmentation after lichen striatus: A retrospective study of 12 patients. J Am Acad Dermatol. 2016;75(3):637-639.
A 36-year-old African American woman presented with an 18-month history of an itchy linear eruption on the anterior side of the right lower shin. It appeared as small slightly hypopigmented to skin-colored papules coalescing into linear plaque (Figure 1). No scaling and excoriations were seen. Fingernails and toenails were not affected.
What is Your Diagnosis?
What Is This Skin Eruption?
A 36-year-old African American woman presented with an 18-month history of an itchy linear eruption on the anterior side of the right lower shin. It appeared as small slightly hypopigmented to skin-colored papules coalescing into linear plaque (Figure 1). No scaling and excoriations were seen. Fingernails and toenails were not affected.
What is Your Diagnosis?
Turn to page 2 for an answer and more details.
Diagnosis: Lichen Striatus
Lichen striatus is an uncommon, acquired, self-limited, linear papulosquamous disorder. It typically presents with sudden onset of flat-topped, erythematous or hyperpigmented, often scaly papules distributed along the Blaschko lines. The condition is predominantly seen in children. Rare familial cases have been described in the literature.1-3 Cases following infection, vaccinations, insect bite, and administration of interferon and etanercept (Enbrel) therapy have also been documented.4-8
Clinical Presentation
Lichen striatus presents as solitary, mostly unilateral eruption composed of hyperkeratotic hypopigmented and hyperpigmented papules9 (Figure 1). The most frequent location is the trunk, followed by the extremities, but cases of facial lesions are known. Lichen striatus may be pruritic.10 Nail involvement has been described with the longitudinal fissuring being the most common presentation.11 Nail involvement may appear before the typical skin eruption and sometimes is an isolated finding; it usually resolves spontaneously.12
Dermoscopy is rarely used for the diagnostic purpose; linear white structures resembling Wickham striae and scar-like depigmentation were described in a case from Coto-Segura and colleagues.13
Histopathology
Lichen striatus is usually diagnosed clinically, based on the typical features described above. A biopsy may be performed, if diagnosis is in question. Prototypical histopathologic findings in lichen striatus are superficial and deep lymphohistiocytic infiltrate with lichenoid or patchy lichenoid changes (Figures 2-5). Deep infiltrate usually surrounds eccrine glands and/or hair follicles (Figures 2 and 5). Other common features include spongiosis, exocytosis of lymphocytes.14
Because the presence of periadnexal infiltrates is important for the establishment of the diagnosis, shallow shave biopsies that lack eccrine glands or hair follicles may miss pertinent findings and lead to erroneous conclusions. Due to epidermotropism and syringotropism, some lichen striatus cases histopathologically may mimic mycosis fungoides; thus, clinical information is essential.15 Dermal lymphocytes in lichen striatus express CD4 and CD7, while epidermal lymphocytes are mostly CD8+.14,16
Differential Diagnosis
The most common differential diagnoses of lichen striatus and their distinguishing features are described in the Table. Rare entities that may present as linear eruption and mimic lichen striatus include linear morphea and lichen sclerosus.17,18
The term blashkitis is somewhat controversial and is not accepted by all dermatologists. Dermatologists are using this term in different settings and there is no unifying concept. Some authors use blashkitis for any case of lichen striatus in adults.19 Others consider it to be a different entity based on the fact that it is mainly pruritic and has mostly spongiotic changes without prominent necrotic keratinocytes.20
Pathogenesis
The exact etiology of lichen striatus is unknown. Genetic mosaicism or loss of heterozygosity in the skin may play a role.21 It is proposed that the aberrant clone is activated by a trigger (trauma, infection, etc.) and initiates T cell-mediated inflammatory process.14,16
Associated Diseases and Syndromes
Association of lichen striatus with atopic dermatitis is most common.9 Other rare associations include pityriasis lichenoides chronica, lichen nitidus, and lichen sclerosus.22-24
Management
Common treatment modalities for lichen striatus include topical steroids and topical pimecrolimus and tacrolimus.10,11 In children, 308-nm excimer laser treatment has been shown to improve residual hypopigmentation.25 Despite these therapeutic options, however, patients with lichen striatus should be reassured that their condition is self-resolving, benign, and nonscarring; treatment is often unnecessary.
Our Patient
Our patient was previously applying triamcinolone 0.1% ointment for 4 weeks. She was instructed to continue topical treatment with hydrocortisone 2.5% ointment as needed for symptomatic relief. At 6-month follow-up visit in our clinic, the eruption was partially resolving with flattened papules and areas of hyperpigmentation (Figure 6).
Conclusion
Lichen striatus is an inflammatory condition presented with linear papular eruption usually along the Blaschko lines. The condition is more frequently seen in children, but rare adult cases as well familial cases have been reported. Histopathology of lichen striatus is characterized by lichenoid lymphocytic infiltrate as well as deeper infiltrate around the sweat glands. Although the condition is usually self-limited, topical corticosteroids and calcineurin inhibitors may be used. Prognosis is usually favorable, and the condition resolves in the majority of cases.
Ms Siegel is with the University of Massachusetts Medical School in Worcester, MA.
Dr Gallitano is with the department of dermatology at SUNY Downstate Medical Center in Brooklyn, NY.
Dr Alapati is the department of dermatology at the Veterans Hospital in Brooklyn, NY.
Dr Kazlouskaya is with the department of dermatology at SUNY Downstate Medical Center in Brooklyn, NY.
Disclosure: The authors report no relevant financial relationships.
References
1. Peramiquel L, Baselga E, Dalmau J, Roe E, del Mar Campos M, Alomar A. Lichen striatus: clinical and epidemiological review of 23 cases. Eur J Pediatr. 2006;165(4):267-269.
2. Karempelis PS, Cely SJ, Davis LS. Lichen striatus in a mother and son. Int J Dermatol. 2014;53(7):e366.
3. Racette AJ, Adams AD, Kessler SE. Simultaneous lichen striatus in siblings along the same Blaschko line. Pediatr Dermatol. 2009;26(1):50-54.
4. Ishikawa M, Ohashi T, Yamamoto T. Lichen striatus following influenza infection. J Dermatol. 2014;41(12):1133-1134.
5. Unal E, Balta I, Bozkurt O. Lichen striatus: after a bite by bumblebee. Cutan Ocul Toxicol. 2015;34(2):171-172.
6. Lora V, Kanitakis J, Latini A, Cota C. Lichen striatus associated with etanercept treatment of rheumatoid arthritis. J Am Acad Dermatol. 2014;70(4):e90-e92.
7. Zaki SA, Sanjeev S. Lichen striatus following BCG vaccination in an infant. Indian Pediatr. 2011;48(2):163-164.
8. Mask-Bull L, Vangipuram R, Carroll BJ, Tarbox MB. Lichen striatus after interferon therapy. JAAD Case Rep. 2015;1(5):254-256.
9. Patrizi A, Neri I, Fiorentini C, Bonci A, Ricci G. Lichen striatus: clinical and laboratory features of 115 children. Pediatr Dermatol. 2004;21(3):197-204.
10. 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(7):732-736.
11. Kim M, Jung HY, Eun YS, Cho BK, Park HJ. Nail lichen striatus: report of seven cases and review of the literature. Int J Dermatol. 2015;54(11):1255-1260.
12. Tosti A, Peluso AM, Misciali C, Cameli N. Nail lichen striatus: clinical features and long-term follow-up of five patients. J Am Acad Dermatol. 1997;36(6 Pt 1):908-913.
13. Coto-Segura P, Costa-Romero M, Gonzalvo P, Mallo-Garcia S, Curto-Iglesias JR, Santos-Juanes J. Lichen striatus in an adult following trauma with central nail plate involvement and its dermoscopy features. Int J Dermatol. 2008;47(12):1324-1325.
14. Zhang Y, McNutt NS. Lichen striatus. Histological, immunohistochemical, and ultrastructural study of 37 cases. J Cutan Pathol. 2001;28(2):65-71.
15. Wang L, Chen F, Liu Y, Gao T, Wang G. Lichen striatus with syringotropism and hyperplasia of eccrine gland cells: a rare phenomenon that should not be confused with syringotropic mycosis fungoides. J Cutan Pathol. 2016;43(11):927-931.
16. Gianotti R, Restano L, Grimalt R, Berti E, Alessi E, Caputo R. Lichen striatus--a chameleon: an histopathological and immunohistological study of forty-one cases. J Cutan Pathol. 1995;22(1):18-22.
17. Muñoz Garza FZ, Manubens Mercadè E, Roè Crespo E, Puig Sanz L, Baselga Torres E. Linear morphea mimicking lichen striatus in its early presentation. Pediatr Dermatol. 2016;33(1):e23-e26.
18. Kumar P, Jha AK, Mallik SK, Raihan M. Bilateral zosteriform extragenital lichen sclerosus. Skinmed. 2014;12(2):123-125.
19. Tejera-Vaquerizo A, Ruiz-Molina I, Solís-Garcia E, Moreno-Giménez JC. [Adult blaschkitis (lichen striatus) successfully treated with topical tacrolimus]. Actas Dermosifiliogr. 2009;100(7):631-632.
20. Keegan BR, Kamino H, Fangman W, Shin HT, Orlow SJ, Schaffer JV. “Pediatric blaschkitis”: expanding the spectrum of childhood acquired Blaschko-linear dermatoses. Pediatr Dermatol. 2007;24(6):621-627.
21. Lipsker D, Cribier B, Girard-Lemaire F, Flori E, Grosshans E. Genetic mosaicism in an acquired inflammatory dermatosis following the lines of Blaschko. Arch Dermatol. 2000;136(6):805-807.
22. Erpolat S, Yenidunya S. Lichen striatus and pityriasis lichenoides chronica in an 11-year-old girl: an etiologic relationship? J Pak Med Assoc. 2015;65(9):1011-1113.
23. Cho EB, Kim HY, Park EJ, Kwon IH, Kim KH, Kim KJ. Three cases of lichen nitidus associated with various cutaneous diseases. Ann Dermatol. 2014;26(4):505-509.
24. Taniguchi Abagge K, Parolin Marinoni L, Giraldi S, Carvalho VO, de Oliveira Santini C, Favre H. Lichen striatus: description of 89 cases in children. Pediatr Dermatol. 2004;21(4):440-443.
25. Bae JM, Choo JY, Chang HS, Kim H, Lee JH, Kim GM. Effectiveness of the 308-nm excimer laser on hypopigmentation after lichen striatus: A retrospective study of 12 patients. J Am Acad Dermatol. 2016;75(3):637-639.
A 36-year-old African American woman presented with an 18-month history of an itchy linear eruption on the anterior side of the right lower shin. It appeared as small slightly hypopigmented to skin-colored papules coalescing into linear plaque (Figure 1). No scaling and excoriations were seen. Fingernails and toenails were not affected.
What is Your Diagnosis?
Diagnosis: Lichen Striatus
Figure 1. Small skin-colored papules
in linear distribution.
Lichen striatus is an uncommon, acquired, self-limited, linear papulosquamous disorder. It typically presents with sudden onset of flat-topped, erythematous or hyperpigmented, often scaly papules distributed along the Blaschko lines. The condition is predominantly seen in children. Rare familial cases have been described in the literature.1-3 Cases following infection, vaccinations, insect bite, and administration of interferon and etanercept (Enbrel) therapy have also been documented.4-8
Clinical Presentation
Lichen striatus presents as solitary, mostly unilateral eruption composed of hyperkeratotic hypopigmented and hyperpigmented papules9 (Figure 1). The most frequent location is the trunk, followed by the extremities, but cases of facial lesions are known. Lichen striatus may be pruritic.10 Nail involvement has been described with the longitudinal fissuring being the most common presentation.11 Nail involvement may appear before the typical skin eruption and sometimes is an isolated finding; it usually resolves spontaneously.12
Dermoscopy is rarely used for the diagnostic purpose; linear white structures resembling Wickham striae and scar-like depigmentation were described in a case from Coto-Segura and colleagues.13
Histopathology
Lichen striatus is usually diagnosed clinically, based on the typical features described above. A biopsy may be performed, if diagnosis is in question. Prototypical histopathologic findings in lichen striatus are superficial and deep lymphohistiocytic infiltrate with lichenoid or patchy lichenoid changes (Figures 2-5). Deep infiltrate usually surrounds eccrine glands and/or hair follicles (Figures 2 and 5). Other common features include spongiosis, exocytosis of lymphocytes.14
Figure 2. Patchy lichenoid infiltrate with periadnexal involvement.
Figures 3 and 4. Focal epidermotropism and superficial fibrosis of the dermis, features mimicking mycosis fungoides.
Figure 5. Lymphocytic infiltrate around eccrine glands.
Because the presence of periadnexal infiltrates is important for the establishment of the diagnosis, shallow shave biopsies that lack eccrine glands or hair follicles may miss pertinent findings and lead to erroneous conclusions. Due to epidermotropism and syringotropism, some lichen striatus cases histopathologically may mimic mycosis fungoides; thus, clinical information is essential.15 Dermal lymphocytes in lichen striatus express CD4 and CD7, while epidermal lymphocytes are mostly CD8+.14,16
Differential Diagnosis
The most common differential diagnoses of lichen striatus and their distinguishing features are described in the Table. Rare entities that may present as linear eruption and mimic lichen striatus include linear morphea and lichen sclerosus.17,18
The term blashkitis is somewhat controversial and is not accepted by all dermatologists. Dermatologists are using this term in different settings and there is no unifying concept. Some authors use blashkitis for any case of lichen striatus in adults.19 Others consider it to be a different entity based on the fact that it is mainly pruritic and has mostly spongiotic changes without prominent necrotic keratinocytes.20
Pathogenesis
The exact etiology of lichen striatus is unknown. Genetic mosaicism or loss of heterozygosity in the skin may play a role.21 It is proposed that the aberrant clone is activated by a trigger (trauma, infection, etc.) and initiates T cell-mediated inflammatory process.14,16
Associated Diseases and Syndromes
Association of lichen striatus with atopic dermatitis is most common.9 Other rare associations include pityriasis lichenoides chronica, lichen nitidus, and lichen sclerosus.22-24
Management
Common treatment modalities for lichen striatus include topical steroids and topical pimecrolimus and tacrolimus.10,11 In children, 308-nm excimer laser treatment has been shown to improve residual hypopigmentation.25 Despite these therapeutic options, however, patients with lichen striatus should be reassured that their condition is self-resolving, benign, and nonscarring; treatment is often unnecessary.
Our Patient
Our patient was previously applying triamcinolone 0.1% ointment for 4 weeks. She was instructed to continue topical treatment with hydrocortisone 2.5% ointment as needed for symptomatic relief. At 6-month follow-up visit in our clinic, the eruption was partially resolving with flattened papules and areas of hyperpigmentation (Figure 6).
Figure 6. At 6-month follow-up visit,
the eruption was partially resolving with
flattened papules and areas of hyperpigmentation.
Conclusion
Lichen striatus is an inflammatory condition presented with linear papular eruption usually along the Blaschko lines. The condition is more frequently seen in children, but rare adult cases as well familial cases have been reported. Histopathology of lichen striatus is characterized by lichenoid lymphocytic infiltrate as well as deeper infiltrate around the sweat glands. Although the condition is usually self-limited, topical corticosteroids and calcineurin inhibitors may be used. Prognosis is usually favorable, and the condition resolves in the majority of cases.
Ms Siegel is with the University of Massachusetts Medical School in Worcester, MA.
Dr Gallitano is with the department of dermatology at SUNY Downstate Medical Center in Brooklyn, NY.
Dr Alapati is the department of dermatology at the Veterans Hospital in Brooklyn, NY.
Dr Kazlouskaya is with the department of dermatology at SUNY Downstate Medical Center in Brooklyn, NY.
Disclosure: The authors report no relevant financial relationships.
References
1. Peramiquel L, Baselga E, Dalmau J, Roe E, del Mar Campos M, Alomar A. Lichen striatus: clinical and epidemiological review of 23 cases. Eur J Pediatr. 2006;165(4):267-269.
2. Karempelis PS, Cely SJ, Davis LS. Lichen striatus in a mother and son. Int J Dermatol. 2014;53(7):e366.
3. Racette AJ, Adams AD, Kessler SE. Simultaneous lichen striatus in siblings along the same Blaschko line. Pediatr Dermatol. 2009;26(1):50-54.
4. Ishikawa M, Ohashi T, Yamamoto T. Lichen striatus following influenza infection. J Dermatol. 2014;41(12):1133-1134.
5. Unal E, Balta I, Bozkurt O. Lichen striatus: after a bite by bumblebee. Cutan Ocul Toxicol. 2015;34(2):171-172.
6. Lora V, Kanitakis J, Latini A, Cota C. Lichen striatus associated with etanercept treatment of rheumatoid arthritis. J Am Acad Dermatol. 2014;70(4):e90-e92.
7. Zaki SA, Sanjeev S. Lichen striatus following BCG vaccination in an infant. Indian Pediatr. 2011;48(2):163-164.
8. Mask-Bull L, Vangipuram R, Carroll BJ, Tarbox MB. Lichen striatus after interferon therapy. JAAD Case Rep. 2015;1(5):254-256.
9. Patrizi A, Neri I, Fiorentini C, Bonci A, Ricci G. Lichen striatus: clinical and laboratory features of 115 children. Pediatr Dermatol. 2004;21(3):197-204.
10. 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(7):732-736.
11. Kim M, Jung HY, Eun YS, Cho BK, Park HJ. Nail lichen striatus: report of seven cases and review of the literature. Int J Dermatol. 2015;54(11):1255-1260.
12. Tosti A, Peluso AM, Misciali C, Cameli N. Nail lichen striatus: clinical features and long-term follow-up of five patients. J Am Acad Dermatol. 1997;36(6 Pt 1):908-913.
13. Coto-Segura P, Costa-Romero M, Gonzalvo P, Mallo-Garcia S, Curto-Iglesias JR, Santos-Juanes J. Lichen striatus in an adult following trauma with central nail plate involvement and its dermoscopy features. Int J Dermatol. 2008;47(12):1324-1325.
14. Zhang Y, McNutt NS. Lichen striatus. Histological, immunohistochemical, and ultrastructural study of 37 cases. J Cutan Pathol. 2001;28(2):65-71.
15. Wang L, Chen F, Liu Y, Gao T, Wang G. Lichen striatus with syringotropism and hyperplasia of eccrine gland cells: a rare phenomenon that should not be confused with syringotropic mycosis fungoides. J Cutan Pathol. 2016;43(11):927-931.
16. Gianotti R, Restano L, Grimalt R, Berti E, Alessi E, Caputo R. Lichen striatus--a chameleon: an histopathological and immunohistological study of forty-one cases. J Cutan Pathol. 1995;22(1):18-22.
17. Muñoz Garza FZ, Manubens Mercadè E, Roè Crespo E, Puig Sanz L, Baselga Torres E. Linear morphea mimicking lichen striatus in its early presentation. Pediatr Dermatol. 2016;33(1):e23-e26.
18. Kumar P, Jha AK, Mallik SK, Raihan M. Bilateral zosteriform extragenital lichen sclerosus. Skinmed. 2014;12(2):123-125.
19. Tejera-Vaquerizo A, Ruiz-Molina I, Solís-Garcia E, Moreno-Giménez JC. [Adult blaschkitis (lichen striatus) successfully treated with topical tacrolimus]. Actas Dermosifiliogr. 2009;100(7):631-632.
20. Keegan BR, Kamino H, Fangman W, Shin HT, Orlow SJ, Schaffer JV. “Pediatric blaschkitis”: expanding the spectrum of childhood acquired Blaschko-linear dermatoses. Pediatr Dermatol. 2007;24(6):621-627.
21. Lipsker D, Cribier B, Girard-Lemaire F, Flori E, Grosshans E. Genetic mosaicism in an acquired inflammatory dermatosis following the lines of Blaschko. Arch Dermatol. 2000;136(6):805-807.
22. Erpolat S, Yenidunya S. Lichen striatus and pityriasis lichenoides chronica in an 11-year-old girl: an etiologic relationship? J Pak Med Assoc. 2015;65(9):1011-1113.
23. Cho EB, Kim HY, Park EJ, Kwon IH, Kim KH, Kim KJ. Three cases of lichen nitidus associated with various cutaneous diseases. Ann Dermatol. 2014;26(4):505-509.
24. Taniguchi Abagge K, Parolin Marinoni L, Giraldi S, Carvalho VO, de Oliveira Santini C, Favre H. Lichen striatus: description of 89 cases in children. Pediatr Dermatol. 2004;21(4):440-443.
25. Bae JM, Choo JY, Chang HS, Kim H, Lee JH, Kim GM. Effectiveness of the 308-nm excimer laser on hypopigmentation after lichen striatus: A retrospective study of 12 patients. J Am Acad Dermatol. 2016;75(3):637-639.
Diagnosis: Lichen Striatus
Figure 1. Small skin-colored papules
in linear distribution.
Lichen striatus is an uncommon, acquired, self-limited, linear papulosquamous disorder. It typically presents with sudden onset of flat-topped, erythematous or hyperpigmented, often scaly papules distributed along the Blaschko lines. The condition is predominantly seen in children. Rare familial cases have been described in the literature.1-3 Cases following infection, vaccinations, insect bite, and administration of interferon and etanercept (Enbrel) therapy have also been documented.4-8
Clinical Presentation
Lichen striatus presents as solitary, mostly unilateral eruption composed of hyperkeratotic hypopigmented and hyperpigmented papules9 (Figure 1). The most frequent location is the trunk, followed by the extremities, but cases of facial lesions are known. Lichen striatus may be pruritic.10 Nail involvement has been described with the longitudinal fissuring being the most common presentation.11 Nail involvement may appear before the typical skin eruption and sometimes is an isolated finding; it usually resolves spontaneously.12
Dermoscopy is rarely used for the diagnostic purpose; linear white structures resembling Wickham striae and scar-like depigmentation were described in a case from Coto-Segura and colleagues.13
Histopathology
Lichen striatus is usually diagnosed clinically, based on the typical features described above. A biopsy may be performed, if diagnosis is in question. Prototypical histopathologic findings in lichen striatus are superficial and deep lymphohistiocytic infiltrate with lichenoid or patchy lichenoid changes (Figures 2-5). Deep infiltrate usually surrounds eccrine glands and/or hair follicles (Figures 2 and 5). Other common features include spongiosis, exocytosis of lymphocytes.14
Figure 2. Patchy lichenoid infiltrate with periadnexal involvement.
Figures 3 and 4. Focal epidermotropism and superficial fibrosis of the dermis, features mimicking mycosis fungoides.
Figure 5. Lymphocytic infiltrate around eccrine glands.
Because the presence of periadnexal infiltrates is important for the establishment of the diagnosis, shallow shave biopsies that lack eccrine glands or hair follicles may miss pertinent findings and lead to erroneous conclusions. Due to epidermotropism and syringotropism, some lichen striatus cases histopathologically may mimic mycosis fungoides; thus, clinical information is essential.15 Dermal lymphocytes in lichen striatus express CD4 and CD7, while epidermal lymphocytes are mostly CD8+.14,16
Differential Diagnosis
The most common differential diagnoses of lichen striatus and their distinguishing features are described in the Table. Rare entities that may present as linear eruption and mimic lichen striatus include linear morphea and lichen sclerosus.17,18
The term blashkitis is somewhat controversial and is not accepted by all dermatologists. Dermatologists are using this term in different settings and there is no unifying concept. Some authors use blashkitis for any case of lichen striatus in adults.19 Others consider it to be a different entity based on the fact that it is mainly pruritic and has mostly spongiotic changes without prominent necrotic keratinocytes.20
Pathogenesis
The exact etiology of lichen striatus is unknown. Genetic mosaicism or loss of heterozygosity in the skin may play a role.21 It is proposed that the aberrant clone is activated by a trigger (trauma, infection, etc.) and initiates T cell-mediated inflammatory process.14,16
Associated Diseases and Syndromes
Association of lichen striatus with atopic dermatitis is most common.9 Other rare associations include pityriasis lichenoides chronica, lichen nitidus, and lichen sclerosus.22-24
Management
Common treatment modalities for lichen striatus include topical steroids and topical pimecrolimus and tacrolimus.10,11 In children, 308-nm excimer laser treatment has been shown to improve residual hypopigmentation.25 Despite these therapeutic options, however, patients with lichen striatus should be reassured that their condition is self-resolving, benign, and nonscarring; treatment is often unnecessary.
Our Patient
Our patient was previously applying triamcinolone 0.1% ointment for 4 weeks. She was instructed to continue topical treatment with hydrocortisone 2.5% ointment as needed for symptomatic relief. At 6-month follow-up visit in our clinic, the eruption was partially resolving with flattened papules and areas of hyperpigmentation (Figure 6).
Figure 6. At 6-month follow-up visit,
the eruption was partially resolving with
flattened papules and areas of hyperpigmentation.
Conclusion
Lichen striatus is an inflammatory condition presented with linear papular eruption usually along the Blaschko lines. The condition is more frequently seen in children, but rare adult cases as well familial cases have been reported. Histopathology of lichen striatus is characterized by lichenoid lymphocytic infiltrate as well as deeper infiltrate around the sweat glands. Although the condition is usually self-limited, topical corticosteroids and calcineurin inhibitors may be used. Prognosis is usually favorable, and the condition resolves in the majority of cases.
Ms Siegel is with the University of Massachusetts Medical School in Worcester, MA.
Dr Gallitano is with the department of dermatology at SUNY Downstate Medical Center in Brooklyn, NY.
Dr Alapati is the department of dermatology at the Veterans Hospital in Brooklyn, NY.
Dr Kazlouskaya is with the department of dermatology at SUNY Downstate Medical Center in Brooklyn, NY.
Disclosure: The authors report no relevant financial relationships.
References
1. Peramiquel L, Baselga E, Dalmau J, Roe E, del Mar Campos M, Alomar A. Lichen striatus: clinical and epidemiological review of 23 cases. Eur J Pediatr. 2006;165(4):267-269.
2. Karempelis PS, Cely SJ, Davis LS. Lichen striatus in a mother and son. Int J Dermatol. 2014;53(7):e366.
3. Racette AJ, Adams AD, Kessler SE. Simultaneous lichen striatus in siblings along the same Blaschko line. Pediatr Dermatol. 2009;26(1):50-54.
4. Ishikawa M, Ohashi T, Yamamoto T. Lichen striatus following influenza infection. J Dermatol. 2014;41(12):1133-1134.
5. Unal E, Balta I, Bozkurt O. Lichen striatus: after a bite by bumblebee. Cutan Ocul Toxicol. 2015;34(2):171-172.
6. Lora V, Kanitakis J, Latini A, Cota C. Lichen striatus associated with etanercept treatment of rheumatoid arthritis. J Am Acad Dermatol. 2014;70(4):e90-e92.
7. Zaki SA, Sanjeev S. Lichen striatus following BCG vaccination in an infant. Indian Pediatr. 2011;48(2):163-164.
8. Mask-Bull L, Vangipuram R, Carroll BJ, Tarbox MB. Lichen striatus after interferon therapy. JAAD Case Rep. 2015;1(5):254-256.
9. Patrizi A, Neri I, Fiorentini C, Bonci A, Ricci G. Lichen striatus: clinical and laboratory features of 115 children. Pediatr Dermatol. 2004;21(3):197-204.
10. 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(7):732-736.
11. Kim M, Jung HY, Eun YS, Cho BK, Park HJ. Nail lichen striatus: report of seven cases and review of the literature. Int J Dermatol. 2015;54(11):1255-1260.
12. Tosti A, Peluso AM, Misciali C, Cameli N. Nail lichen striatus: clinical features and long-term follow-up of five patients. J Am Acad Dermatol. 1997;36(6 Pt 1):908-913.
13. Coto-Segura P, Costa-Romero M, Gonzalvo P, Mallo-Garcia S, Curto-Iglesias JR, Santos-Juanes J. Lichen striatus in an adult following trauma with central nail plate involvement and its dermoscopy features. Int J Dermatol. 2008;47(12):1324-1325.
14. Zhang Y, McNutt NS. Lichen striatus. Histological, immunohistochemical, and ultrastructural study of 37 cases. J Cutan Pathol. 2001;28(2):65-71.
15. Wang L, Chen F, Liu Y, Gao T, Wang G. Lichen striatus with syringotropism and hyperplasia of eccrine gland cells: a rare phenomenon that should not be confused with syringotropic mycosis fungoides. J Cutan Pathol. 2016;43(11):927-931.
16. Gianotti R, Restano L, Grimalt R, Berti E, Alessi E, Caputo R. Lichen striatus--a chameleon: an histopathological and immunohistological study of forty-one cases. J Cutan Pathol. 1995;22(1):18-22.
17. Muñoz Garza FZ, Manubens Mercadè E, Roè Crespo E, Puig Sanz L, Baselga Torres E. Linear morphea mimicking lichen striatus in its early presentation. Pediatr Dermatol. 2016;33(1):e23-e26.
18. Kumar P, Jha AK, Mallik SK, Raihan M. Bilateral zosteriform extragenital lichen sclerosus. Skinmed. 2014;12(2):123-125.
19. Tejera-Vaquerizo A, Ruiz-Molina I, Solís-Garcia E, Moreno-Giménez JC. [Adult blaschkitis (lichen striatus) successfully treated with topical tacrolimus]. Actas Dermosifiliogr. 2009;100(7):631-632.
20. Keegan BR, Kamino H, Fangman W, Shin HT, Orlow SJ, Schaffer JV. “Pediatric blaschkitis”: expanding the spectrum of childhood acquired Blaschko-linear dermatoses. Pediatr Dermatol. 2007;24(6):621-627.
21. Lipsker D, Cribier B, Girard-Lemaire F, Flori E, Grosshans E. Genetic mosaicism in an acquired inflammatory dermatosis following the lines of Blaschko. Arch Dermatol. 2000;136(6):805-807.
22. Erpolat S, Yenidunya S. Lichen striatus and pityriasis lichenoides chronica in an 11-year-old girl: an etiologic relationship? J Pak Med Assoc. 2015;65(9):1011-1113.
23. Cho EB, Kim HY, Park EJ, Kwon IH, Kim KH, Kim KJ. Three cases of lichen nitidus associated with various cutaneous diseases. Ann Dermatol. 2014;26(4):505-509.
24. Taniguchi Abagge K, Parolin Marinoni L, Giraldi S, Carvalho VO, de Oliveira Santini C, Favre H. Lichen striatus: description of 89 cases in children. Pediatr Dermatol. 2004;21(4):440-443.
25. Bae JM, Choo JY, Chang HS, Kim H, Lee JH, Kim GM. Effectiveness of the 308-nm excimer laser on hypopigmentation after lichen striatus: A retrospective study of 12 patients. J Am Acad Dermatol. 2016;75(3):637-639.
