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{{SI}}
{{SI}}


{{CMG}}
{{CMG}}; {{M.P}} {{KS}}
 
{{SK}} Linear lichenoid dermatosis


==Overview==
==Overview==
Lichen striatus is also known as Blaschko linear acquired inflammatory skin eruption<ref name="Fitz2">Freedberg, et al. (2003). ''Fitzpatrick's Dermatology in General Medicine''. (6th ed.). McGraw-Hill. ISBN 0-07-138076-0.</ref> and Linear lichenoid dermatosis.<ref name="Bolognia">{{cite book |author=Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. |title=Dermatology: 2-Volume Set |publisher=Mosby |location=St. Louis |year=2007 |pages= |isbn=1-4160-2999-0 |oclc= |doi= |accessdate=}}</ref>
Lichens striatus (LS) is an acquired, self-limiting inflammatory dermatosis that follows the lines of Blaschko.
 
==Pathophysiology==
[[Blaschko lines]] have an embryologic origin and correspond to the direction of growth of the cutaneous cells, resulting in a cutaneous mosaicism. The genetic mosaicism could be responsible for cutaneous antigenic mosaicism,  the expression of which might be induced by various external factors. Lichen striatus has been considered to be the consequence of an acquired stimulus that induces a loss of immunotolerance to embryologically abnormal clones, resulting in a T-cell-mediated inflammatory reaction.<ref name="pmid15165195">{{cite journal| author=Patrizi A, Neri I, Fiorentini C, Bonci A, Ricci G| title=Lichen striatus: clinical and laboratory features of 115 children. | journal=Pediatr Dermatol | year= 2004 | volume= 21 | issue= 3 | pages= 197-204 | pmid=15165195 | doi=10.1111/j.0736-8046.2004.21302.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15165195  }} </ref>


==Causes==
==Causes==
The etiology of the eruption is unknown. Several theories suggest the following factors could be a possible etiology.<ref name="pmid15165195">{{cite journal| author=Patrizi A, Neri I, Fiorentini C, Bonci A, Ricci G| title=Lichen striatus: clinical and laboratory features of 115 children. | journal=Pediatr Dermatol | year= 2004 | volume= 21 | issue= 3 | pages= 197-204 | pmid=15165195 | doi=10.1111/j.0736-8046.2004.21302.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15165195  }} </ref>
The etiology of the eruption is unknown. Several theories suggest a genetic predispostion with the following acting as possible triggers.<ref name="pmid15165195">{{cite journal| author=Patrizi A, Neri I, Fiorentini C, Bonci A, Ricci G| title=Lichen striatus: clinical and laboratory features of 115 children. | journal=Pediatr Dermatol | year= 2004 | volume= 21 | issue= 3 | pages= 197-204 | pmid=15165195 | doi=10.1111/j.0736-8046.2004.21302.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15165195  }} </ref>
* Genetic predisposition
* [[Hypersensitivity]]
* Hypersensitivity
* Cutaneous injury
* Cutaneous injury
* Viral infection
* [[Viral|Viral infection]]
* Environmental factors
* Environmental factors
* [[Immunization]]<ref name="pmid16043931">{{cite journal| author=Karakaş M, Durdu M, Uzun S, Karakaş P, Tuncer I, Cevlik F| title=Lichen striatus following HBV vaccination. | journal=J Dermatol | year= 2005 | volume= 32 | issue= 6 | pages= 506-8 | pmid=16043931 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16043931  }} </ref><ref name="pmid9136170">{{cite journal| author=Hwang SM, Ahn SK, Lee SH, Choi EH| title=Lichen striatus following BCG vaccination. | journal=Clin Exp Dermatol | year= 1996 | volume= 21 | issue= 5 | pages= 393-4 | pmid=9136170 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9136170  }} </ref>
* [[Pregnancy]]<ref name="pmid16008653">{{cite journal| author=Brennand S, Khan S, Chong AH| title=Lichen striatus in a pregnant woman. | journal=Australas J Dermatol | year= 2005 | volume= 46 | issue= 3 | pages= 184-6 | pmid=16008653 | doi=10.1111/j.1440-0960.2005.00176.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16008653  }} </ref>
==Differentiating Lichen Striatus from other Conditions==
* [[Lichen planus]]


==Epidemiology and Demographics==
==Epidemiology and Demographics==
Lichen striatus is a rare skin condition that is seen primarily in children, most frequently appearing ages 5–15.<ref name="Andrews">{{cite book |author=James, William D.; Berger, Timothy G.; et al. |title=Andrews' Diseases of the Skin: clinical Dermatology |publisher=Saunders Elsevier |location= |year=2006 |pages= |isbn=0-7216-2921-0 |oclc= |doi= |accessdate=}}</ref> It consists of a [[self-limiting (biology)|self-limiting]] eruption of small, scaly [[papule]]s.<ref name="Andrews new ed">{{cite book| edition = 11th| publisher = Elsevier| isbn = 9781437703146| last = James| first = William D.| first2 = Timothy G. |last2=Berger|first3= Dirk M.|last3= Elston| title = Andrews' Diseases of the Skin: Clinical Dermatology|location=London|year=2011|pages=223–224}}</ref>
Lichen striatus is a rare skin condition that is seen primarily in children, most frequently appearing ages 5–15.<ref name="Andrews">{{cite book |author=James, William D.; Berger, Timothy G.; et al. |title=Andrews' Diseases of the Skin: clinical Dermatology |publisher=Saunders Elsevier |location= |year=2006 |pages= |isbn=0-7216-2921-0 |oclc= |doi= |accessdate=}}</ref> It consists of a [[self-limiting (biology)|self-limiting]] eruption of small, scaly [[papule]]s.<ref name="Andrews new ed">{{cite book| edition = 11th| publisher = Elsevier| isbn = 9781437703146| last = James| first = William D.| first2 = Timothy G. |last2=Berger|first3= Dirk M.|last3= Elston| title = Andrews' Diseases of the Skin: Clinical Dermatology|location=London|year=2011|pages=223–224}}</ref>
==Natural History, Prognosis and Complications==
Lichen striatus has spontaneous remission, although the course of the disease is prolonged when nail involvement exists. Patients treated by a combination of topical retinoid with topical steroid have rapid resolution of lichen striatus and they not only achieve satisfying cosmesis, but also complete resolution of their pruritus. The most common side effect of the topical medication is localized irritation at treatment sites, but most of them would tolerate the treatment well.
==Diagnosis==
===History and Symptoms===
Lichen striatus presents as an eruption characterized by sudden onset of flat-topped, 1 to 4 mm, pink, tan, or hypopigmented papules in a linear configuration or [[Blaschko lines|Blaschkoid distribution]]. It may be associated with some irritation and soreness in the muscles of the affected parts.
===Physical Examination===
====Skin====
=====Trunk=====
<gallery>
Image:Lichen striatus04.jpg|Lichen striatus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
</gallery>
=====Extremity=====
<gallery>
Image:Lichen striatus01.jpg|Lichen striatus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lichen striatus02.jpg|Lichen striatus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lichen striatus03.jpg|Lichen striatus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lichen striatus05.jpg|Lichen striatus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lichen striatus06.jpg|Lichen striatus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Lichen striatus07.jpg|Lichen striatus. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
</gallery>
===Laboratory Findings===
Histopathologic examination of papules would reveal the presence of a lichenoid, lymphocytic infiltration and scattered melanin incontinence in the papillary dermis with epidermal hyperkeratosis, exocytosis of lymphocytes and necrotic keratinocytes.
==Treatment==
The condition is benign and no need for biopsy. Studies have showed monitoring without biopsy is a reasonable approach to the management of uncomplicated lichen striatus, particularly when the face is involved. However topical medications would produce rapid resolution. The following are currently used medications :
* [[Tretinoin|Topical retinoids]]
* [[Corticosteroids|Topical steroids]]
* [[Tacrolimus]], especially for facial lesions<ref name="pmid12653755">{{cite journal| author=Fujimoto N, Tajima S, Ishibashi A| title=Facial lichen striatus: successful treatment with tacrolimus ointment. | journal=Br J Dermatol | year= 2003 | volume= 148 | issue= 3 | pages= 587-90 | pmid=12653755 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12653755  }} </ref>
* [[Light therapy|Photodynamic theraphy]]<ref name="pmid22300391">{{cite journal| author=Park JY, Kim YC| title=Lichen striatus successfully treated with photodynamic therapy. | journal=Clin Exp Dermatol | year= 2012 | volume= 37 | issue= 5 | pages= 570-2 | pmid=22300391 | doi=10.1111/j.1365-2230.2011.04284.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22300391  }} </ref>


==References==
==References==

Latest revision as of 18:05, 9 September 2014

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Mugilan Poongkunran M.B.B.S [2] Kiran Singh, M.D. [3]

Synonyms and keywords: Linear lichenoid dermatosis

Overview

Lichens striatus (LS) is an acquired, self-limiting inflammatory dermatosis that follows the lines of Blaschko.

Pathophysiology

Blaschko lines have an embryologic origin and correspond to the direction of growth of the cutaneous cells, resulting in a cutaneous mosaicism. The genetic mosaicism could be responsible for cutaneous antigenic mosaicism, the expression of which might be induced by various external factors. Lichen striatus has been considered to be the consequence of an acquired stimulus that induces a loss of immunotolerance to embryologically abnormal clones, resulting in a T-cell-mediated inflammatory reaction.[1]

Causes

The etiology of the eruption is unknown. Several theories suggest a genetic predispostion with the following acting as possible triggers.[1]

Differentiating Lichen Striatus from other Conditions

Epidemiology and Demographics

Lichen striatus is a rare skin condition that is seen primarily in children, most frequently appearing ages 5–15.[5] It consists of a self-limiting eruption of small, scaly papules.[6]

Natural History, Prognosis and Complications

Lichen striatus has spontaneous remission, although the course of the disease is prolonged when nail involvement exists. Patients treated by a combination of topical retinoid with topical steroid have rapid resolution of lichen striatus and they not only achieve satisfying cosmesis, but also complete resolution of their pruritus. The most common side effect of the topical medication is localized irritation at treatment sites, but most of them would tolerate the treatment well.

Diagnosis

History and Symptoms

Lichen striatus presents as an eruption characterized by sudden onset of flat-topped, 1 to 4 mm, pink, tan, or hypopigmented papules in a linear configuration or Blaschkoid distribution. It may be associated with some irritation and soreness in the muscles of the affected parts.

Physical Examination

Skin

Trunk
Extremity

Laboratory Findings

Histopathologic examination of papules would reveal the presence of a lichenoid, lymphocytic infiltration and scattered melanin incontinence in the papillary dermis with epidermal hyperkeratosis, exocytosis of lymphocytes and necrotic keratinocytes.

Treatment

The condition is benign and no need for biopsy. Studies have showed monitoring without biopsy is a reasonable approach to the management of uncomplicated lichen striatus, particularly when the face is involved. However topical medications would produce rapid resolution. The following are currently used medications :

References

  1. ↑ 1.0 1.1 Patrizi A, Neri I, Fiorentini C, Bonci A, Ricci G (2004). "Lichen striatus: clinical and laboratory features of 115 children". Pediatr Dermatol. 21 (3): 197–204. doi:10.1111/j.0736-8046.2004.21302.x. PMID 15165195.
  2. ↑ Karakaş M, Durdu M, Uzun S, Karakaş P, Tuncer I, Cevlik F (2005). "Lichen striatus following HBV vaccination". J Dermatol. 32 (6): 506–8. PMID 16043931.
  3. ↑ Hwang SM, Ahn SK, Lee SH, Choi EH (1996). "Lichen striatus following BCG vaccination". Clin Exp Dermatol. 21 (5): 393–4. PMID 9136170.
  4. ↑ Brennand S, Khan S, Chong AH (2005). "Lichen striatus in a pregnant woman". Australas J Dermatol. 46 (3): 184–6. doi:10.1111/j.1440-0960.2005.00176.x. PMID 16008653.
  5. ↑ James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0.
  6. ↑ James, William D.; Berger, Timothy G.; Elston, Dirk M. (2011). Andrews' Diseases of the Skin: Clinical Dermatology (11th ed.). London: Elsevier. pp. 223–224. ISBN 9781437703146.
  7. ↑ 7.0 7.1 7.2 7.3 7.4 7.5 7.6 "Dermatology Atlas".
  8. ↑ Fujimoto N, Tajima S, Ishibashi A (2003). "Facial lichen striatus: successful treatment with tacrolimus ointment". Br J Dermatol. 148 (3): 587–90. PMID 12653755.
  9. ↑ Park JY, Kim YC (2012). "Lichen striatus successfully treated with photodynamic therapy". Clin Exp Dermatol. 37 (5): 570–2. doi:10.1111/j.1365-2230.2011.04284.x. PMID 22300391.


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