Lichen Striatus

Lichen Striatus

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Lichen striatus is a rare, benign, self-limited linear dermatosis of unknown origin that predominantly affects children. Lichen striatus is clinically diagnosed on the basis of its appearance and characteristic developmental pattern following the lines of Blaschko. [1]

The skin is the primary organ system affected by lichen striatus. However, lichen striatus also may involve the nails. [2, 3]

The etiology of lichen striatus is unknown. Many etiologic or predisposing factors are suggested for lichen striatus. The most commonly accepted hypothesis is the combination of genetic predisposition with environmental stimuli.

Atopy may be a predisposing factor. One group reported that 85% of patients with lichen striatus have a family history of atopic dermatitis, asthma, or allergic rhinitis. However, another report disputes this claim, stating that the incidence of atopy is no greater than that of the general population.

An autoimmune response may also be involved in lichen striatus. A case of lichen striatus has been reported during pregnancy, and it has been postulated that the pregnancy may have triggered an autoimmune response leading to the appearance of the eruption. [4] Lichen striatus has also been reported concurrently with vitiligo [5, 6] and after adalimumab [7] and etanercept. [8] Some reports simply suggest that lichen striatus is an inflammatory skin disease mediated by T cells. It has been reported 17 months after allogenic peripheral blood stem cell transplantation. [9]

An environmental (infectious or trauma [10] ) etiology has also been suggested. Familial cases, [11, 12] outbreaks among unrelated children in a shared living environment, and a possible seasonal variation suggest an environmental agent, such as a virus. Support of infectious involvement includes elevations of interleukin 1-beta in lichen striatus biopsy specimens. [13] However, results of viral testing have not conclusively proven this association. In addition, familial episodes of lichen striatus are not always simultaneous, signifying a possible genetic predisposition as a second explanation. Lichen striatus has been reported to occur shortly following immunization with BCG and hepatitis B vaccination, after UV exposure from a tanning bed, [14] following a prick from a pineapple leaf, after a bite by a bumblebee, [15] and after varicella and influenza infection. [16, 17]

One group of authors has suggested that epigenetic mosaicism may be involved. They hypothesize that lichen striatus is triggered by an immunologic reaction to an infection, which triggers methylation or demethylation of a partially silenced genomic element in predisposed patients. [13] A report of concurrent pityriasis rosea and lichen striatus may lend support to this theory. Human herpes viruses 6 and 7 have been implicated in the etiology of pityriasis rosea. The concurrent lichen striatus eruption may have manifested after being triggered by this viral infection. [18]

Lesions of lichen striatus follow the lines of Blaschko. [19, 13, 20, 21, 22] Blaschko lines are thought to be embryologic in origin. They are believed to be the result of the segmental growth of clones of cutaneous cells or the mutation-induced mosaicism of cutaneous cells. In lichen striatus, an acquired event (eg, viral infection) may allow an aberrant clone of cutaneous cells to express a new antigen, resulting in the phenotypic skin changes.

No racial predilection is recognized for lichen striatus.

No consensus exists on sex predilection in lichen striatus. Some studies show a 2- to 3-fold increased incidence in girls compared with boys, whereas others show an equal sex distribution.

Lichen striatus is primarily a disease of young children. More than 50% of all lichen striatus cases occur in children aged 5-15 years. Other reports dispute this age range and claim that the median age of onset for lichen striatus is 3 years. Although lichen striatus is rare in both infants and adults, the disease can occur in persons of any age. [23, 24]

The prognosis of patients with lichen striatus is excellent. Recovery is complete. Lichen striatus lesions usually regress spontaneously within 1 year, with a range of 4 weeks to 3 years. Relapses of lichen striatus may occur, but these are uncommon.

Lichen striatus of the nail may take a protracted course, lasting from 6 months to 5 years. [25] Nail involvement resolves spontaneously without deformity.

Suárez-Peñaranda JM, Figueroa O, Rodríguez-Blanco I, Aliste C, Casas L. Unusual Interface Dermatoses Distributed Along Blaschko’s Lines in Adult Patients. Am J Dermatopathol. 2017 Feb. 39 (2):144-149. [Medline].

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 Jun. 36(6 Pt 1):908-13. [Medline].

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 Nov. 54 (11):1255-60. [Medline].

Brennand S, Khan S, Chong AH. Lichen striatus in a pregnant woman. Australas J Dermatol. 2005 Aug. 46(3):184-6. [Medline].

Mu EW, Abuav R, Cohen BA. Facial lichen striatus in children: retracing the lines of blaschko. Pediatr Dermatol. 2013 May-Jun. 30(3):364-6. [Medline].

Correia LD, Silva de Castro CC. Association between bilateral segmental vitiligo and lichen striatus: an expression of mosaicism?. Int J Dermatol. 2018 Mar 8. [Medline].

Monteagudo B, Cabanillas M, Suárez-Amor O, Ramírez-Santos A, Alvarez JC, de Las Heras C. [Adult blaschkitis (lichen striatus) in a patient treated with adalimumab]. Actas Dermosifiliogr. 2010 Dec. 101(10):891-2. [Medline].

Lora V, Kanitakis J, Latini A, Cota C. Lichen striatus associated with etanercept treatment of rheumatoid arthritis. J Am Acad Dermatol. 2014 Apr. 70 (4):e90-2. [Medline].

Mun JH, Park HJ, Kim HS, Kim SH, Ko HC, Kim BS. Lichen striatus occurring after allogenic peripheral blood stem cell transplantation in an adult with aplastic anemia. Ann Dermatol. 2012 Feb. 24(1):87-9. [Medline].

Shepherd V, Lun K, Strutton G. Lichen striatus in an adult following trauma. Australas J Dermatol. 2005 Feb. 46(1):25-8. [Medline].

Patrizi A, Neri I, Fiorentini C, Chieregato C, Bonci A. Simultaneous occurrence of lichen striatus in siblings. Pediatr Dermatol. 1997 Jul-Aug. 14(4):293-5. [Medline].

Yaosaka M, Sawamura D, Iitoyo M, Shibaki A, Shimizu H. Lichen striatus affecting a mother and her son. J Am Acad Dermatol. 2005 Aug. 53(2):352-3. [Medline].

Racette AJ, Adams AD, Kessler SE. Simultaneous lichen striatus in siblings along the same Blaschko line. Pediatr Dermatol. 2009 Jan-Feb. 26(1):50-4. [Medline].

Ciconte A, Bekhor P. Lichen striatus following solarium exposure. Australas J Dermatol. 2007 May. 48(2):99-101. [Medline].

Unal E, Balta I, Bozkurt O. Lichen striatus: after a bite by bumblebee. Cutan Ocul Toxicol. 2015. 34 (2):171-2. [Medline].

Hafner C, Landthaler M, Vogt T. Lichen striatus (blaschkitis) following varicella infection. J Eur Acad Dermatol Venereol. 2006 Nov. 20(10):1345-7. [Medline].

Ishikawa M, Ohashi T, Yamamoto T. Lichen striatus following influenza infection. J Dermatol. 2014 Dec. 41 (12):1133-4. [Medline].

Verma P, Singal A, Yadav P, Sharma R. Concurrence of lichen striatus and localised pityriasis rosea: Cutaneous mosaicism. Australas J Dermatol. 2013 Feb. 54(1):41-2. [Medline].

Arias-Santiago SA, Sierra Giron-Prieto M, Fernandez-Pugnarie MA, Naranjo-Sintes R. [Lichen striatus following Blaschko lines]. An Pediatr (Barc). 2009 Jul. 71(1):76-7. [Medline].

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 Nov-Dec. 24(6):621-7. [Medline].

Patrizi A, Neri I, Fiorentini C, Bonci A, Ricci G. Lichen striatus: clinical and laboratory features of 115 children. Pediatr Dermatol. 2004 May-Jun. 21(3):197-204. [Medline].

Taieb A, el Youbi A, Grosshans E, Maleville J. Lichen striatus: a Blaschko linear acquired inflammatory skin eruption. J Am Acad Dermatol. 1991 Oct. 25(4):637-42. [Medline].

Hofer T. Lichen striatus in adults or ‘adult blaschkitis’?. There is no need for a new naming. Dermatology. 2003. 207(1):89-92. [Medline].

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 Jul-Aug. 21(4):440-3. [Medline].

Kim GW, Kim SH, Seo SH, Jung DS, Ko HC, Kim MB, et al. Lichen striatus with nail abnormality successfully treated with tacrolimus ointment. J Dermatol. 2009 Nov. 36(11):616-7. [Medline].

Aloi F, Solaroli C, Pippione M. Diffuse and bilateral lichen striatus. Pediatr Dermatol. 1997 Jan-Feb. 14(1):36-8. [Medline].

Kurokawa M, Kikuchi H, Ogata K, Setoyama M. Bilateral lichen striatus. J Dermatol. 2004 Feb. 31(2):129-32. [Medline].

Vukicevic J, Milobratovic D, Vesic S, Milosevic-Jovcic N, Ciric D, Medenica L. Unilateral multiple lichen striatus treated with tacrolimus ointment: a case report. Acta Dermatovenerol Alp Panonica Adriat. 2009 Mar. 18(1):35-8. [Medline].

Kavak A, Kutluay L. Nail involvement in lichen striatus. Pediatr Dermatol. 2002 Mar-Apr. 19(2):136-8. [Medline].

Amer A. Bilateral onychodystrophy in a boy with a history of isolated lichen striatus. Cutis. 2014 Nov. 94 (5):E16-9. [Medline].

Leposavic R, Belsito DV. Onychodystrophy and subungual hyperkeratosis due to lichen striatus. Arch Dermatol. 2002 Aug. 138(8):1099-100. [Medline].

Al-Niaimi FA, Cox NH. Unilateral lichen striatus with bilateral onychodystrophy. Eur J Dermatol. 2009 Jun 5. [Medline].

Coto-Segura P, Costa-Romero M, Gonzalvo P, Mallo-García 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 Dec. 47(12):1324-5. [Medline].

Mascolo M, Russo D, Scalvenzi M, Di Lorenzo P, Cerroni L. Lichen striatus histopathologically mimicking mycosis fungoides. J Dtsch Dermatol Ges. 2014 Nov. 12(11):1048-50. [Medline].

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 Nov. 43 (11):927-931. [Medline].

Tilly JJ, Drolet BA, Esterly NB. Lichenoid eruptions in children. J Am Acad Dermatol. 2004 Oct. 51(4):606-24. [Medline].

Youssef SM, Teng JM. Effective topical combination therapy for treatment of lichen striatus in children: a case series and review. J Drugs Dermatol. 2012 Jul. 11(7):872-5. [Medline].

Park JY, Kim YC. Lichen striatus successfully treated with photodynamic therapy. Clin Exp Dermatol. 2012 Feb 2. [Medline].

Lee DY, Kim S, Kim CR, Kim HJ, Byun JY, Yang JM. Lichen striatus in an adult treated by a short course of low-dose systemic corticosteroid. J Dermatol. 2011 Mar. 38(3):298-9. [Medline].

Errichetti E, Stinco G, Trevisan G, Patrone P. Lichen striatus associated with psoriasis vulgaris treated with oral acitretin. Indian Dermatol Online J. 2014 Oct. 5 (4):501-3. [Medline].

Fujimoto N, Tajima S, Ishibashi A. Facial lichen striatus: successful treatment with tacrolimus ointment. Br J Dermatol. 2003 Mar. 148(3):587-90. [Medline].

Sorgentini C, Allevato MA, Dahbar M, Cabrera H. Lichen striatus in an adult: successful treatment with tacrolimus. Br J Dermatol. 2004 Apr. 150(4):776-7. [Medline].

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 Jul. 47(7):732-6. [Medline].

Tejera-Vaquerizo A, Ruiz-Molina I, Solis-Garcia E, Moreno-Gimenez JC. [Adult blaschkitis (lichen striatus) successfully treated with topical tacrolimus.]. Actas Dermosifiliogr. 2009 Sep. 100(7):631-2. [Medline].

Romita P, Ettorre G, Bufano T, Marzullo A, Ballini A, Dipalma G, et al. Lichen striatus successfully treated with oral cyclosporine. Int J Immunopathol Pharmacol. 2017 Dec. 30 (4):420-422. [Medline].

June Kim, MD Mohs Surgeon/Dermatologist, Cascade Eye and Skin Center, PC

June Kim, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, American Medical Association, American Society for Dermatologic Surgery

Disclosure: Nothing to disclose.

Wingfield Rehmus, MD, MPH Dermatologist, BC Children’s Hospital, Vancouver, British Columbia

Wingfield Rehmus, MD, MPH is a member of the following medical societies: American Academy of Dermatology, Society for Pediatric Dermatology

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Abbvie; Valeant Canada<br/> Received honoraria from Valeant Canada for advisory board; Received honoraria from Pierre Fabre for advisory board; Received honoraria from Mustella for advisory board; Received honoraria from Abbvie for advisory board.

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Paul Krusinski, MD Director of Dermatology, Fletcher Allen Health Care; Professor, Department of Internal Medicine, University of Vermont College of Medicine

Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Daniel J Hogan, MD Clinical Professor of Internal Medicine (Dermatology), Nova Southeastern University College of Osteopathic Medicine; Investigator, Hill Top Research, Florida Research Center

Daniel J Hogan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, Canadian Dermatology Association

Disclosure: Nothing to disclose.

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Nelly Rubeiz, MD, and Amal Mehanna, MD, to the development and writing of this article.

Lichen Striatus

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