- Deepti Gupta, MD
Deepti Gupta, MD
- Assistant Professor of Dermatology and Pediatrics
- Department of Pediatrics and Division of Dermatology
- University of Washington School of Medicine
- Erin Mathes, MD
Erin Mathes, MD
- Assistant Professor of Dermatology - Departments of Dermatology and Pediatrics
- University of California, San Francisco
Lichen striatus is an acquired, asymptomatic, and self-limited linear inflammatory skin disorder that predominantly affects children . The eruption is typically unilateral, involves most often the extremities, and follows the lines of Blaschko in a continuous or interrupted pattern. The onset is sudden, with full progression over a few weeks and resolution typically within 6 to 12 months.
This topic will discuss the pathogenesis, clinical manifestations, diagnosis, and treatment of lichen striatus.
Lichen striatus is a relatively uncommon disease that most frequently occurs in children 5 to 15 years of age. However, it may occur at any age, from early infancy to adulthood [2-7]. Lichen striatus has been reported in all ethnic groups and appears to be more common in females [3,5-7]. There are a few reports of familial cases [3,8-12].
The precise etiology of lichen striatus is unknown. Viral infections, trauma, hypersensitivity reactions, vaccines, medications, and pregnancy have been proposed as triggering factors [13-17]. A positive personal or family history of asthma, atopic dermatitis, or allergic rhinitis has been reported in 60 to 85 percent of individuals with lichen striatus, suggesting that atopy may be a predisposing factor [5,18].
The distribution of lichen striatus along the lines of Blaschko (lines corresponding to the direction of growth of cutaneous cells during embryogenesis (figure 1)) suggests that lichen striatus is a condition of cutaneous mosaicism, due to somatic (postzygotic) mutations that produce abnormal keratinocyte clones during early embryogenesis. These aberrant clones may remain silent until a triggering event causes a break in immunologic tolerance and initiates an autoimmune response [4,19]. Potential triggers include viral infections, vaccines, trauma, pregnancy, hypersensitivity reactions, and medications [5,9,13-16,20-22].
- Senear FE, Caro MR. Lichen Striatus. Arch Dermatol Syphil 1941; 43:116.
- Peramiquel L, Baselga E, Dalmau J, et al. Lichen striatus: clinical and epidemiological review of 23 cases. Eur J Pediatr 2006; 165:267.
- Kennedy D, Rogers M. Lichen striatus. Pediatr Dermatol 1996; 13:95.
- 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.
- Patrizi A, Neri I, Fiorentini C, et al. Lichen striatus: clinical and laboratory features of 115 children. Pediatr Dermatol 2004; 21:197.
- Hofer T. Lichen striatus in adults or 'adult blaschkitis'?. There is no need for a new naming. Dermatology 2003; 207:89.
- Taniguchi Abagge K, Parolin Marinoni L, Giraldi S, et al. Lichen striatus: description of 89 cases in children. Pediatr Dermatol 2004; 21:440.
- Patrizi A, Neri I, Fiorentini C, et al. Simultaneous occurrence of lichen striatus in siblings. Pediatr Dermatol 1997; 14:293.
- Racette AJ, Adams AD, Kessler SE. Simultaneous lichen striatus in siblings along the same Blaschko line. Pediatr Dermatol 2009; 26:50.
- Kanegaye JT, Frieden IJ. Lichen striatus: simultaneous occurrence in siblings. Pediatrics 1992; 90:104.
- Yaosaka M, Sawamura D, Iitoyo M, et al. Lichen striatus affecting a mother and her son. J Am Acad Dermatol 2005; 53:352.
- Karempelis PS, Cely SJ, Davis LS. Lichen striatus in a mother and son. Int J Dermatol 2014; 53:e366.
- Dragos V, Mervic L, Zgavec B. Lichen striatus in a child after immunization. A case report. Acta Dermatovenerol Alp Pannonica Adriat 2006; 15:178.
- Karakaş M, Durdu M, Uzun S, et al. Lichen striatus following HBV vaccination. J Dermatol 2005; 32:506.
- Brennand S, Khan S, Chong AH. Lichen striatus in a pregnant woman. Australas J Dermatol 2005; 46:184.
- Lora V, Kanitakis J, Latini A, Cota C. Lichen striatus associated with etanercept treatment of rheumatoid arthritis. J Am Acad Dermatol 2014; 70:e90.
- Hafner C, Landthaler M, Vogt T. Lichen striatus (blaschkitis) following varicella infection. J Eur Acad Dermatol Venereol 2006; 20:1345.
- Toda K, Okamoto H, Horio T. Lichen striatus. Int J Dermatol 1986; 25:584.
- Gianotti R, Restano L, Grimalt R, et al. Lichen striatus--a chameleon: an histopathological and immunohistological study of forty-one cases. J Cutan Pathol 1995; 22:18.
- Hwang SM, Ahn SK, Lee SH, Choi EH. Lichen striatus following BCG vaccination. Clin Exp Dermatol 1996; 21:393.
- Shepherd V, Lun K, Strutton G. Lichen striatus in an adult following trauma. Australas J Dermatol 2005; 46:25.
- Coto-Segura P, Costa-Romero M, Gonzalvo P, et al. Lichen striatus in an adult following trauma with central nail plate involvement and its dermoscopy features. Int J Dermatol 2008; 47:1324.
- Keegan BR, Kamino H, Fangman W, et al. "Pediatric blaschkitis": expanding the spectrum of childhood acquired Blaschko-linear dermatoses. Pediatr Dermatol 2007; 24:621.
- Mu EW, Abuav R, Cohen BA. Facial lichen striatus in children: retracing the lines of Blaschko. Pediatr Dermatol 2013; 30:364.
- Litvinov IV, Jafarian F. Images in clinical medicine. Lichen striatus and lines of Blaschko. N Engl J Med 2012; 367:2427.
- Kurokawa M, Kikuchi H, Ogata K, Setoyama M. Bilateral lichen striatus. J Dermatol 2004; 31:129.
- Sato H, Shirai A, Asahina A. Case of lichen striatus presenting with multiple lesions along Blaschko's lines. J Dermatol 2012; 39:802.
- Karp DL, Cohen BA. Onychodystrophy in lichen striatus. Pediatr Dermatol 1993; 10:359.
- 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; 36:908.
- Kavak A, Kutluay L. Nail involvement in lichen striatus. Pediatr Dermatol 2002; 19:136.
- Kim M, Jung HY, Eun YS, et al. Nail lichen striatus: report of seven cases and review of the literature. Int J Dermatol 2015; 54:1255.
- Feely MA, Silverberg NB. Two cases of lichen striatus with prolonged active phase. Pediatr Dermatol 2014; 31:e67.
- Zhang Y, McNutt NS. Lichen striatus. Histological, immunohistochemical, and ultrastructural study of 37 cases. J Cutan Pathol 2001; 28:65.
- Müller CS, Schmaltz R, Vogt T, Pföhler C. Lichen striatus and blaschkitis: reappraisal of the concept of blaschkolinear dermatoses. Br J Dermatol 2011; 164:257.
- Requena C, Torrelo A, de Prada I, Zambrano A. Linear childhood cutaneous lupus erythematosus following Blaschko lines. J Eur Acad Dermatol Venereol 2002; 16:618.
- Gaitanis G, Nomikos K, Chaniotakis I, et al. Linear cutaneous lupus erythematosus: a subset of childhood cutaneous lupus erythematosus. Lupus 2009; 18:759.
- Kabbash C, Laude TA, Weinberg JM, Silverberg NB. Lichen planus in the lines of Blaschko. Pediatr Dermatol 2002; 19:541.
- Vassallo C, Derlino F, Ripamonti F, Borroni G. Lichenoid cutaneous chronic GvHD following Blaschko lines. Int J Dermatol 2014; 53:473.
- Kennedy FE, Hilari H, Ferrer B, Garcia-Patos V. Lichenoid chronic graft-vs-host disease following Blaschko lines. Actas Dermosifiliogr 2014; 105:89.
- Sertznig P, von Felbert V, Megahed M. Porokeratosis: present concepts. J Eur Acad Dermatol Venereol 2012; 26:404.
- Meziane M, Chraibi R, Kihel N, et al. Linear Darier disease. Dermatol Online J 2008; 14:11.
- Campanati A, Brandozzi G, Giangiacomi M, et al. Lichen striatus in adults and pimecrolimus: open, off-label clinical study. Int J Dermatol 2008; 47:732.
- Jo JH, Jang HS, Park HJ, et al. Early treatment of multiple and spreading lichen striatus with topical tacrolimus. J Am Acad Dermatol 2007; 57:904.
- Sorgentini C, Allevato MA, Dahbar M, Cabrera H. Lichen striatus in an adult: successful treatment with tacrolimus. Br J Dermatol 2004; 150:776.