• Users Online: 114
  • Print this page
  • Email this page


 
  Table of Contents  
LETTER TO THE EDITOR
Year : 2012  |  Volume : 3  |  Issue : 1  |  Page : 71-73  

Linear psoriasis: A rare presentation


1 Department of Dermatology, Sri Venkateshwaraa Medical College Hospital and Research Centre, Ariyur, Puducherry-605102, India
2 Department of Pathology, Sri Venkateshwaraa Medical College Hospital and Research Centre, Ariyur, Puducherry-605102, India

Date of Web Publication3-Mar-2012

Correspondence Address:
Nidhi Singh
Department of Dermatology, Sri Venkateshwaraa Medical College Hospital and Research Centre, Ariyur, Puducherry-605102
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5178.93489

Rights and Permissions

How to cite this article:
Singh N, Noorunnisa N. Linear psoriasis: A rare presentation. Indian Dermatol Online J 2012;3:71-3

How to cite this URL:
Singh N, Noorunnisa N. Linear psoriasis: A rare presentation. Indian Dermatol Online J [serial online] 2012 [cited 2019 Sep 17];3:71-3. Available from: http://www.idoj.in/text.asp?2012/3/1/71/93489

Sir,

A 70-year-old female presented with occasional mildly pruritic linear lesions over left upper limb of 10 years duration. The lesions initially started on the left forearm and progressed proximally over the left arm and distally up to the first web space of hand. There was no history of trauma or skin lesions elsewhere in the body. No other family members had similar lesions. Examination revealed well-defined, erythematous scaly papules and plaques arranged linearly over the lateral border of distal left arm, left forearm extending up to the first web space [Figure 1], [Figure 2] and [Figure 3]. There was no involvement of nail or scalp. There were no psoriatic skin lesions elsewhere in the body. Skin biopsy was taken and histopathology revealed orthokeratosis, parakeratosis, Munro's microabscesses, elongated and club-shaped rete ridges, suprapapillary thinning of epidermis and focal lymphocytic infiltrates in superficial dermis [Figure 4]. Thus, the diagnosis of linear psoriasis was established. The patient was treated with twice daily application of combination of 0.05% clobetasol propionate and 3% salicylic acid for 4 weeks following which the lesions resolved.
Figure 1: Forearm with psoriatic lesions in the linear distribution

Click here to view
Figure 2: Close view of the lesions showing erythematous scaly plaques

Click here to view
Figure 3: Psoriatic lesions extending to hand

Click here to view
Figure 4: Histopathological examination showing hyperkeratosis, parakeratosis, Munro's microabscess, elongated and club-shaped rete ridges, suprapapillary thinning of epidermis and focal lymphocytic infiltrates in superficial dermis

Click here to view


Linear psorias is characterized by a linear distribution of psoriatic lesions along Blaschko's lines. True linear psoriasis in the absence of lesions elsewhere is extremely rare with few cases reported in the literature. [1] Happle proposed the pathogenesis of linear psoriasis as somatic recombination of a gene predisposing to psoriasis leading to segmental mosaicism. This hypothesis offers a reasonable explanation for linear psoriasis being a nonhereditary trait and the linear distribution similar to many other mosaic skin disorders. [2] Linear psoriasis may be confused with inflammatory linear verrucous epidermal nevus (ILVEN) or Koebners's response of psoriasis over verrucous epidermal nevus. [3] ILVEN tends to develop during the first month of life, progresses slowly, can be very pruritic and is usually unresponsive to treatment. However, linear psoriasis tends to develop later in life, progresses rapidly, only occasionally pruritic and responds well to antipsoriatic treatment. [4] Immunohistopathological studies may be helpful in further distinguishing linear psoriasis and ILVEN. There is lower expression of keratin 10 in psoriasis as compared to normal levels in ILVEN. Involucrin expression is absent in ILVEN, but detectable in psoriasis. [4] Psoriasis overlying an epidermal nevus also has been described, but the lesions are extremely pruritic and most of the cases develop typical psoriatic lesions elsewhere in the body. [5] Our patient had onset of lesions late in life and did not develop lesions of psoriasis elsewhere in the body during the span of 10 years and the lesions progressed only in a linear distribution causing only mild pruritus. In addition, histopathology revealed features of psoriasis and the lesions responded well to treatment.

 
   References Top

1.Chien P Jr, Rosenman K, Cheung W, Wang N, Sanchez M. Linear psoriasis. Dermatol Online J 2009;15:4.  Back to cited text no. 1
    
2.Happle R. Somatic recombination may explain linear psoriasis. J Med Genet 1991;28:337.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.Morag C, Metzker A. Inflammatory linear verrucous epidermal nevus: Report of seven new cases and review of the literature. Pediatr Dermatol 1985;3:15-8.  Back to cited text no. 3
[PUBMED]    
4.de Jong E, Rulo HF, van de Kerkhof PC. Inflammatory linear verrucous epidermal naevus (ILVEN) versus linear psoriasis: Clinical, histological and immunohistochemical study. Acta Derm Venereol 1991;71:343-6.  Back to cited text no. 4
[PUBMED]    
5.Bondi EE. Psoriasis overlying an epidermal nevus. Arch Dermatol 1979;115:624-5.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    References
    Article Figures

 Article Access Statistics
    Viewed1937    
    Printed48    
    Emailed0    
    PDF Downloaded283    
    Comments [Add]    

Recommend this journal