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CASE REPORT
Year : 2017  |  Volume : 8  |  Issue : 4  |  Page : 264-266  

Bilateral lichen striatus: A case report with review of literature


1 Department of Dermatology, Dr. Ram Manohar Lohia Hospital, New Delhi, India
2 Department of Pathology, Dr. Ram Manohar Lohia Hospital, New Delhi, India

Date of Web Publication5-Jul-2017

Correspondence Address:
Aastha Gupta
C-31, Sector 47, Noida - 201 303, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/idoj.IDOJ_304_16

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   Abstract 

Lichen striatus is a self-limiting dermatosis presenting with sudden eruption of lichenoid papules along the lines of Blaschko. A 5-year-old girl presented with asymptomatic hypopigmented linear lesions over both upper limbs. The histopathological examination revealed spongiosis, vacuolar alteration of the basal layer and lymphocytic exocytosis with a mild-to-moderate perivascular mononuclear infiltrate in the dermis. Lichen striatus was diagnosed based upon the characteristic clinical and histopathological findings. The pathogenetic mechanism of bilateral lichen striatus is unknown at present, however, a somatic mutation in two different clones of cells can be a possibility.

Keywords: Bilateral, Blaschko, lichen striatus


How to cite this article:
Gupta A, Gautam RK, Bhardwaj M. Bilateral lichen striatus: A case report with review of literature. Indian Dermatol Online J 2017;8:264-6

How to cite this URL:
Gupta A, Gautam RK, Bhardwaj M. Bilateral lichen striatus: A case report with review of literature. Indian Dermatol Online J [serial online] 2017 [cited 2020 Sep 30];8:264-6. Available from: http://www.idoj.in/text.asp?2017/8/4/264/209614


   Introduction Top


Lichen striatus is an uncommon, self-limiting linear dermatosis that predominantly affects children of 5–15 years of age. It is diagnosed based upon its appearance and morphological expression along the  Lines of Blaschko More Details.[1] It usually appears as a sudden eruption of small skin-colored or pink lichenoid papules forming a continuous or interrupted, linear band on the limbs or trunk. The papules are usually asymptomatic, flat topped, smooth or scaly and evolve within several days to weeks. In dark-pigmented individuals, it may appear as a band-like area of hypopigmentation.[2] The lesions may extend from a few centimeters to involve the full length of an extremity. It is usually unilateral and single, although, bilateral or multiple parallel bands have been documented.[1],[2],[3],[4] To the best of our knowledge, only four cases of bilateral lichen striatus have been previously reported in the literature.


   Case Report Top


A 5-year-old girl presented with a hypopigmented linear band on the left upper extremity since 1 month. The lesions first appeared on the inner aspect of the left forearm and later extended linearly to involve the posterior aspect of the arm and trunk on the same side [Figure 1]. Further, her parents had also noticed hypopigmented pin head-sized asymptomatic raised lesions on the contralateral forearm in the last 5 days [Figure 2]. The lesions were not itchy. Nails were uninvolved. There were no features suggestive of atopy. Skin biopsy from the right forearm showed mild hyperkeratosis, spongiosis, vacuolar alteration of basal layer and lymphocytic exocytosis with a mild-to-moderate perivascular mononuclear inflammatory infiltrate and melanin incontinence in the dermis [Figure 3]. A distinctive feature of lichen striatus is a dense infiltrate extending deep into the dermis around the hair follicles and eccrine sweat glands and ducts in some cases, which was absent in our case. It was diagnosed as a case of lichen striatus based upon the characteristic clinical and histopathological findings. Emollients were prescribed for treatment and the lesions resolved within 3 months leaving no sequelae.
Figure 1: Hypopigmented macules forming a linear band along the lines of Blaschko extending from the back to the left arm and forearm

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Figure 2: Hypopigmented papules present linearly on the right forearm and hypopigmented linear macular lesion on the left forearm

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Figure 3: Epidermis showing spongiosis, vacuolar alteration of basal layer and lymphocytic exocytosis with a mononuclear infiltrate in the dermis (H and E, ×100)

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   Discussion Top


The pathogenesis of lichen striatus is elusive, however, various etiological factors have been implicated. The most commonly accepted hypothesis is that of environmental stimuli acting in a genetically predisposed individual.[5] Linear dermatoses such as lichen striatus follow the lines of Blaschko, which are embryonic in origin. A somatic mutation in early embryogenesis results in formation of an abnormal clone of cells, which on subsequent exposure to an environmental stimulus results in formation of lichen striatus.

Others believe that it is secondary to an autoimmune response mediated by T cells.[6] Atopy has been reported to be a predisposing factor. Drugs, such as adalimumab and etanercept, BCG and hepatitis B vaccination, UV exposure from a tanning bed, minor trauma, insect bite, and viral infections, such as varicella, influenza, and human herpes viruses 6 and 7 have been reported as triggers.[7],[8],[9]

The histopathological findings are nonspecific and vary depending on the stage of evolution. Usually a superficial perivascular lymphohistiocytic infiltrate is seen, which may extend focally into the lower part of epidermis causing vacuolar alteration of basal layer with melanin incontinence. The epidermal reaction pattern may include spongiosis, focal parakeratosis, and lymphocyte exocytosis.[10]

The course of LS is self-limiting, usually regressing spontaneously within 3–12 months, thus requiring symptomatic treatment only. The patient should be reassured and emollients and topical steroids may be used to relieve dryness and pruritus. Post-inflammatory hypopigmentation or hyperpigmentation can develop as a sequelae.[1]

Our patient had lesions which corroborated with the clinical and histopathological findings in lichen striatus, however, they were distributed bilaterally. To the best of our knowledge, only four cases of bilateral LS have been described previously [Table 1].[1],[2],[3],[11] Although the pathogenesis is unknown at present, a somatic mutation in two different clones of keratinocytes can be a possibility.
Table 1: Review of cases of bilateral lichen striatus

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Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Kurokawa M, Kikuchi H, Ogata K, Setoyama M. Bilateral lichen striatus. J Dermatol 2004;31:129-32.  Back to cited text no. 1
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2.
Aloi F, Solaroli C, Pippione M. Diffuse and bilateral lichen striatus. Pediatr Dermatol 1997;14:36-8.  Back to cited text no. 2
[PUBMED]    
3.
Patri P. Bilateral lichen striatus. G Ital Dermatol Venereol 1983;118:101-3.  Back to cited text no. 3
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4.
Mittal R, Khaitan BK, Ramam M, Verma KK, Manchanda M. Multiple lichen striatus-An unusual presentation. Indian J Dermatol Venereol Leprol 2001;67:204.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Taieb A, El Youbi A, Grosshans E, Maleville J. Lichen striatus: A Blaschko linear acquired inflammatory skin eruption. J Am Acad Dermatol 1991;25:637-42.  Back to cited text no. 5
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6.
Brennand S, Khan S, Chong AH. Lichen striatus in a pregnant woman. Australas J Dermatol 2005;46:184-6.  Back to cited text no. 6
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7.
Lora V, Kanitakis J, Latini A, Cota C. Lichen striatus associated with etanercept treatment of rheumatoid arthritis. J Am Acad Dermatol 2014;70:90-2.  Back to cited text no. 7
[PUBMED]    
8.
Ciconte A, Bekhor P. Lichen striatus following solarium exposure. Australas J Dermatol 2007;48:99-101.  Back to cited text no. 8
[PUBMED]    
9.
Ishikawa M, Ohashi T, Yamamoto T. Lichen striatus following influenza infection. J Dermatol 2014;41:1133-4.  Back to cited text no. 9
[PUBMED]    
10.
Gianotti R. Restano L, Grimalt R. Beni E, Alessi E, Caputo R. Lichen striatus - A chameleon; an histopathological and immunohistologieal study of forty-one eases. J Cutan Pathol 1995;22:18-22.  Back to cited text no. 10
    
11.
Mopper C, Horwitz DC. Bilateral lichen striatus. Cutis 1971;8:140-1.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1]


This article has been cited by
1 Asymmetric Bilateral Lichen Striatus: A Rare Presentation following Multiple Blaschko’s Lines
Jeffrey S. Dickman,McKay D. Frandsen,Andrew J. Racette
Case Reports in Dermatological Medicine. 2018; 2018: 1
[Pubmed] | [DOI]



 

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