The

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images in clinical medicine

Lichen Striatus and Lines of Blaschko

A B

3-year-old boy presented with a 3-week history of a V-shaped Ivan V. Litvinov, M.D., Ph.D. rash on his back (Panel A). On the basis of the acute appearance and typical Fatemeh Jafarian, M.D. blaschkoid distribution of the rash, lichen striatus was diagnosed. Lichen McGill University striatus is a benign, self-limited, linear inflammatory skin condition that follows Montreal, QC, Canada the lines of Blaschko. Usually diagnosed clinically, lichen striatus may require a fatemeh.jafarian@mcgill.ca biopsy in cases of uncertainty. Histologic findings show lichenoid, lymphocytic infiltrate with overlying epidermal acanthosis, dyskeratosis, hyperkeratosis, occasional parakeratosis, and lymphocytic exocytosis. Although most physicians are skilled at recognizing dermatomal borders, few are aware of the lines of Blaschko. These lines represent pathways of epidermal-cell migration and proliferation during fetal development and reflect the existence of cutaneous mosaicism (Panel B). Many skin eruptions, including certain epidermal nevi, linear psoriasis, linear morphea, and linear cutaneous lupus erythematosus, may follow the lines of Blaschko. Given the self-limited course of lichen striatus, the family decided to observe the child. At a 4-month follow-up visit, the rash was still unresolved.

DOI: 10.1056/NEJMicm1200973 Copyright 2012 Massachusetts Medical Society.

n engl j med 367;25

nejm.org

december 20, 2012

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The New England Journal of Medicine Downloaded from nejm.org by chintya permata sari on August 18, 2013. For personal use only. No other uses without permission. Copyright 2012 Massachusetts Medical Society. All rights reserved.