LICHEN STRIATUS IN A RARE

PATTERN
Surajit Nayak, Basanti Acharjya, Basanti Devi, Gitanjali Sethi*
Indian J Dermatol 2007:52(1): *Department of Paediatrics

Surajit Nayak, Dept of Skin and VD, MKCG Medical College, Berhampur - 760 010,
Orissa, India.
E-mail: surajitnyk@yahoo.co.in

Lichen striatus is a self-limited linear dermatosis of unknown origin, most commonly

seen in children between 5-15 years of age. There is a female preporendence with a
ratio of 2:1. We report a case of a 10-month-old female child, who presented with
lichen striatus distributed along lines of Blaschko forming a peculiar pattern as
multiple parallel bands like branches of a tree.
The 10-month-old child was brought with complaints of linear, dull-colored, slightly
scaly band extending across left lower limb, along anterior trunk in median line then
traversing left upper limb in median aspect (Fig. 1). Three parallel bands of similar
morphology were found extending from linear band in trunk in a horizontal manner.
So also few linear bands were seen running parallel to the linear band on the arm on
its either side (Fig. 2). The bands were around 3 cm wide and were almost continuous
and consisted of small papules closely placed. As per the history given by parents it
started two months back in lower limb first, as a few small papules, which gradually
proceeded proximally and coalesced to form a linear band in due course of time.

On examination, the baby was found to be otherwise healthy child. The lesions
showed no umbilication or Wicham’s striae. Nail and hair were normal on
examination. Her investigation revealed a normal hematological and biochemical
profile. A biopsy was done, which showed hyperkeratosis, focal parakeratosis, with
lymphocytic exocytosis. In dermis there is superficial and deep perivascular
infiltration of lymphocytes and histiocytes, few necrotic keratinocytes were observed.
Histopathological study was consistent with lichen striatus. Parents were explained
about the benign nature of the disease and about its self-regressing nature. Though
lichen stritus is a disease of childhood, it can occur rarely in both infants and adults,
with a female predominance. Etiology is unknown, but report of its occurrence in
sibling, topic individuals, in spring and summer support genetic, infectious and
environmental factors.1-3
Figure-1 Tree like branching pattern over trunk

Figure 2 Linear parallel bands over extremity

In lichen striatus, an acquired event such as, viral infection may allow an aberrant
clone of cutaneous cells to express a new antigen, resulting in the phenotypic skin
changes.4 Though asymptomatic, few may experience mild pruritus. Nail
involvement may be observed in few patients as ridging, splitting, onycholysis or nail
loss.5,6 Though commonly on one arm or leg or on the neck, but may develop on the
trunk. Though in abdomen, buttock, thigh lesion is commonly seen as single
extensive linear lesion, it
may present as bilateral or parallel lesions, as seen in our case. Bilateral involvement
though very exceptional, has been reported.7,8
Usually it progresses over a few weeks and then remains stable for few months, but
eventually regresses by one year with some residual hypo pigmentation. Nail
involvement also regresses spontaneously. Histopathological study is not diagnostic
but very useful for excluding other conditions like nevus unius lateris and linear
lichen planus, as they closely resemble lichen striatus. Its diagnosis is basically made
on history and physical examination. In differential diagnosis come linear lichen
planus, porokeratosis, lichen nitidus and ILVEN. In ILVEN, clinical features appear at
birth or early infancy but do not regress spontaneously. Linear porokeratosis is also
need to be differentiated.9 Our case presents a very interesting case of lichen
striatus with a rare presentation of parallel bands like branches of a tree.
The patient was advised topical tacrolimus ointment, as reported to be effective.
Lichen stritus is a T-cell-mediated inflammatory disease and tacrolimus ointment may
be an effective alternative treatment for this disease. The patient was discharged
with advice to use topical tacrolimus as reported to be effective by few authors.10,
11

References
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Correspondence