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 1. Kennedy D, Rogers M. Lichen striatus. Pediatr Dermatol 1996; 13:95-9. 2. Di Lernia V, Ricci G, Bonci A, Patrizi A. Lichen striatus and atopy. Int J Dermatol 1991; 30:453-4. 3. Patrizi A, Neri I, Fiorentini C, Chieregato C, Bonci A. Simultaneous occurrence of Lichen striatus in siblings. Pediatr 2005 Feb 23]. 5. Baran R, Dupre A, Lauret P et al. Le Lichen striatus onychodystrophique. Ann Dermatol Venereol 1979; 106:885- 91. 6. Kaufman JP. Lichen striatus with nail involvement. Cutis 1974; 14:232-4. 7. Aloi F, Solaroli C, Pippione M. Diffuse and bilateral Lichen striatus. Pediatr Dermatol 1997;14:36-8. 8. Kurokawa M, Kikuchi H, Ogata K, Setoyama M. Bilateral lichen striatus. J Dermatol 2004;31:129-32. 9. Rahbari H, Cordero AA, Mehergan AH. Linear porokeratosis. A distinctive clinical variant of porokeratosis of Mibelli. Arch Dermatol 1974; 109:526-8. Dermatol 1997; 14:293-5. 4. June K, Wingfield, Rehmus, Nelly R, Amal M, et al. Emedicine. [Last accessed on

10. Fujimoto N, Tajima S, Ishibashi A. Facial lichen striatus: Successful treatment with tacrolimus ointment. Br J Dermatol 2003; 148:587-90. 11. Sorgentini C, Allevato MA, Dahbar M, Cabrera H. Lichen striatus in an adult: Successful treatment with tacrolimus. Br J Dermatol 2004; 150:776-7. Correspondence