Lichen striatus: Difference between revisions
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{{Infobox_Disease | |||
| Name = Lichen striatus | |||
| Image = Ad-24-87-g001.jpg|500px| | |||
| Caption = Dermatosis following the Blaschko line | |||
}} | |||
{{SI}} | {{SI}} | ||
{{CMG}} | {{CMG}}; {{M.P}} | ||
{{SK}} Linear lichenoid dermatosis | |||
==Overview== | ==Overview== | ||
Lichens striatus (LS) is an acquired, self-limiting inflammatory dermatosis that follows the lines of Blaschko. | |||
==Pathophysiology== | |||
[[Blaschko lines]] have an embryologic origin and correspond to the direction of growth of the cutaneous cells, resulting in a cutaneous mosaicism. The genetic mosaicism could be responsible for cutaneous antigenic mosaicism, the expression of which might be induced by various external factors. Lichen striatus has been considered to be the consequence of an acquired stimulus that induces a loss of immunotolerance to embryologically abnormal clones, resulting in a T-cell-mediated inflammatory reaction.<ref name="pmid15165195">{{cite journal| author=Patrizi A, Neri I, Fiorentini C, Bonci A, Ricci G| title=Lichen striatus: clinical and laboratory features of 115 children. | journal=Pediatr Dermatol | year= 2004 | volume= 21 | issue= 3 | pages= 197-204 | pmid=15165195 | doi=10.1111/j.0736-8046.2004.21302.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15165195 }} </ref> | |||
==Causes== | ==Causes== | ||
The etiology of the eruption is unknown. Several theories suggest | The etiology of the eruption is unknown. Several theories suggest a genetic predispostion with following factors acting as possible triggers.<ref name="pmid15165195">{{cite journal| author=Patrizi A, Neri I, Fiorentini C, Bonci A, Ricci G| title=Lichen striatus: clinical and laboratory features of 115 children. | journal=Pediatr Dermatol | year= 2004 | volume= 21 | issue= 3 | pages= 197-204 | pmid=15165195 | doi=10.1111/j.0736-8046.2004.21302.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15165195 }} </ref> | ||
* Hypersensitivity | * Hypersensitivity | ||
* Cutaneous injury | * Cutaneous injury | ||
* Viral infection | * Viral infection | ||
* Environmental factors | * Environmental factors | ||
* [[Immunization]]<ref name="pmid16043931">{{cite journal| author=Karakaş M, Durdu M, Uzun S, Karakaş P, Tuncer I, Cevlik F| title=Lichen striatus following HBV vaccination. | journal=J Dermatol | year= 2005 | volume= 32 | issue= 6 | pages= 506-8 | pmid=16043931 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16043931 }} </ref><ref name="pmid9136170">{{cite journal| author=Hwang SM, Ahn SK, Lee SH, Choi EH| title=Lichen striatus following BCG vaccination. | journal=Clin Exp Dermatol | year= 1996 | volume= 21 | issue= 5 | pages= 393-4 | pmid=9136170 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9136170 }} </ref> | |||
* [[Pregnancy]]<ref name="pmid16008653">{{cite journal| author=Brennand S, Khan S, Chong AH| title=Lichen striatus in a pregnant woman. | journal=Australas J Dermatol | year= 2005 | volume= 46 | issue= 3 | pages= 184-6 | pmid=16008653 | doi=10.1111/j.1440-0960.2005.00176.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16008653 }} </ref> | |||
==Differentiating Lichen Striatus from other Conditions== | |||
* [[Lichen planus]] | |||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
Lichen striatus is a rare skin condition that is seen primarily in children, most frequently appearing ages 5–15.<ref name="Andrews">{{cite book |author=James, William D.; Berger, Timothy G.; et al. |title=Andrews' Diseases of the Skin: clinical Dermatology |publisher=Saunders Elsevier |location= |year=2006 |pages= |isbn=0-7216-2921-0 |oclc= |doi= |accessdate=}}</ref> It consists of a [[self-limiting (biology)|self-limiting]] eruption of small, scaly [[papule]]s.<ref name="Andrews new ed">{{cite book| edition = 11th| publisher = Elsevier| isbn = 9781437703146| last = James| first = William D.| first2 = Timothy G. |last2=Berger|first3= Dirk M.|last3= Elston| title = Andrews' Diseases of the Skin: Clinical Dermatology|location=London|year=2011|pages=223–224}}</ref> | Lichen striatus is a rare skin condition that is seen primarily in children, most frequently appearing ages 5–15.<ref name="Andrews">{{cite book |author=James, William D.; Berger, Timothy G.; et al. |title=Andrews' Diseases of the Skin: clinical Dermatology |publisher=Saunders Elsevier |location= |year=2006 |pages= |isbn=0-7216-2921-0 |oclc= |doi= |accessdate=}}</ref> It consists of a [[self-limiting (biology)|self-limiting]] eruption of small, scaly [[papule]]s.<ref name="Andrews new ed">{{cite book| edition = 11th| publisher = Elsevier| isbn = 9781437703146| last = James| first = William D.| first2 = Timothy G. |last2=Berger|first3= Dirk M.|last3= Elston| title = Andrews' Diseases of the Skin: Clinical Dermatology|location=London|year=2011|pages=223–224}}</ref> | ||
==Natural History, Prognosis and Complications== | |||
Lichen striatus has spontaneous remission, although the course of the disease is prolonged when nail involvement exists. Patients treated by a combination of topical retinoid with a topical steroid have rapid resolution of lichen striatus and they not only achieve satisfying cosmesis, but also complete resolution of their pruritus. The most common side effect of the topical medication is localized irritation at treatment sites, but most of them would tolerate the treatment well. | |||
==Diagnosis== | |||
===History and Symptoms== | |||
Lichen striatus presents as an eruption characterized by sudden onset of flat-topped, 1 to 4 mm, pink, tan, or hypopigmented papules in a linear configuration or Blaschkoid distribution. It may be associated with some irritation and soreness in the muscles of the affected parts. | |||
===Laboratory Findings=== | |||
* The condition is benign and no need for biopsy. | |||
* Histopathologic examination of papules would reveal the presence of a lichenoid, lymphocytic infiltration and scattered melanin incontinence in the papillary dermis with epidermal hyperkeratosis, exocytosis of lymphocytes and necrotic keratinocytes. | |||
[[Image:Ad-24-87-g002.jpg|frame|none|100px|HPE of the lesion shows epidermal hyperkeratosis, exocytosis, necrotic keratinocytes and superficial perivascular inflitrates of lymphocytes and histiocytes in the dermis.]] | |||
==Treatment== | |||
Studies have showed monitoring without biopsy is a reasonable approach to the management of uncomplicated lichen striatus, particularly when the face is involved. However topical medications would produce rapid resolution. The following are currently used medications | |||
* Topical retinoid | |||
* Topical steroid | |||
* Tacrolimus, especially facial lesions<ref name="pmid12653755">{{cite journal| author=Fujimoto N, Tajima S, Ishibashi A| title=Facial lichen striatus: successful treatment with tacrolimus ointment. | journal=Br J Dermatol | year= 2003 | volume= 148 | issue= 3 | pages= 587-90 | pmid=12653755 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12653755 }} </ref> | |||
* Photodynamic theraphy<ref name="pmid22300391">{{cite journal| author=Park JY, Kim YC| title=Lichen striatus successfully treated with photodynamic therapy. | journal=Clin Exp Dermatol | year= 2012 | volume= 37 | issue= 5 | pages= 570-2 | pmid=22300391 | doi=10.1111/j.1365-2230.2011.04284.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22300391 }} </ref> | |||
==References== | ==References== | ||
Revision as of 16:51, 31 July 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Mugilan Poongkunran M.B.B.S [2]
Synonyms and keywords: Linear lichenoid dermatosis
Overview
Lichens striatus (LS) is an acquired, self-limiting inflammatory dermatosis that follows the lines of Blaschko.
Pathophysiology
Blaschko lines have an embryologic origin and correspond to the direction of growth of the cutaneous cells, resulting in a cutaneous mosaicism. The genetic mosaicism could be responsible for cutaneous antigenic mosaicism, the expression of which might be induced by various external factors. Lichen striatus has been considered to be the consequence of an acquired stimulus that induces a loss of immunotolerance to embryologically abnormal clones, resulting in a T-cell-mediated inflammatory reaction.[1]
Causes
The etiology of the eruption is unknown. Several theories suggest a genetic predispostion with following factors acting as possible triggers.[1]
- Hypersensitivity
- Cutaneous injury
- Viral infection
- Environmental factors
- Immunization[2][3]
- Pregnancy[4]
Differentiating Lichen Striatus from other Conditions
Epidemiology and Demographics
Lichen striatus is a rare skin condition that is seen primarily in children, most frequently appearing ages 5–15.[5] It consists of a self-limiting eruption of small, scaly papules.[6]
Natural History, Prognosis and Complications
Lichen striatus has spontaneous remission, although the course of the disease is prolonged when nail involvement exists. Patients treated by a combination of topical retinoid with a topical steroid have rapid resolution of lichen striatus and they not only achieve satisfying cosmesis, but also complete resolution of their pruritus. The most common side effect of the topical medication is localized irritation at treatment sites, but most of them would tolerate the treatment well.
Diagnosis
=History and Symptoms
Lichen striatus presents as an eruption characterized by sudden onset of flat-topped, 1 to 4 mm, pink, tan, or hypopigmented papules in a linear configuration or Blaschkoid distribution. It may be associated with some irritation and soreness in the muscles of the affected parts.
Laboratory Findings
- The condition is benign and no need for biopsy.
- Histopathologic examination of papules would reveal the presence of a lichenoid, lymphocytic infiltration and scattered melanin incontinence in the papillary dermis with epidermal hyperkeratosis, exocytosis of lymphocytes and necrotic keratinocytes.
Treatment
Studies have showed monitoring without biopsy is a reasonable approach to the management of uncomplicated lichen striatus, particularly when the face is involved. However topical medications would produce rapid resolution. The following are currently used medications
References
- ↑ 1.0 1.1 Patrizi A, Neri I, Fiorentini C, Bonci A, Ricci G (2004). "Lichen striatus: clinical and laboratory features of 115 children". Pediatr Dermatol. 21 (3): 197–204. doi:10.1111/j.0736-8046.2004.21302.x. PMID 15165195.
- ↑ Karakaş M, Durdu M, Uzun S, Karakaş P, Tuncer I, Cevlik F (2005). "Lichen striatus following HBV vaccination". J Dermatol. 32 (6): 506–8. PMID 16043931.
- ↑ Hwang SM, Ahn SK, Lee SH, Choi EH (1996). "Lichen striatus following BCG vaccination". Clin Exp Dermatol. 21 (5): 393–4. PMID 9136170.
- ↑ Brennand S, Khan S, Chong AH (2005). "Lichen striatus in a pregnant woman". Australas J Dermatol. 46 (3): 184–6. doi:10.1111/j.1440-0960.2005.00176.x. PMID 16008653.
- ↑ James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0.
- ↑ James, William D.; Berger, Timothy G.; Elston, Dirk M. (2011). Andrews' Diseases of the Skin: Clinical Dermatology (11th ed.). London: Elsevier. pp. 223–224. ISBN 9781437703146.
- ↑ Fujimoto N, Tajima S, Ishibashi A (2003). "Facial lichen striatus: successful treatment with tacrolimus ointment". Br J Dermatol. 148 (3): 587–90. PMID 12653755.
- ↑ Park JY, Kim YC (2012). "Lichen striatus successfully treated with photodynamic therapy". Clin Exp Dermatol. 37 (5): 570–2. doi:10.1111/j.1365-2230.2011.04284.x. PMID 22300391.