Lichen striatus

1 - ACKNOWLEDGEMENTS

Chapter written with the help of the EADV, the Fondation René Touraine and the Therapeutics in Dermatology

2 - OVERVIEW

Lichen striatus is an uncommon acquired, usually asymptomatic, and self-limited linear inflammatory skin disorder that predominantly affects children.¹ Although it may occur at any age, it most often presents in children aged 5-15 years.² Rarely, lichen striatus has been described in adults.³ It has been reported in all ethnic groups and appears to be more common in females.^4–6

A family history is rarely encountered, suggesting a genetic predisposition and/or a common environmental etiology in this cases.⁷

It is associated with seasonal variation with most series reporting the majority of patients presenting in spring and summer.²

The diagnosis is usually clinical based on the appearance of the lesions and the development pattern.

3 - SYMPTOMS

Clinically, lichen striatus is typically asymptomatic, but intense pruritus can occasionally occur most often in individuals with atopy.^2,8 The eruption is classically unilateral and follows the lines of Blaschko, which are lines of normal cell development in the skin and are believed to trace the migration of embryogenic cells, in a continuous or interrupted pattern.^1,2 The lesion consists of small discrete or clustered pink, skin-colored or hypopigmented papules. The extremities followed by the neck are the most often involved sites.^2,9 Sometimes a band may extend from the leg onto the buttock or abdomen. The face and the trunk are less frequently affected.¹⁰ Rarely, the eruption can be bilateral and/or can present multiple parallel bands.¹¹

Although rare, lichen striatus may involve the nail apparatus.¹² It is usually seen in association with typical skin lesions and may precede, follow, or develop concurrently with skin lesions.¹² Nail change, which may affect a single nail, include onycholysis, splitting, fraying and total nail loss.^2,12

The eruption usually has a sudden onset, develops during days to weeks, and after several months to years it undergoes spontaneous resolution.^2,5,9 Although lichen striatus does not usually recur, relapses may occasionally occur, either in the same site or on the same side of the body.⁹

Post-inflammatory hypopigmentation may be seen, specially in those with darkly pigmented skin.⁹

4 - CAUSES

The cause of lichen striatus is unknown. Although lichen striatus follows the lines of Blaschko, which are thought to be embryogenic in origin, neither the gene(s) involved nor the triggering factors are known.²

Environmental agents, particularly viral infections, trauma, hypersensitivity reactions, vaccines, drugs, and pregnancy have been proposed as triggering factors.¹³ Moreover, lichen striatus may represent a manifestation of an atopic diathesis with the abnormal immune responses associated with atopy being implicated as a predisposing trigger.⁸ It has been suggested that an infectious agent acts as a trigger in a genetically predisposed individual.²

5 - TREATMENT

As lichen striatus is a benign, self-limited condition, most of the times treatment is not necessary. Patients and specially the parents should be reassured that the eruption will resolve spontaneously in months without scarring, leaving a transient hypopigmentation that can last for several years.

Topical corticoids under occlusion can be used to hasten resolution or for symptomatic treatment of pruritus.⁵ There are isolated reports of successful treatment with topical calcineurin inhibitors (tacrolimus ointment and pimecrolimus cream), including for nail dystrophy.^14,15

6 - TIPS FOR MANAGING

• Lichen striatus is an acquired, asymptomatic, and self-limited linear inflammatory skin disorder
• It affects predominantly children and adolescents
• Lichen striatus typically present as a single, unilateral band of papules involving most often the extremities
• The diagnosis is usually clinical. However, sometimes a biopsy may be necessary.
• Patients and specially the parents should be reassured that the eruption will resolve spontaneously in months, leaving a transient hypopigmentation
• Emollients and/or topical corticoids may be used if the skin is itchy
• Calcineurin inhibitors have been reported as successful in treating persistent and pruritic lesions

7 - REFERENCES

1. Senear FE, Caro MR. LICHEN STRIATUS. Arch Dermatol 1941 ;43:116.

2. Calonje JE, Brenn T, Lazar AJ, Billings SD. McKee’s Pathology of the Skin. 5th Revise. Elsevier Health Sciences ; 2019.

3. Hofer T. Lichen striatus in Adults or ‘Adult Blaschkitis’ ? Dermatology 2003 ;207:89–92.

4. Peramiquel L, Baselga E, Dalmau J, Roé E, del Mar Campos M, Alomar A. Lichen striatus : clinical and epidemiological review of 23 cases. Eur J Pediatr 2006 ;165:267–9.

5. Patrizi A, Neri I, Fiorentini C, Bonci A, Ricci G. Lichen Striatus : Clinical and Laboratory Features of 115 Children. Pediatr Dermatol 2004 ;21:197–204.

6. Taniguchi Abagge K, Parolin Marinoni L, Giraldi S, Carvalho VO, de Oliveira Santini C, Favre H. Lichen Striatus : Description of 89 Cases in Children. Pediatr Dermatol 2004 ;21:440–3.

7. Karempelis PS, Cely SJ, Davis LS. Lichen striatus in a mother and son. Int J Dermatol 2014 ;53:e366–e366.

8. García-Briz MI, Santos-Alarcón S, Fuertes-Prosper MD, Mateu-Puchades A. Liquen estriado en la infancia. ¿Una entidad relacionada con la dermatitis atópica ? Actas Dermosifiliogr 2017 ;108:882–4.

9. Bolognia JL, Jorizzo JL, Rapini RP. Dermatology. 3rd Editio. Gulf Professional Publishing ; 2012.

10. Mu EW, Abuav R, Cohen BA. Facial Lichen Striatus in Children : Retracing the Lines of Blaschko. Pediatr Dermatol 2013 ;30:364–6.

11. Kurokawa M, Kikuchi H, Ogata K, Setoyama M. Bilateral Lichen Striatus. J Dermatol 2004 ;31:129–32.

12. Kim M, Young Jung H, Sun Eun Y, Kee Cho B, Jeong Park H, Hyun Jeong Park C. Nail lichen striatus : report of seven cases and review of the literature.

13. Karakaş M, Durdu M, Uzun S, Karakaş P, Tuncer İ, Çevlik F. Lichen Striatus Following HBV Vaccination. J Dermatol 2005 ;32:506–8.

14. Campanati A, Brandozzi G, Giangiacomi M, Simonetti O, Marconi B, Offidani AM. Lichen striatus in adults and pimecrolimus : open, off-label clinical study. Int J Dermatol 2008 ;47:732–6.

15. Jo J-H, Jang H-S, Park H-J, Kim M-B, Oh C-K, Kwon K-S. Early treatment of multiple and spreading lichen striatus with topical tacrolimus. J Am Acad Dermatol 2007 ;57:904–5.