eMedicine Specialties > Dermatology > Pediatric Diseases

Lichen Striatus

Author: June Kim, MD, Staff Physician, Department of Dermatology, Kaiser Permanente San Jose
Coauthor(s): Wingfield Rehmus, MD, MPH,
Contributor Information and Disclosures

Updated: Oct 2, 2009

Introduction

Background

Lichen striatus is a rare, benign, self-limited linear dermatosis of unknown origin that predominantly affects children. Lichen striatus is clinically diagnosed on the basis of its appearance and characteristic developmental pattern following the lines of Blaschko.

Pathophysiology

The skin is the primary organ system affected by lichen striatus. However, lichen striatus also may involve the nails.1

Race

No racial predilection is recognized for lichen striatus.

Sex

No consensus exists on sex predilection in lichen striatus. Some studies show a 2- to 3-fold increased incidence in girls compared with boys, whereas others show an equal sex distribution.

Age

Lichen striatus is primarily a disease of young children. More than 50% of all lichen striatus cases occur in children aged 5-15 years. Other reports dispute this age range and claim that the median age of onset for lichen striatus is 3 years. Although lichen striatus is rare in both infants and adults, the disease can occur in persons of any age.2,3

Clinical

History

Lichen striatus often appears as a sudden eruption of small papules on an extremity. The papules are usually asymptomatic, reaching maximum involvement within several days to weeks. When lichen striatus patients are symptomatic, the most common complaint is pruritus. Lichen striatus is self-limited, but it may resolve with postinflammatory hyper or hypopigmentation.

Physical

  • Lichen striatus appears as a continuous or interrupted, linear band consisting of small (1- to 3-mm) pink, tan, or skin-colored lichenoid papules.
    • The papules may be smooth, scaly, or flat topped. Occasionally, a vesicular component is present.
    • The band may range from a few millimeters to 1-2 cm wide and extends from a few centimeters to the full length an extremity. The lesions are usually unilateral and single on an extremity along the lines of Blaschko.4,5 In rare cases, they may be bilateral or occur in multiple parallel bands.6,7
    • The lesions are most commonly located on a proximal extremity and less commonly on the trunk, head, neck, or buttock.
    • In darkly pigmented individuals, eruptions may appear as a bandlike area of hypopigmentation.
Extensive unilateral lichen striatus that affects...

Extensive unilateral lichen striatus that affects both the upper and lower extremities. Grouped keratotic lichenoid papules form plaques over the leg.

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Extensive unilateral lichen striatus that affects...

Extensive unilateral lichen striatus that affects both the upper and lower extremities. Grouped keratotic lichenoid papules form plaques over the leg.


Lichen striatus over the inner thigh.

Lichen striatus over the inner thigh.

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Lichen striatus over the inner thigh.

Lichen striatus over the inner thigh.


Hypopigmented lichen striatus over the leg.

Hypopigmented lichen striatus over the leg.

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Hypopigmented lichen striatus over the leg.

Hypopigmented lichen striatus over the leg.

  • Nail involvement is uncommon in lichen striatus, with fewer than 30 reported cases worldwide.8
    • Nail lesions may occur before, after, or concurrently with the skin lesions. They may also be the only area of involvement.
    • Often, only the medial or lateral portions are involved, and involvement is almost always restricted to one single nail.
    • Nail changes may include longitudinal ridging, splitting, onycholysis, nail loss, hyperkeratosis of the nail bed, thinning or thickening of the nail plate, nail pitting, onychodystrophy, punctuate and striate leukonychia, and overcurvature of the nail plate.9,10

Causes

The etiology of lichen striatus is unknown.

  • Many etiologic or predisposing factors are suggested for lichen striatus.
    • The most commonly accepted hypothesis is the combination of genetic predisposition with environmental stimuli.
    • Atopy may be a predisposing factor. One group reported that 85% of patients with lichen striatus have a family history of atopic dermatitis, asthma, or allergic rhinitis. However, another report disputes this claim, stating that the incidence of atopy is no greater than that of the general population.
    • An autoimmune response may also be involved in lichen striatus. A case of lichen striatus has been reported during pregnancy, and it has been postulated that the pregnancy may have triggered an autoimmune response leading to the appearance of the eruption.11 Some reports simply suggest that lichen striatus is an inflammatory skin disease mediated by T cells.
    • An environmental (infectious or trauma12 ) etiology has also been suggested. Familial cases,13,14 outbreaks among unrelated children in a shared living environment, and a possible seasonal variation suggest an environmental agent, such as a virus. However, results of viral testing have not conclusively proven this association. In addition, familial episodes of lichen striatus are not always simultaneous, signifying a possible genetic predisposition as a second explanation. Lichen striatus has been reported to occur shortly following immunization with BCG and hepatitis B vaccination, after UV exposure from a tanning bed,15 following a prick from a pineapple leaf, and after varicella infection.16
  • Lesions of lichen striatus follow the lines of Blaschko.4,5,17,18,19
    • Blaschko lines are thought to be embryologic in origin. They are believed to be the result of the segmental growth of clones of cutaneous cells or the mutation-induced mosaicism of cutaneous cells.
    • In lichen striatus, an acquired event (eg, viral infection) may allow an aberrant clone of cutaneous cells to express a new antigen, resulting in the phenotypic skin changes.

More on Lichen Striatus

Overview: Lichen Striatus
Differential Diagnoses & Workup: Lichen Striatus
Treatment & Medication: Lichen Striatus
Follow-up: Lichen Striatus
Multimedia: Lichen Striatus
References
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References

  1. Tosti A, Peluso AM, Misciali C, Cameli N. Nail lichen striatus: clinical features and long-term follow-up of five patients. J Am Acad Dermatol. Jun 1997;36(6 Pt 1):908-13. [Medline].

  2. Hofer T. Lichen striatus in adults or 'adult blaschkitis'?. There is no need for a new naming. Dermatology. 2003;207(1):89-92. [Medline].

  3. 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. Jul-Aug 2004;21(4):440-3. [Medline].

  4. Arias-Santiago SA, Sierra Giron-Prieto M, Fernandez-Pugnarie MA, Naranjo-Sintes R. [Lichen striatus following Blaschko lines]. An Pediatr (Barc). Jul 2009;71(1):76-7. [Medline].

  5. Racette AJ, Adams AD, Kessler SE. Simultaneous lichen striatus in siblings along the same Blaschko line. Pediatr Dermatol. Jan-Feb 2009;26(1):50-4. [Medline].

  6. Aloi F, Solaroli C, Pippione M. Diffuse and bilateral lichen striatus. Pediatr Dermatol. Jan-Feb 1997;14(1):36-8. [Medline].

  7. Kurokawa M, Kikuchi H, Ogata K, Setoyama M. Bilateral lichen striatus. J Dermatol. Feb 2004;31(2):129-32. [Medline].

  8. Kavak A, Kutluay L. Nail involvement in lichen striatus. Pediatr Dermatol. Mar-Apr 2002;19(2):136-8. [Medline].

  9. Leposavic R, Belsito DV. Onychodystrophy and subungual hyperkeratosis due to lichen striatus. Arch Dermatol. Aug 2002;138(8):1099-100. [Medline].

  10. Al-Niaimi FA, Cox NH. Unilateral lichen striatus with bilateral onychodystrophy. Eur J Dermatol. Jun 5 2009;[Medline].

  11. Brennand S, Khan S, Chong AH. Lichen striatus in a pregnant woman. Australas J Dermatol. Aug 2005;46(3):184-6. [Medline].

  12. Shepherd V, Lun K, Strutton G. Lichen striatus in an adult following trauma. Australas J Dermatol. Feb 2005;46(1):25-8. [Medline].

  13. Patrizi A, Neri I, Fiorentini C, Chieregato C, Bonci A. Simultaneous occurrence of lichen striatus in siblings. Pediatr Dermatol. Jul-Aug 1997;14(4):293-5. [Medline].

  14. Yaosaka M, Sawamura D, Iitoyo M, Shibaki A, Shimizu H. Lichen striatus affecting a mother and her son. J Am Acad Dermatol. Aug 2005;53(2):352-3. [Medline].

  15. Ciconte A, Bekhor P. Lichen striatus following solarium exposure. Australas J Dermatol. May 2007;48(2):99-101. [Medline].

  16. Hafner C, Landthaler M, Vogt T. Lichen striatus (blaschkitis) following varicella infection. J Eur Acad Dermatol Venereol. Nov 2006;20(10):1345-7. [Medline].

  17. Keegan BR, Kamino H, Fangman W, Shin HT, Orlow SJ, Schaffer JV. "Pediatric blaschkitis": expanding the spectrum of childhood acquired Blaschko-linear dermatoses. Pediatr Dermatol. Nov-Dec 2007;24(6):621-7. [Medline].

  18. Patrizi A, Neri I, Fiorentini C, Bonci A, Ricci G. Lichen striatus: clinical and laboratory features of 115 children. Pediatr Dermatol. May-Jun 2004;21(3):197-204. [Medline].

  19. Taieb A, el Youbi A, Grosshans E, Maleville J. Lichen striatus: a Blaschko linear acquired inflammatory skin eruption. J Am Acad Dermatol. Oct 1991;25(4):637-42. [Medline].

  20. Tilly JJ, Drolet BA, Esterly NB. Lichenoid eruptions in children. J Am Acad Dermatol. Oct 2004;51(4):606-24. [Medline].

  21. Fujimoto N, Tajima S, Ishibashi A. Facial lichen striatus: successful treatment with tacrolimus ointment. Br J Dermatol. Mar 2003;148(3):587-90. [Medline].

  22. Sorgentini C, Allevato MA, Dahbar M, Cabrera H. Lichen striatus in an adult: successful treatment with tacrolimus. Br J Dermatol. Apr 2004;150(4):776-7. [Medline].

  23. 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. Jul 2008;47(7):732-6. [Medline].

  24. Vukicevic J, Milobratovic D, Vesic S, Milosevic-Jovcic N, Ciric D, Medenica L. Unilateral multiple lichen striatus treated with tacrolimus ointment: a case report. Acta Dermatovenerol Alp Panonica Adriat. Mar 2009;18(1):35-8. [Medline].

  25. Tejera-Vaquerizo A, Ruiz-Molina I, Solis-Garcia E, Moreno-Gimenez JC. [Adult blaschkitis (lichen striatus) successfully treated with topical tacrolimus.]. Actas Dermosifiliogr. Sep 2009;100(7):631-2. [Medline].

  26. Gianotti R, Restano L, Grimalt R, Berti E, Alessi E, Caputo R. Lichen striatus--a chameleon: an histopathological and immunohistological study of forty-one cases. J Cutan Pathol. Feb 1995;22(1):18-22. [Medline].

  27. Kennedy D, Rogers M. Lichen striatus. Pediatr Dermatol. Mar-Apr 1996;13(2):95-9. [Medline].

  28. 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. Apr 2006;165(4):267-9. [Medline].

  29. Pujol RM, Tuneu A, Moreno A, de Moragas JM. Perforating lichen striatus. Acta Derm Venereol. 1988;68(2):171-3. [Medline].

  30. Rubio FA, Robayna G, Herranz P, et al. Linear lichen planus and lichen striatus: is there an intermediate form between these conditions?. Clin Exp Dermatol. Jan 1997;22(1):61-2. [Medline].

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Further Reading

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Keywords

lichen striatus, LS, linear lichenoid dermatosis, linear neurodermatitis, blaschkitis, Blaschko linear acquired inflammatory skin eruption, BLAISE

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Contributor Information and Disclosures

Author

June Kim, MD, Staff Physician, Department of Dermatology, Kaiser Permanente San Jose
June Kim, MD is a member of the following medical societies: American Academy of Dermatology and American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Wingfield Rehmus, MD, MPH, 
Wingfield Rehmus, MD, MPH is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Medical Editor

Daniel J Hogan, MD, Clinical Professor of Internal Medicine (Dermatology), NOVA Southeastern University; Investigator, Hill Top Research, Florida Research Center
Daniel J Hogan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, and Canadian Dermatology Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Paul Krusinski, MD, Director of Dermatology, Professor, Department of Internal Medicine, Fletcher Allen Health Care, University of Vermont
Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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