Lichen Striatus Clinical Presentation

Updated: Jun 04, 2018
  • Author: June Kim, MD; Chief Editor: Dirk M Elston, MD  more...
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Presentation

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.

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Physical Examination

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. [19, 13] In rare cases, they may be bilateral or occur in multiple parallel bands. [26, 27, 28] The lesions are most commonly located on a proximal extremity and less commonly on the trunk, head, neck, or buttock. A recent study suggests that facial lichen striatus is underreported and may represent up to 15% of all cases. [5] In darkly pigmented individuals, eruptions may appear as a bandlike area of hypopigmentation. Note the images below.

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.
Hypopigmented lichen striatus over the leg. Hypopigmented lichen striatus over the leg.

Nail involvement is uncommon in lichen striatus, with approximately 40 reported cases worldwide. [29, 3, 30] 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. [31, 32] Dermoscopic examination may reveal sharply marginated, deep-white structures resembling Wickham striae and brown, keratotic, cerebriform structures with pinpoint red dots surrounded by a pale halo. [33]

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Complications

Postinflammatory hyperpigmentation and hypopigmentation may last for several months to years after lichen striatus resolves.

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