O/E: The dermatosis extends from the posterior right shoulder to the right upper arm and consists of confluent barely elevated hypopigmented papules in a linear distribution.
Clinical Photos:
Lab and Biopsy: These will be non-contributory.
Diagnosis: Lichen striatus vs. Blaschkitis
Questions: Can one differentiate between L.s. and Blaschlitis? Is any treatment indicated for an asymptomatic child who is not bothered by the eruption?
Reference:
Lichen striatus: clinical and
laboratory features of 115 children.
Patrizi A, et.al. Email: patrizi@almadns.unibo.it
Department of Clinical and
Experimental Medicine, Division of Dermatology, University of Bologna, Bologna,
Italy.
Abstract: To analyze the clinical features, response to
treatment, and follow-up of lichen striatus and any associated symptoms or
disease, we designed a retrospective study involving 115 affected children at
the Pediatric Dermatology Unit of the Department of Dermatology of the
University of Bologna, Bologna, Italy. Between January 1989 and January 2000 we
diagnosed lichen striatus in 37 boys and 78 girls (mean age 4 years 5 months).
We studied their family history and the season of onset, morphology,
distribution, extent, duration, histopathology, and treatment of their lichen
striatus. We found that family history was negative in all our patients except
for two pairs of siblings. The majority of children had the disease in the cold
seasons; precipitating factors were found in only five cases. The most
frequently involved sites were the limbs, with no substantial difference
between upper and lower limb involvement. When lichen striatus was located on
the trunk and face, it always followed Blaschko lines; in seven children the
bands on the limbs appeared to be along the axial lines of Sherrington. In 70
cases, lichen striatus was associated with atopy. The mean duration of the
disease was 6 months and relapses were observed in five children, and in one
instance the disease had a prolonged course. Only a few case study series of
lichen striatus in children have been reported and ours is the largest to date.
The etiology of lichen striatus remains unknown in the majority of our
patients. The confirmed association with atopy observed in our patients may be
a predisposing factor. It has generally been accepted that lichen striatus
follows the lines of Blaschko, and this distribution is a sign of both a
topographic and a pathogenetic concept. In patients where lichen striatus is
along axial lines, a locus minoris resistentiae, we suppose that this
distribution may only be an illusory phenomenon in instances in which the
trigger factor prefers this route, consisting of several successive Blaschko
lines, but appearing as a single band.
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