Unusual Linear Dermatosis

Presented by Dr. Wagdy El Kifty

Giza Skin Specialist Centre

Pamukkale Baths

The patient is a 38 year-old businesswoman who presents with a six-month history of a progressive linear dermatitis that began on her left hand and has spread centripetally over the ensuing months.  It is mildly pruritic. She takes no medications by mouth.  The rash began shortly after she visited the Pamukkale baths in Southwestern Turkey with her family.  At a Turkish bath, attendants scrape and abrade one's skin for a vigorous exfoliation.

She saw another dermatologist in Amman, Jordan three months ago and a biopsy was performed.

O/E:  The patient has Type IV skin

There is a linear dermatitis which follows Blaschko’s lines.  Acrally, it is erythematous, but more centrally it is hyperpigmented.  On her back the pattern is whorled.

Clinical Images:

 

Pathology:  We have not received the slide, but it was signed out as “Lichen planus.”

Diagnosis: Blaschkolinear Lichen Planus.

Discussion:   There are a number of rare and overlapping blaschkolinear dermatoses.  Histologically, some have features of lichen planus and some lichen striatus, with considerable overlap.  These are usually self-limited and resolve over time, but some can be followed by post-inflammatory hyperpigmentation in darker individuals.  Association with underlying pathology has not been found.

Questions: Do you have any specific comments?  It appears that potent topical corticosteroids can be helpful. Do you have any experience treating a similar patient?

References:

1. Adult blaschkolinear acquired inflammatory skin eruption (BLAISE) with simultaneous features of lichen striatus and blaschkitis.

Raposo I. et. al Dermatol Online J. 2018 Jan 15;24(1 Full Text.

Abstract

Blaschkitis and lichen striatus are generally distinguished in the literature by the age of onset, lesion distribution, and histopathology. However, there is currently no clear consensus among authors about whether to consider blaschkitis and lichen striatus different clinical entities or a spectrum ofthe same disease. We present a case of adult BLAISE with features of both lichen striatus and blaschkitis, which seems to support the theory that these clinical entities may in fact represent a spectrum of the same pathological process.

           

2. Lichen planus-like dermatosis with Blaschko line distribution: a case report. Stojanović S, Jovanović M, Vucković N. Acta Dermatovenerol Alp Pannonica Adriat. 2008 Sep;17(3):137-8. Full Text.

Abstract: The authors describe the case of a healthy 46-year-old woman with a unilateral linear papular band on the left side of the trunk that followed the lines of Blaschko from the lower back extending to the left anterior side of her abdomen. The lesions were flat-topped, slightly elevated, violaceous, agglomerated lichenoid papules. The biopsy specimen demonstrated the typical histology of lichen planus. A working diagnosis of linear lichen planus was confirmed. Because congenital and/or nevoid skin disorders in a blaschkolinear distribution may have a delayed onset after birth, these lesions must be differentiated from acquired dermatoses following the lines of Blaschko. This distinction should be made in cases with isolated lesions, such as the case presented here.

3. Linear lichen planus. Batra P.

Dermatol Online J. 2008 Oct 15;14(10):16. Full Text.