Case Report of A Rare Case of Adult-Onset Multi-site Lichen Striatus in an Adult

Summary@#Lichen striatus (LS) is a rare self-limiting inflammatory dermatosis characterized by Blaschkoid distribution. We report a 34-year-old woman with a 1-year history of asymptomatic unilateral rashes on her left trunk and limbs. Physical examination revealed light to dark brown papules, macules, patches and plaques with some erythematous areas in a Blaschkoid pattern with proven skin biopsy as well. Patient received potent topical corticosteroid therapy which resulted in the resolution of the lesion. This case report highlights two rare aspect of lichen striatus; involvement of multiple sites and late adult-onset. It is also a reminder that lichen striatus should be included in the differentials of acquired linear dermatoses.

Reflectance confocal microscopy characteristics of childhood hypopigmented lichen striatus / 中华皮肤科杂志

Objective To investigate reflectance confocal microscopy (RCM) characteristics of childhood hypopigmented lichen striatus.Methods RCM was performed to image skin lesions and perilesional normal skin in 11 children with hypopigmented lichen striatus.Then,confocal microscopic findings of the skin lesions were compared with pathological findings.Results Histopathological examination of the skin lesions showed mild intercellular and intracellular edema,thickening of prickle cell layer to different extent,local liquefaction degeneration of basal cells,and perivascular infiltration of plenty of lymphocytes and a few melanophages in the superficial dermis.RCM horizontal images showed multifocal liquefaction degeneration of basal cells,which caused indistinct dermo-epidermal junction,incomplete or unclear dermal papillary rings,infiltration of many highly refractive melanophages and slightly to moderately refractive inflammatory cells in papillary and superficial dermis.Conclusion RCM characteristics can serve as strong evidences for the diagnosis and differential diagnosis of childhood hypopigmented lichen striatus.

Three Cases of Lichen Nitidus Associated with Various Cutaneous Diseases

Lichen nitidus (LN) is an uncommon, usually asymptomatic cutaneous eruption characterized by the presence of multiple, small, flesh-colored papules. The epidemiologic and pathophysiologic characteristics of LN have not yet been defined. Furthermore, LN has rarely been described in association with other cutaneous diseases. We herein report 3 cases of LN associated with various cutaneous diseases, including lichen striatus, oral lichen planus, and psoriasis vulgaris.

A Clinical and Histopathologic Study of Lichen Striatus according to the Clinical Type and Age / 대한피부과학회지

BACKGROUND: Lichen striatus is an uncommon, self-limiting, linear inflammatory disease occurring along the lines of Blaschko, mainly affecting children, and is diagnosed by clinical history and histopathological study of typical lesions. However, various aspects of the histopathologic findings have not yet been studied sufficiently. OBJECTIVE: The aim of this study was to investigate the clinical and histopathologic characteristics of lichen striatus in Korea, according to age and clinical subtype. METHODS: This retrospective study on lichen striatus was performed at our center; clinical and histopathologic findings from 32 patients were evaluated. RESULTS: In all, 22 children and 10 adults were included. The lesions were predominantly distributed on the extremities (78.1%), including those that showed multiregional involvement. Twenty-four patients had erythematous papular lichen striatus (75%), and eight had hypopigmented macular type lesions (25%). All cases of hypopigmented macular subtypes had occurred in children. The histopathologic features of lichen striatus included basal vacuolar degeneration (93.3%), hyperkeratosis (83.3%), spongiosis (63.3%), and exocytosis of lymphocytes (63.3%) in the epidermis. Superficial and deep perivascular lymphocytic inflammatory infiltration (96.7%), lichenoid lymphohistiocytic infiltration (76.7%), and periappendageal involvement (53.3%) in the dermis were also observed. Papular lesions showed greater spongiosis, exocytosis, dyskeratosis, and vacuolar degeneration than hypopigmented lesions. Increased dyskeratosis and pigmentary incontinence as well as more severe lichenoid infiltration were observed in the adults. CONCLUSION: This study provides the first national data about the clinical and histopathologic characteristics of lichen striatus in adults and children. Some of the clinical and histopathologic characteristics differed according to the age group as well as clinical subtype.

A Case of Lichen Striatus Presenting with Hypopigmented Patch / 대한피부과학회지

No abstract available.

Lichen Striatus Occurring after Allogenic Peripheral Blood Stem Cell Transplantation in an Adult with Aplastic Anemia

Lichens striatus (LS) is an acquired, self-limiting inflammatory dermatosis that follows the lines of Blaschko. The etiology of the eruption is unknown, but several theories have been proposed with focus on environmental factors, viral infection, cutaneous injury, hypersensitivity, and genetic predisposition. We describe a 19-year-old woman who developed a unilateral linear eruption 17 months after allogenic peripheral blood stem cell transplantation. Histopathology revealed features, which were consistent with LS. To the best of our knowledge, our patient is the first case describing the appearance of LS occurring after allogenic stem cell transplantation. We speculate that this condition represents an unusual form of localized, chronic graft-versus-host disease.

Lichen Striatus-Induced Pterygium Unguis / 대한피부과학회지

Pterygium unguis occurs as a result of the scarring process between the proximal nail-fold and matrix and lichen planus is a typical example, although it has also been reported to occur in patients with sarcoidosis or leprosy. Lichen striatus is a childhood linear inflammatory dermatitis of unknown etiology. Many nail changes such as nail-bed hyperkeratosis, nail pitting, longitudinal ridging, onycholysis, and longitudinal fissures have been described in patients with lichen striatus, but pterygium unguis is very rare. It has been suggested that the onset and resolution of onychodystrophy correlates well with the course of skin eruption, but pterygium unguis results in permanent nail changes regardless of skin eruption. A 3-year-old boy presented with a linear papular eruption on the right hand and pterygium on the index finger. He was diagnosed with lichen striatus by histopathological findings, and the papular eruption was resolved with topical tacrolimus ointment, but the pterygium did not improve.

Multiple Lichen Striatus in an Adult / 대한피부과학회지

Lichen striatus is an uncommon, self-limiting dermatosis that is characterized by linearly distributed eruptions that follow Blaschko's lines. It usually occurs unilaterally, but few cases of bilateral or multilinear eruptions have also been reported. In addition, lichenstriatus is commonly seen in children and rarely affects adults. We report a case of 29-year-old woman with multiple, unilateral lichen striatus on the right abdomen and right chest that was treated successfully with topical tacrolimus.

The Efficacy of Topical Calcineurin Inhibitors for Treating Lichen Striatus / 대한피부과학회지

BACKGROUND: Lichen striatus is a well-known, acquired, self-healing, linear inflammatory dermatosis. The therapeutic approach that is usually adopted is topical steroid, even though the prolonged use of this may lead to several side-effects, and particularly cutaneous atrophy. OBJECTIVE: The purpose of this study was to evaluate the efficacy of topical calcineurin inhibitors for the treatment of lichen striatus. METHODS: Twenty nine patients received topical application of calcineurin inhibitors twice a day up to the marked disappearance of the cutaneous lesions. RESULTS: Six (20.7%) of 29 patients achieved a complete response after a mean treatment period of 2.5 months. A good response was observed in 8 patients (27.6%) and a partial response was seen in 8 patients (27.6%). Of the 29 patients, 22 patients (75.9%) had more than a 50% response without any severe adverse effects. No significant differences in the therapeutic responses were found with regard to the patients' ages, the duration of the disease and the length of the treatment periods. CONCLUSION: Our results show that topical calcineurin inhibitors may well represent a useful therapeutic alternative for the treatment of lichen striatus.

Clinical Effects of 0.1% Tacrolimus Ointment for the Treatment of Lichen Striatus / 대한피부과학회지

BACKGROUND: Lichen striatus (LS) is a rare disorder that's characterized by a distinctive linear distribution of papules. There are many reports suggesting that LS is a T cell-mediated inflammatory skin disease. Tacrolimus ointment is a topical immunomodulator that inhibits the production of inflammatory cytokines in T cells. Preliminary studies have suggested that the topical application of tacrolimus is effective for the treatment of lichen striatus. OBJECTIVE: The purpose of this study was to evaluate the efficacy and safety of 0.1% tacrolimus ointment for treating LS patients. METHODS: We evaluated the efficacy and safety of 0.1% tacrolimus ointment applied twice daily for treating 15 biopsy-proven LS patients. The therapeutic effects were evaluated after 2, 4, 8, 12 and 24 weeks according to 3 grades: NR (no response, 50% improvement), CR (complete remission). RESULTS: Of the 15 LS patients, 13 patients (87%) showed either a CR (53%) or a PR (33%) after 12 weeks and a CR (67%) or a PR (20%) after 24 weeks. The median time to a CR was 11 weeks (range: 2~24 weeks). Transient burning and itching on the application site were the most common adverse effects. The occurrence of these symptoms decreased after the first few days of treatment. There was no increased incidence of other significant adverse events. CONCLUSION: This study showed that 0.1% tacrolimus ointment could be an effective and safe treatment modality to shorten the remission period for LS.

A Case of Lichen Nitidus with the Koebner Phenomenon Mimicking Lichen Striatus / 대한피부과학회지

Lichen nitidus is an uncommon, asymptomatic cutaneous shiny papular eruption and it can rarely show Koebner's phenomenon, which may clinically resemble lichen striatus. It is known that for such cases, the clinicopathological correlation is the most important factor for making the diagnosis and immunohistochemical staining for CD4, CD8 and CD68 can be helpful to differentiate these two diseases. We experienced a case of Koebner phenomenon, which clinically mimicked lichen striatus, in a patient suffering with lichen nitidus.

A Case of Adult-onset Lichen Striatus / 대한피부과학회지

Lichen striatus and linear lichen planus are rare disorders that can be confused because they share similar clinical and histopathologic findings. We report a case of lichen striatus on the left wrist and fingers in a 54-year-old woman, who was initially diagnosed with linear lichen planus. She had overlapping clinico-histopathologic features of both lichen striatus and linear lichen planus. To discriminate between the two disorders, careful histological and clinical evaluations are needed, especially when a lichen striatus-like eruption occurs in adults.

Two Cases of Lichen Striatus Mimicking Lichen Nitidus / 대한피부과학회지

Lichen striatus is an uncommon dermatosis that generally affects children. Lichen striatus can usually be identified by the typical clinical and histological features. However, sometimes a differential diagnosis of lichen nitidus is difficult to determine because the clinical manifestations and histologic findings are so diverse. In such cases, immunohistochemical staining can be helpful to differentiate these two diseases. We experienced two cases of lichen striatus which mimicked lichen nitidus clinically and histologically, but were finally diagnosed by immunohistochemical staining.

Lichen Striatus in a Girl: Successful Treatment with Pimecrolimus

Lichen striatus (LS) is a self-resolving condition, which may occasionally need treatment for significant pruritus, a persistent course or cosmetic problems. The options for treatment have usually been topical or intralesional corticosteroids, salicylic acid, coal tar, or more recently, topical tacrolimus and pimecrolimus. We report a case of LS successfully treated with pimecrolimus in a 15-year-old girl.

A Case of Facial Lichen Striatus Improved with Topical Tacrolimus / 대한피부과학회지

A 31-year-old woman presented with 2 year history of multiple, pinhead-sized erythematous papules, which had become coalescent in linear arrangement from the forehead to the left nasal ala. Histopathologically, the lesion showed hyperkeratosis, spongiosis and inflammatory cell infiltration around the skin appendages, and was therefore diagnosed as facial lichen striatus. The patient had been treated with an intermittent topical steroid application for about two years, but this had not been effective. However, application of 0.03% tacrolimus ointment showed dramatic improvement.

A Case of Milia Occurring on Lichen Striatus of the Face / 대한피부과학회지

A healthy 4-year-old boy presented with a linear erythematous eruption, along with some pearly papules on the right cheek. The distribution of the lesions corresponded to that of Blaschko?s lines. Histopathological examination showed necrotic keratinocytes and vacuolar changes on the basal layer in the epidermis, and a superficial and deep perivascular, perieccrine, and perifollicular lymphocytic infiltrate in the dermis. In addition, a small keratin-filled cyst was observed in the upper dermis. These findings were consistent with a diagnosis of milium developing on lichen striatus. We applied 0.03% topical tacrolimus ointment twice daily. On follow-up 12 months later, the linear erythematous eruption cleared, but the pearly papules persisted.

Histopathological and Immunohistochemical Study of Lichen Nitidus and Lichen Striatus / 대한피부과학회지

BACKGROUND: Lichen nitidus and lichen striatus are often confused because they are thought to share similar clinical and histopathologic features. OBJECTIVE: The purpose of this study was to histopathologically and immunohistochemically evaluate the characteristic differences and common features between the two disorders. METHOD: Histopathological and immunohistochemical slides of 14 patients with lichen nitidus and 14 patients with lichen striatus were reviewed. Immunohistochemical staining with anti CD45RO, CD68, CD4, CD8 and CD20 antibodies was performed. RESULTS: 1) In lichen nitidus, the frequent histopathologic findings were liquefaction degeneration of the basal layer (100%), edema of the dermis within the areas of the infiltate (100%), and claw-like rete ridges (96.8%). 2) In lichen striatus, the frequent histopathologic findings were edema of the dermis within the areas of the infiltate (100%), liquefaction degeneration of the basal layer (92.9%), and perivascular inflammatory cell infiltrate (92.9%). 3) The majority of the cells in the infiltrate of lichen nitidus were T lymphocytes mixed with histiocytes. In most cases, CD4+ T lymphocytes predominated CD8+ T lymphocytes. 4) However, in lichen striatus, infiltrating cells in the dermis were composed dominantly of T lymphocytes, with a minority of histiocytes. CD8+ T lymphocytes were also found to outnumber CD4+ T lymphocytes. CONCLUSION: Our study did differentiate each disease as having distinctive characteristics and differences. Furthermore, the immunologic pathophysiology of lichen nitidus and lichen striatus was proved to be distinctive. Therefore, we conclude that these two diseases are not in the spectrum of the same disease, but separate disease entities which are indeed different from each other.

Two Cases of Lichen Striatus in an Adult / 대한피부과학회지

Lichen striatus is a fairly common, linear, self-limited eruption that is seen primarily in children. The average age is 3 years, but it can occur at any age. In adults, lichen striatus often presents a quite different clinical feature rather than in childhood. It is characterized by papulovesicles, multilinearity, relapse, and histological spongiotic change. We report two cases of lichen striatus occured in a 45-year-old and 32-year-old man.

One Case of Linear Lichen Planus / 대한피부과학회지

Linear lichen planus, a variant of lichen planus, accounts for 0.24-0.62% of all patients with lichen planus. Clinically, it consists of itchy linearly distributed violaceous papules, usually lasts for more than 1 year and the mucous membranes may also be affected. This disorder shows the same histologic findings of lichen planus, which is characterized by a band like dermal inflammatory cell infiltration with hyperkeratosis, focal hypergranulosis, acanthosis, excytosis and the presence of Civatte body. We report a 66-year-old man showing typical clinical and histological features of linear lichen planus with pruritus.

A Clinical and Histopathologic Study of 20 cases of Lichen striatus / 대한피부과학회지

BACKGROUND: Lichen striatus(LS) is an uncommon dermatosis that generally affects children. LS can usually be identified by clinical history and histology of typical lesions. However, the clinical manifestations and the histologic features are diverse. OBJECTIVE: The aim of this study is to investigate clinical and histopathologic features of LS in Koreans. METHODS: Total 20 patients were included in this study. Data complied were sex, age, duration, distribution, symptoms, course and some histopathologic findings including hyperkeratosis, acanthosis, dyskeratosis, basal degeneration, perivascular lymphocytic infiltration, lichenoid infiltration and eccrine sweat gland inflammation. Seventeen cases were studied further by immunohistochemistry for interleukin(IL)-1beta to understand the biological basis of the disease. RESULTS AND CONCLUSIONS: 1. It was observed predominantly in females as the sex ratio of 1: 2.3. The mean age was 5.5 years and the mean duration was 17.7 months. 2. Most of patients were asymptomatic, but only five patients complained of mild itching. 3. It occured most frequently in the lower(11 cases), upper extremities(6 cases), axilla(1 case), anterior chest(1 case) and multiple location(1 case). Twelve cases were consisted of erythematous papules, and the rest appeared hypopigmented macules. 4. The lesions of 9 of 10 patients were almostly cleared in one year. Five of 9 were consisted of erythematous papules and four hypopigmented macules. One who had no change was consisted of hypopigmented macules. Therefore, there was no significant difference of prognosis between two groups. 5. Histologic examination revealed hyperkeratosis(65%), acanthosis(70%), parakeratosis(50%), exocytosis(95%), spongiosis(55%), dyskeratosis(70%), basal degeneration(90%) in epidermis, and colloid body(35%), lichenoid infiltration(65%), perivascular lymphocytic infiltration(95%) and eccrine sweat gland inflammation(50%) in dermis. 6. There was no significant difference between the papular group and the macular group, except parakeratosis and spongiosis, which were increased in the papular group as compared with the macular group. 7. IL-1beta was expressed diffusely in keratinocytes, endothelial cells, hair follicles and eccrine sweat glands. IL-1beta immunoreactivity was expressed in the entire epidermis in 15 of 17 cases. Most of the eccrine sweat glands showed intense immunolabeling in 12 of 17 cases. In contrast, only 2 cases of lichen planus were positive for epidermis and only 1 case for eccrine sweat gland. Therefore, we think that it is helpful for discriminating two diseases immunohistochemically.