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ORIGINAL ARTICLE
Year : 2017  |  Volume : 18  |  Issue : 2  |  Page : 89-93

Lichen striatus in children: A clinical study of ten cases with review of literature


Department of Dermatology, Gauhati Medical College and Hospital, Guwahati, Assam, India

Date of Web Publication27-Mar-2017

Correspondence Address:
Seujee Das
Department of Dermatology, Gauhati Medical College and Hospital, Kamrup (M), Guwahati - 781 032, Assam
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-7250.202997

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  Abstract 

Background: Lichen striatus is an idiopathic self-limiting inflammatory linear dermatosis, mostly affecting children. There is a definite paucity of studies on the clinical profile of lichen striatus in children from India.
Objective: The aim of this study was to analyze the clinical profile of lichen striatus in children.
Materials and Methods: The present observational study was conducted in the Department of Dermatology, Assam Medical College and Hospital, Dibrugarh, from June 2014 to May 2015. All children up to 13 years presenting with lichen striatus in the Dermatology Outpatient Department of Assam Medical College and Hospital, Dibrugarh, were taken as study participants. A detailed general, systemic, and cutaneous examination was done. Relevant investigations were carried out whenever necessary. The findings were recorded in a pro forma for analysis and interpretation of data.
Results: The prevalence of lichen striatus in our outpatient pediatric population was 0.48%. Female cases outnumbered males with a ratio of 4:1. The mean age of onset was found to be 4.7 years. Upper extremities and trunk were the most common sites involved. An association with atopy was noted in 30% of the cases.
Conclusion: Long-term studies with increased number of cases will help in better understanding of this rare disease in children and also its association with atopy.

Keywords: Atopy, lichen striatus, linear dermatosis


How to cite this article:
Das S, Adhicari P. Lichen striatus in children: A clinical study of ten cases with review of literature. Indian J Paediatr Dermatol 2017;18:89-93

How to cite this URL:
Das S, Adhicari P. Lichen striatus in children: A clinical study of ten cases with review of literature. Indian J Paediatr Dermatol [serial online] 2017 [cited 2019 Dec 10];18:89-93. Available from: http://www.ijpd.in/text.asp?2017/18/2/89/202997


  Introduction Top


Lichen striatus is an idiopathic self-limiting inflammatory linear dermatosis, mostly affecting children. Interaction of various factors such as genetic, environmental, and atopy at a certain age may contribute to the development of lichen striatus.

The key elements of lichen striatus include [1] (a) linear lesions that follow the developmental lines of Blaschko, (b) self-limited course with a duration varying from a few weeks to 2–3 years, relapses occur, (c) mixed spongiotic-lichenoid histological pattern, frequently with a lymphocytic infiltrate along eccrine ducts or glands, and (d) postinflammatory pigmentation.

It is a papulosquamous disorder of rare occurrence and should be considered as a differential diagnosis of linear dermatoses in children. A proper insight into this disease is required as it predominantly affects children, thereby to settle the worries of the anxious parents. Various studies on lichen striatus have been done across the globe, but there is a paucity of such studies in India. A detailed study on the clinical and epidemiological profile of lichen striatus will help dermatologists understand the disease better and henceforth manage it appropriately.

Objective

The aim of this study was to analyze the clinical profile of lichen striatus in children.


  Materials and Methods Top


The present observational study was conducted in the Department of Dermatology, Assam Medical College and Hospital, Dibrugarh, during a period of 12 months from June 2014 to May 2015. All children up to 13 years presenting with lichen striatus in the Dermatology Outpatient Department of Assam Medical College and Hospital, Dibrugarh, for the period of 1 year were taken as study participants. A detailed general, systemic, and cutaneous examination was done. Relevant investigations were carried out whenever necessary. The findings were recorded in a pro forma for analysis and interpretation of data.


  Results Top


During the study, 2094 pediatric patients attended our dermatology outpatient department. Of these, 10 had lichen striatus. Thus, the prevalence of lichen striatus in our outpatient pediatric population was 0.48%. Female cases (8; 80.00%) outnumbered males (2; 20.00%) with a ratio of 4:1. The maximum number of cases was seen in patients from 0 to 4 years of age (6; 60.00%). The age and sex distribution of lichen striatus in children is shown in [Table 1]. The mean age of onset was found to be 4.7 years. The youngest patient was 1 year old. Upper extremities (4; 40.00%) and trunk (4; 40.00%) were the most common sites involved in lichen striatus followed by lower extremities (2; 20.00%) and face (1; 10.00%) [Figure 1]. All the cases had unilateral presentation. Involvement of right side (6; 60.00%) was more than the left side (4; 40.00%). About 40% of cases were reported each in spring and summer months, 20% in autumn, while no cases were recorded in the winter months [Figure 2]. History of atopy was present in 3 cases constituting 30% of all the cases of lichen striatus [Figure 3]. Family history was absent in all the cases. Nail involvement was not noted in our study.
Table 1: Age and sex distribution

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Figure 1: Sites involved

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Figure 2: Seasonal distribution

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Figure 3: Atopy in lichen striatus

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  Discussion Top


Lichen striatus is acquired and not congenital. Small, pink, lichenoid papules, discrete at first but rapidly coalescing, appear suddenly and extend over the course of a week or more to form a dull-red, slightly scaly linear band, usually 2 mm to 2 cm in width, and often irregular, along the Blaschko's lines. The most characteristic feature is the linear arrangement of inflammatory lesions, ranging in extent from a few centimeters to an entire limb or half of the trunk. The lesions are erythematous, papular, and sometimes vesicular and eczematous.[2]

The lesions are usually localized to limbs but can involve trunk, neck, face, and buttocks. The lesions may be multifocal involving more than one body part, unilateral, or bilateral. Characteristically, the lesions begin on the buttock and spread down the leg or begin on the shoulder and progress down the arm. They may first be noticed distally, however.

The etiology is unknown. Several theories have been proposed including environmental agents, cutaneous injury, viral infection, hypersensitivity, and genetic predisposition.

The development of lesions along the lines of Blaschko suggests that the cutaneous defect may result from a somatic mutation that arises embryologically. Expression of the aberrant clone may be triggered by an environmental insult such as a viral infection or trauma. The ensuing inflammation results in clinical lesions with a predominance of CD8+ T-cells, and resolution occurs with the elimination of the abnormal keratinocyte clone.[3]

Hauber et al.[4] reported a male predominance with male to female ratio of 3:1. Patrizi et al.[5] in their study reported a female predominance with male to female ratio of 0.5:1. The present study recorded a female predominance with male to female ratio of 1:4 which is similar to the study by Taniguchi et al.[6] which reported a male to female ratio of 1:3. Peramiquel et al.[7] reported an equal incidence of lichen striatus in male and female children.

Over 50% of cases occur in children, usually between the ages of 5 and 15 years, with a mean age of 4 years, but onset in early infancy and in old age has also been reported. Hauber et al.[4] reported a mean age of 5 years. In a study by Patrizi et al.,[5] the mean age was 4 years 5 months. Peramiquel et al.[7] reported a mean age of 3.41 years. The mean age of onset in our study was recorded to be 4.7 years which is consistent with most other studies.

Our study recorded a maximum occurrence of lichen striatus in the spring and summer months similar to the study by Kennedy and Rogers [8] and Sittart et al.[9] which reported a greater occurrence in the months of September and March which corresponds to spring and summer. There was no difference in the incidence of lichen striatus in regard to the season of the year in a study by Taniguchi et al.[6] Sittart et al.[9] suggested a possible viral etiology due to the greater occurrence of lichen striatus in preschool children, siblings, during the months of September and March which correspond to spring and summer and spontaneous involution in their study.

Taieb et al.[10] found upper limbs to be the most common sites involved. In a study by Patrizi et al.,[5] most frequently involved sites were the limbs, with no substantial difference between upper and lower limb involvement. In a study by Taniguchi et al.,[6] lesions predominated on the lower limbs. In another study by Peramiquel et al.,[7] lesions predominated over the inferior extremities. In our study, upper extremities (4; 40.00%) and trunk (4; 40.00%) were the most common sites involved in lichen striatus followed by lower extremities (2; 20.00%) and face (1; 10.00%) [Figure 4],[Figure 5],[Figure 6].
Figure 4: Lichen striatus involving the arm and forearm

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Figure 5: Lichen striatus involving the arm

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Figure 6: Lichen striatus involving upper back and arm

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Facial involvement is less uncommon than previously thought [5] but can be difficult to diagnose if a limited portion of a Blaschko's line is involved because of less frequent access to biopsy. Follicular involvement with transient focal hair loss and nail dystrophy is sometimes noted before typical cutaneous lesions have been observed.[1]

The authors found that lesions occur more commonly on the left side of the body, and particularly on the upper left side (trunk and arms),[10] but this was not confirmed in a larger series.[5] The right side was more commonly involved in our study. Bilateral involvement, though very exceptional, has been reported.[11],[12]

The abnormal immune status usually associated with atopy might contribute to the development of lichen striatus. In one series, one-third of patients with lichen striatus had atopic dermatitis, and in another, 84.6% had a positive history of atopic disorders.[10],[13] The present study recorded atopy in 30% of the cases with lichen striatus. Hauber et al.[4] reported atopy in 58% cases, Patrizi et al.[5] in 60.86% cases, Taniguchi et al.[6] in 20%, and Peramiquel et al.[7] in 47.8% cases. Our study is somewhat similar to Taniguchi et al.[6] with regard to the presence of atopy.

Patrizi et al.[5] noted that family history was negative in all the patients except for two pairs of siblings. Our study noted a negative family history in all the cases.

Nail involvement may be observed in few patients as ridging, splitting, onycholysis, or nail loss.[14],[15] Tosti et al.[16] reported two cases of lichen striatus limited only to the nails. Hauber et al.[4] reported nail involvement in 16.67% cases while none of our cases had nail involvement.


  Conclusion Top


Our study showed the prevalence of lichen striatus to be 0.48% in the pediatric population, thus indicating it to be an uncommon disease. Long-term studies with increased number of cases will help in better understanding of the disease in children and also its association with atopy. Follow-up studies will provide an insight into the time required for resolution of the disease as lichen striatus is known to be a self-limiting disease.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.

 
  References Top

1.
Taieb A, Grosshans E. Lichen striatus. In: Irvine A, Hoeger P, Yan A, editors. Harper's Textbook of Pediatric Dermatology. 3rd ed. Hoboken, NJ: Blackwell Publishing Ltd.; 2011. p. 86.1-86.7.  Back to cited text no. 1
    
2.
Muller SA, Winkelmann RK. Lichen striatus. Clinical histopathologic study with emphasis on vesicular aspects. JAMA 1963;183:206-8.  Back to cited text no. 2
    
3.
Cohen BA, editor. Papulosquamous eruptions. In: Pediatric Dermatology. 3rd ed. Philadelphia: Elsevier; 2005. p. 67-99.  Back to cited text no. 3
    
4.
Hauber K, Rose C, Bröcker EB, Hamm H. Lichen striatus: Clinical features and follow-up in 12 patients. Eur J Dermatol 2000;10:536-9.  Back to cited text no. 4
    
5.
Patrizi A, Neri I, Fiorentini C, Bonci A, Ricci G. Lichen striatus: Clinical and laboratory features of 115 children. Pediatr Dermatol 2004;21:197-204.  Back to cited text no. 5
    
6.
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 2004;21:440-3.  Back to cited text no. 6
    
7.
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 2006;165:267-9.  Back to cited text no. 7
    
8.
Kennedy D, Rogers M. Lichen striatus. Pediatr Dermatol 1996;13:95-9.  Back to cited text no. 8
    
9.
Sittart JA, Pegas JR, Sant'Ana LA, Pires MC. Lichen striatus. Epidemiologic study. Med Cutan Ibero Lat Am 1989;17:19-21.  Back to cited text no. 9
    
10.
Taieb A, el Youbi A, Grosshans E, Maleville J. Lichen striatus: A Blaschko linear acquired inflammatory skin eruption. J Am Acad Dermatol 1991;25:637-42.  Back to cited text no. 10
    
11.
Aloi F, Solaroli C, Pippione M. Diffuse and bilateral lichen striatus. Pediatr Dermatol 1997;14:36-8.  Back to cited text no. 11
    
12.
Kurokawa M, Kikuchi H, Ogata K, Setoyama M. Bilateral lichen striatus. J Dermatol 2004;31:129-32.  Back to cited text no. 12
    
13.
Toda K, Okamoto H, Horio T. Lichen striatus. Int J Dermatol 1986;25:584-5.  Back to cited text no. 13
    
14.
Baran R, Dupré A, Lauret P, Puissant A. Lichen striatus with nail involvement. Ann Dermatol Venereol 1979;106:885-91.  Back to cited text no. 14
    
15.
Kaufman JP. Lichen striatus with nail involvement. Cutis 1974;14:232-4.  Back to cited text no. 15
    
16.
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 1997;36:908-13.  Back to cited text no. 16
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
 
 
    Tables

  [Table 1]



 

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