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Lichen Striatus - Submitted on: Thursday July, 04, 2002
Contributed by:Bizhan Bandarchi, MD,
Lichen striatus is an inflammatory papular eruption with a distinctive linear distribution, often following Blaschko’s line, which should be differentiated from many other cutaneous diseases with linear pattern. Variants of this disorder has also been called blaschkitis(1), Blaschko linear acquired inflammatory skin eruption (1,2), zonal dermatosis, linear neurodermatitis, linear dermatosis, linear lichenoid dermatosis, lichenoid eruption, systematized lichenification, and linear eczema (3-5).

Definition:
Lichen striatus is an uncommon self-limiting linear dermatosis with unknown etiology and spontaneous regression. It primarily occurs in children from 5 to 15 years of age, but may also be seen in adults (6).

Clinical Features:
Lichen striatus has a predilection for female children and adolescents (7). Lesions of lichen striatus are usually solitary and unilateral and rarely multiple and bilateral (8,11). They can affect any site (9) but are more common on extremities, trunk and neck. One study showed that the lower limb was involved more often than the upper limb and trunk (10). Lichen striatus typically begins suddenly with eruption of small flat- topped erythematous or skin colored lichenoid scaly papules on a proximal extremity (8,11). These papules coalesce into small plaques into a continuous or interrupted linear band that progresses toward the distal extremity (8,11). The eruption is usually asymptomatic (11) and infrequently pruritic (8). Nail involvement (such as onychodystrophy, longitudinal ridging) (10) have been reported. After months to 1 year the lesions spontaneously resolve, often in the same proximal to distal fashion in which they appeared (11), leaving variable dyspigmentation (9). In one study the duration of the disease until regression ranged from 4 months to 4 years (median, 12 months) (10). In the same study , both skin and nail lesions disappeared completely even if they last longer than one year (10).

Histology:
Figures
(Click on an image for a larger view)
Fig 1. Hyperkeratosis, acanthosis, rare necrotic keratinocytes
Fig 2. Focal spongiosis, lymphocytic exocytosis, basal layer vacuolation
Fig 3. Lymphocytic exocytosis, focal lichenoid lymphocytic infiltrate
Fig 4. Distinctive perifollicular infiltrate
Fig 5. Lymphocytic exocytosis.
The histopathologic features of lichen striatus are variable and non-specific although some constant microscopic findings are present. Lichen striatus is a chronic lichenoid dermatitis (8). The epidermis may be slightly acanthotic with mild spongiosis (7,8), exocytosis of lymphocytes and focal parakeratosis (6). Less frequently, small intraepidermal vesicles containing Langerhans cells are present (6). Dyskratotic cells are often identified at all levels of the epidermis (7). Focally in the papillary dermis there is a variably intense band-like infiltrate of lymphocytes, histiocytes and melanophages with extension into the lower portion of epidermis (6,7). There is also a superficial perivascular lymphocytic and histiocytic infiltrate (6,8). The presence of the inflammatory infiltrate around hair follicles and vessels in the mid-plexus with extension to eccrine glands is a characteristic feature (6,7). Zhang and McNutt found that the most consistent histologic features of lichen striatus are : hyperkeratosis, parakeratosis with a few necrotic keratinocytes in the epidermis, mild spongiosis with lymphocytic exocytosis (12). The lichenoid infiltrate can be focal or band-like. Another study found that the presence of the inflammatory infiltrate along eccrine ducts and glands and/or hair follicles was a fairly specific feature of lichen striatus (13).
The differential diagnoses of lichen striatus include linear lichen planus, linear lichen nitidus, linear epidermal nevus, inflammatory linear verrucous epidermal nevus, linear psoriasis and linear lichen simplex chronicus.
Immunohistochemistry has shown that most of lymphocytes in the upper dermis and epidermis are CD7+ (12), and most of the lymphocytes in the epidermis are CD8+ T-cells expressing HLA-DR+ antigen on their surface (6,12). These findings suggest a cell-mediated immunologic mechanism (6). In one study CD1a Langerhans’ cells were either decreased or increased or normal in the epidermis (12).


Treatment:
Because the lesions are self-limited and resolve spontaneously within one year usually there is no treatment necessary. Reassuring the patient is essential. Postinflammatory hypopigmentation may persist longer (11).

Bibliography:
  • Grosshans E, Lichens et eruptions lichenoides. Ann Dermatol Venereol 1989;116:925- 929.
  • Taieb A,El Youbi A, Grosshans E, et al. Lichen striatus: a Blaschko linear acquired inflammatory skin eruption. J Am Acad Dermatol 1991;25:637-642.
  • Staricco Rg. Lichen striatus: a study of fifteen new cases with special emphasis on the histopathological changes and a review of the literature. Arch Dermatol 1959;79:311- 324.
  • Senear FE, Caro MR. Lichen striatus. Arch Dermatol Syph 1941;43:116-133.
  • Vasily DB, Bhatia SG. Lichen striatus. Cutis 1981;28:442-446
  • Elder D,Elenitsas R, Jaworsky C, et al. In: Lever’s Histopathology of the Skin, 8th ed., Philadelphia, Lippincott-Raven, 1997; P174.
  • Weedon D, Strutton G. In: Skin Pathology, Churchill Livingstone, 1997; P38.
  • McKee PH. In: Pathology of the Skin with Clinical Correlation, 2nd ed, London, Mosby-Wolfe, 1996; P9.8
  • Barnhill Rl, Crowson AN. In: Textbook of Dermatopathology, McGraw-Hill, 1998;P52
  • Hauber K,Rose C, Broker EB, Hamm H. Lichen Striatus: clinical features and follow- up in 12 patients.Eur J Dermatol 2000; 10(7):536-9.
  • Arndt KA, Robinson JK, Leboit PE, et al. In: Cutaneous Medicine and Surgery, An Integrated Program in Dermatology, Vol.1, W.B.Saunders Company, 1996; P244-246.
  • Zhang Y, McNutt NS. Lichen striatus. Histological, immunohistochemical, and ultrastructural study of 37 cases. J Cutan Pathol 2001; 28(2):65-71
  • Miquel C, Brousse N, De Prost Y, Rraitag S.Lichen striatus: evaluation of histologic criteria in 13 cases. Ann Pathol 2000; 20(4):308-12.
     

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