Background Lichen striatus is a well-known, acquired, self-healing, linear inflammatory dermatosis. Lichen striatus occurring in adults tends to be more extensive and itchy than in children, sometimes requiring symptomatic treatment. The therapeutic approach usually adopted is topical steroids, even though prolonged use may lead to several side-effects, particularly cutaneous atrophy.

Objective  To report the results of an open, off-label study on the use of pimecrolimus 1% in the treatment of diffuse, nonresponsive forms of lichen striatus.

Methods  Three adult patients suffering from relapsing or disseminated and itchy lichen striatus received topical application of pimecrolimus 1% cream (Elidel®, Novartis Pharma, Basle, Switzerland) twice daily for 6 weeks, or until complete disappearance of the cutaneous lesions.

Results  All patients experienced rapid healing of the dermatosis, without any recurrence for at least 14 months.

Conclusion  Our preliminary results show that pimecrolimus may represent a useful therapeutic alternative for lichen striatus, although further studies on a larger number of cases are needed to confirm its safety and efficacy in the treatment of this condition.

Lichen striatus in adults and pimecrolimus: open, off-label clinical study

Lichen Striatus is an uncommon inflammatory skin eruption of unknown etiology. It rarely affects adults, and it is characterized by abrupt onset of coalescent papules, in a linear disposition, usually on the extremities. Histopathology shows lichenoid reaction involving follicles and glands. Occasionally, there is overlap with linear lichen planus and "blaschkitis", the main differential diagnoses. It is reported here the case of an adult woman with erythematous violaceous papules on the right side of the neck and face, diagnosed with lichen striatus by clinical and histopathological correlation. The atypical findings and the diagnostic difficulty are discussed.

http://www.scielo.br/pdf/abd/v86n1/v86n1a22.pdf

Lichen striatus on adult.

Since the first description of adult blaschkitis (AB), the existence of this entity has been a matter of great debate. To compare clinicopathological features of lichen striatus (LS) and AB cases. Materials and Methods: We retrospectively reviewed the clinicopathological features of patients who clinically showed linear inflammatory dermatosis along Blaschko’s lines based on a skin biopsy registry. Through a process of clinicopathological differential diagnosis, 27 cases of LS, three of AB, eight of linear lichen planus, and two of linear psoriasis were identified. Clinicopathological differences between LS and ABwere mostly insignificant except for age at onset and multiple site involvement. In these cases, females were affected more frequently than males. The mean age at onset was 31.6 years, and the most common involved site was the leg. The lesions lasted approximately 8.3 months with few relapses. The most common histopathological finding was perivascular infiltration followed by peri-appendageal infiltration. Distinction between LS and AB appears to be unnecessary given their overlapping features.

Adult-onset lichen striatus versus adult blaschkitis: a clinicopathological review of 40 cases of acquired blaschkolinear inflammatory dermatosis.

Lichen striatus is a self-limiting dermatosis presenting with sudden eruption of lichenoid papules along the lines of Blaschko. A 5-year-old girl presented with asymptomatic hypopigmented linear lesions over both upper limbs. The histopathological examination revealed spongiosis, vacuolar alteration of the basal layer and lymphocytic exocytosis with a mild-to-moderate perivascular mononuclear infiltrate in the dermis. Lichen striatus was diagnosed based upon the characteristic clinical and histopathological findings. The pathogenetic mechanism of bilateral lichen striatus is unknown at present, however, a somatic mutation in two different clones of cells can be a possibility.

Bilateral lichen striatus: A case report with review of literature

Lichen striatus (LS) is a relatively rare and self-limited linear dermatosis of unknown etiology. It primarily affects children, with more than 50% of cases occurring in patients aged 5 to 15 years. The case of a 2-year-old boy who presented for evaluation of a nonpruritic linear rash on the left side of the lower abdomen of 3 weeks' duration is discussed. A diagnosis of lichen striatus (LS) was made and the lesions completely resolved within 6 months. At 5 years of age, the patient returned for evaluation of bluish discoloration and thinning of the nails on the left middle and ring fingers, which ultimately fell off and started to regrow 2 months prior to the second evaluation. The rare diagnosis of isolated onychodystrophy as a late manifestation of LS was made.

Bilateral onychodystrophy in a boy with a history of isolated lichen striatus.

We report a case of lichen striatus in a 37-year-old woman in the third trimester of pregnancy. She presented at 35 weeks of pregnancy with a 6-week history of a pruritic rash on the left side of her abdomen. Examination revealed an erythematous papular eruption arranged in a linear fashion from the umbilicus to the left mid back. Histological examination demonstrated lichenoid perivascular and periadnexal inflammatory infiltrate and the presence of colloid bodies. The eruption resolved prior to delivery with the application of mometasone furoate 0.1% ointment.

Lichen striatus in a pregnant woman.

preparations were expensive and not easily available. With his background in chemistry the patient researched topical hypochlorous acid and prepared a hypochlorous acid spray and a hypochlorous acid gel. The use of hypochlorous acid for treatment of wounds has been reported. The recent formulation of stable hypochlorous acid solutions has made this approach viable for routine treatment of skin infections. While only a small fraction of hypochlorite ion found in bleach solutions is present as hypochlorous acid, it is possible to obtain almost 100% hypochlorous acid by adjusting the solution pH to lie within the range of 4.5–5.5 by addition of a buffer solution. This hypochlorous acid solution was prepared from inexpensive household products readily available: baking soda (sodium bicarbonate), white vinegar (4% acetic acid) and Milton sanitising solution (1% sodium hypochlorite) in demineralised water. A simple preparation using standard kitchen measures was developed: combine 1/2 cup (125 mL) of demineralised water with 1/4 cup (60 mL) of white vinegar in a medium sized glass or plastic measuring jug. Slowly add 1/2 teaspoon (2.5 mL) of baking soda while stirring the solution until no further bubbles are produced. Finally add two teaspoons (10 mL) of Milton sanitising solution. This 0.04% hypochlorous acid solution has a pH of approximately 5, similar to the pH of the skin. The solution should be stored away from direct sunlight. A viscous liquid or gel can be made by adding a small amount of xanthan gum or gelatine powder to a portion of hypochlorous acid solution until the desired consistency is obtained. A plastic squeeze bottle was used for applying the gel. The patient noted the frequency of his use of antibiotics was reduced and there was less redness and weeping with more rapid healing of erosions and thinning of hyperkeratotic plaques using hypochlorous acid and reported increased well-being. The use of hypochlorous acid in a time of increasing antimicrobial resistance is important given the risk of erosions becoming infected in patients. Many investigators have demonstrated the significant anti-microbial activity in vitro of hypochlorous acid against common bacteria, improved healing of ulcers as well as antipruritic potential. The efficacy of hypochlorous acid combined with the more practical application of our preparations to body parts such as the face compared to bleach baths further highlights the potential of this agent to not only porphyria but other dermatological conditions with risk of secondary infection such as atopic dermatitis.

Two cases of generalised granuloma annulare successfully treated with acitretin and NB UVB therapy.

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Lichen striatus in a pregnant woman.

Two cases of generalised granuloma annulare successfully treated with acitretin and NB UVB therapy.