This child developed a linear rash that extended all the way to the fingernail (see below).

LICHEN STRIATUS

Lichen striatus (LS) is a linear inflammatory condition that typically affects young children.

• It is thought that an acquired stimulus such as a virus or vaccination may induce loss of immunotolerance toward mosaic keratinocyte clones that undergo attack from, and clearance by, cytotoxic T cells.
• Known triggers to LS (or Blaschkitis) include trauma, vaccines, medications, and viral infections, including Covid and Covid vaccines.

Blaschkitis

The term "blaschkitis" was coined to describe an acquired linear inflammatory dermatosis following Blaschko's lines in an adult patient. The similarities to LS are many and it has been argued that Blaschkitis and LS represent the same entity.

Clinical

Linear papules or red, scaly lesions which appear suddenly in a child and follow Blaschko's lines are characteristic. It may occur at any age and may affect nearly any body site, including the face. Post inflammatory hypopigmentation is common. Some patients who present late may just have linear hypopigmentation.

Treatment

No specific treatment is known effective. Lichen striatus usually involutes within a year. IL steroids may be tried to limited areas if persistent. Nail matrix lichen striatus resolves in 1-2 years.  Tacrolimus 0.1% cleared a woman's LS after 4 weeks.   Acitretin 0.5 mg/kg/day completely cleared one woman's LS after 4 weeks of therapy

For any residual hypopigmentation, the 308-nm excimer laser completely repigmented over 90% of patients in one retrospective study.

Additional Pictures

Lichen Striatus can cause dystrophy of the nail.

RegionalDerm

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