The differential diagnosis includes linear lichen planus (LP), blaschkitis, linear graft versus host disease (GVHD), linear epidermal nevus, lichen nitidus, and other inflammatory disorders in a linear pattern such as linear porokeratosis, and linear psoriasis. Blaschkitis more often favors the trunk, has multiple streaks, and presents in adults,4 and linear GVHD occurs in a specific clinical setting. Although lichen striatus and linear LP can look similar histologically, their clinical appearance is what sets them apart. Hypopigmentation is the most common sequala of lichen striatus, whereas linear lichen planus resolves with hyperpigmentation.1 If lichen striatus persists beyond a year’s time, a biopsy can help distinguish lichen striatus from other entities.
Lichen striatus is a benign, transitory condition not requiring treatment unless the lesion is pruritic, in which case topical steroids or nonsteroidal antiinflammatory agents such as calcineurin inhibitors can be prescribed.3-5
For this patient, lichen striatus was diagnosed clinically and no further workup was required. The natural history of the disease was discussed with the family, and they elected to have the boy followed clinically without treatment.
1. Shiohara T, Kano Y. Lichen planus and lichenoid dermatoses. In: Bolognia J, Jorizzo J, Schaffer J, eds. Dermatology. 3rd ed. Philadelphia: Elsevier/Saunders; 2012:183-202.
2. Tilly JJ, Drolet BA, Esterly NB. Lichenoid eruptions in children. J Am Acad Dermatol.2004;51(4):606-624.
3. Graham JN, Hossler EW. Lichen striatus. Cutis. 2016;97(2):86;120;122.
4. Mu EW, Abuav R, Cohen BA. Facial lichen striatus in children: retracing the lines of Blaschko. Pediatr Dermatol. 2013;30(3):364-366.
5. Goyal S, Cohen BA. Pathological case of the month. Lichen striatus. Arch Pediatr Adolesc Med. 2001;155(2):197-198.