|THE CLINICAL PICTURE
|Year : 2017 | Volume
| Issue : 1 | Page : 50-51
Lichen planus along the lines of Blaschko
P Arunprasath DDVL, Senior Resident , Steffy Reji, V Sivasubramanian
Department of Dermatology and STD, Vinayaka Mission’s Medical College and Hospital, Karaikal, Pondicherry, India
|Date of Web Publication||19-Jun-2017|
Department of Dermatology and STD, Vinayaka Mission’s Medical College and Hospital, Karaikal 609609, U.T. of Pondicherry
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Arunprasath P, Reji S, Sivasubramanian V. Lichen planus along the lines of Blaschko. Pigment Int 2017;4:50-1
A 17-year-old male presented with multiple, asymptomatic, hyperpigmented skin lesions of 1-year duration, which involved the right side of the chest and back. Examination revealed multiple, hyperpigmented patches and plaques that showed a segmental pattern extending from right side of the chest wall to involve the lateral aspect and back [Figure 1]. Amidst the hyperpigmented patches and plaques, there were multiple striae, which were probably topical steroid induced, as the patient had reported a history of topical application of drugs that his primary healthcare physician had prescribed. Examination of mucosae, nails, and scalp did not reveal any abnormality. A differential diagnosis of Becker’s nevus, linear lichen planus, zosteriform lentiginous nevus, and progressive cribriform and zosteriform hyperpigmentation were considered. Histopathological examination revealed compact orthohyperkeratosis and focal thickening of granular layer. The dermoepidermal junction was obscured by the lichenoid infiltrate and showed necrotic keratinocytes and colloid bodies, which were consistent with lichen planus [Figure 2], and, thereby, helped to culminate in a diagnosis of linear lichen planus.
|Figure 1: Hyperpigmented patches and plaques in a segmental pattern involving (a) right side of the chest, (b) extension from anterior to lateral chest, (c) lesions involving lateral chest wall, and (d) right side of the back|
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|Figure 2: Section shows mild compact orthohyperkeratosis and focal hypergranulosis. The dermoepidermal junction is obscured by moderately dense lichenoid infiltrate of lymphocytes (H&E ×100)|
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Linear lichen planus is a rare variant among various morphological patterns of lichen planus characterized by distribution of lesions along the lines of Blaschko. The lesions follow a linear pattern in extremities and S-shaped pattern in the trunk. Most of the reported lesions on the trunk were labelled as zosteriform lichen planus. However, according to Happle,, these reported lesions were arranged along the lines of Blaschko rather than a dermatomal pattern. In this case, careful examination showed that the lesions were arranged in an S-shaped fashion following the lines of Blaschko and was highlighted for its unique array.
The authors thank Dr. Uday Khopkar, MD, DVD, DNB, FIDP, Mumbai for his valuable opinion on histopathology in this case.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Happle R. ‘Zosteriform’ lichen planus: Is it zosteriform? Dermatology 1996;192:385-6.
Happle R.“Zosteriform” lichen planus: The bizarre consequences of a misnomer. Acta Derm Venereol 1998;78:300.
[Figure 1], [Figure 2]