ORIGINAL ARTICLE
Year: 2020 • Volume: 3 • Issue: 1 • Page: 08-11

CLINICO-EPIDEMIOLOGICAL PROFILE OF PATIENTS WITH LICHEN STRIATUS:A RETROSPECTIVE STUDY FROM A TERTIARY CARE CENTRE IN NORTH INDIA

Arti Singh1, Ramesh Kumar2, Kapil Vyas3, Rozy Badyal2, Pritee Sharma2, Suresh Kumar Jain2, Dinesh Chand Mathur1

1Department of Dermatology, Venereology , Leprology, JNU Medical College, Jaipur, Rajasthan
2Department of Dermatology, Venereology, Leprology, Government Medical College Kota, Rajasthan
Department of Dermatology, Venereology, Leprology, Geetanjali Medical College, Udaipur, Rajasthan

Corresponding Author:
Ramesh Kumar
Government Medical College Kota, Rajasthan
E-mail:kush_ramesh3@yahoo.com

How to cite this article:
Singh A, Kumar R, Vyas K, Badyal R, Sharma P, Jain SK, Mathur DC. Clinico-epidemiological profile of patients with lichen striatus: A retrospective study from a tertiary care centre in North india. JDA Indian Journal of Clinical Dermatology 2020;3:08-11

Abstract
Background: Lichen striatus (LS) is a benign, self-limited, linear, inflammatory dermatosis of unknown etiology that usually affects
children. Most of the literature on lichen striatus has appeared as case reports or isolated case series from India.
Material and Methods: Clinical records of children with LS, who attended the Department of dermatology, at our tertiary care centre,
from July 2013 to December 2017, were analyzed.
Results: Twenty nine patients were analyzed. Mean age was 6.5 years, ranging from 1.6 year to 12 years. We found 17 (58.62%) male
and 12 (41.38%) female cases with slight male preponderance. Nine (31.03%) patients were less than 3 year, 13 (44.82%) patients from
3-6 year age group, 7 (24.13%) patients from 6-12 year age group . Most common site was upper limbs 11 (37.93%) cases followed by
trunk 7 (24.13%). Most common complaint was hypo pigmentation in 22 (75.86%) children by the parents. Nail involvement was seen
in 3 (10.34%) boys.
Conclusion: In this large case study, lichen striatus appears as a disease of young children with a male predilection. The disease appears
statistically more often in the cold seasons, particularly in the winter. The most frequently involved sites are the limbs, while nail
involvement is very rare.
Keywords: Lichen striatus, Linear inflammatory dermatosis

Introduction
Lichen striatus (LS) is an asymptomatic self-limited skin disease of unknown etiology which was first described by Senear and Caro in 1941.[1] LS is characterized by erythematous or brownish papules with a flattened surface that are frequently scaly in appearance and occasionally display vesicles. The lesions are usually solitary and unilateral and have a linear distribution following Blaschko’s lines, usually on the extremities. Atypical forms with multiple and bilateral lesions have been described. Onset is usually sudden, with the disease progressing
over days or weeks and slowly decreasing spontaneously until the papules resolve within 6–24 months, leaving a transitory residual hypopigmentation, especially in patients with a dark complexion. The inflammatory phase is not always detected, and hypopigmentation may be the first manifestation. The higher incidence during spring and summer, along with the existence of familiar clustering, suggest that viral infections could be an elicitation factor. Other possible precipitating factors may include cutaneous injury, trauma, hypersensitivity, or other as yet unspecified factors.

Material and methods
Medical records and photographs were used in a retrospective study of 29 children affected by lichen striatus who were seen at the Department of Dermatology, Government Medical College, Kota, India, between July 2013 and December 2017. We studied the gender, age, and family history of the patients as well as the season of onset, morphology, distribution, extent, duration, itching, residual hypopigmentation and treatment of lichen striatus and any associated symptoms or diseases.

Results
Twenty nine patients were analyzed ( Table 1). Mean age was 6.5 years, ranging from 1.6 year to 12 years. We found 17 (58.62%) male and 12 (41.38%) female cases with slight male preponderance. Nine (31.03%) patients were less than 3 year, 13 (44.82%) patients from 3-6 year age group, 7 (24.13%) patients from 6-12 year age group. Most common site was upper limbs 11 (37.93%) cases followed by trunk 7 (24.13%) (figure-1). Most common complaint was hypo pigmentation in 22 (75.86%) children by the parents. Nail involvement was seen in 3 (10.34%)
boys.

Morphology
Based on the morphology of the lesions, we identified the following three clinical patterns:
Lichen striatus albus, with hypopigmented macules and/or papules with only a few typical lichenoid pink papules in 22(75.86%) patients. Typical lichen striatus, with pink, red, or flesh colored, flat-topped, lichenoid papules was found in 4(13.79%) patients.

Table 1. Comparison of Visual analogue scale (VAS) in both the study groups at different time interval.

Nail lichen striatus, which includes onychodystrophy, thinning, longitudinal ridging and splitting, fraying, and onycholysis restricted to the lateral portion of the affected nail, or more rarely, to the medial portion. Nail lichen striatus was seen in three (10.34%) boys, ages 9 and 11 years (figure-2). In all patients of nail lichen striatus, cutaneous involvement was also seen.

Distribution of lesions was unilateral in all patients with 19 (65.55%) on the right side and 10 (34.48%) on the left side of the body. Thirteen patients (44.82%) had pruritus and 16 (55.17%) were asymptomatic. Eight patients (27.58%) had a history of atopy.

All of the 29 patients analyzed in regard to seasonality, the appearance of lesions occurred in 7 (24.13%) during spring months, in 6 (20.68%) in the summer, in 8 (27.58%) in autumn and in 8 (27.58%) in winter.

Figure 1a : Showing distribution of lichen striatus lesions ; 1a- over face

Figure 1b : lichen striatus lesions over penis Ltd

Figure 1c : lichen striatus lesions over trunk

Figure 2a : Variants of lichen striatus ;2a -linear LS

Figure 2b : : Hypopigmented variant of lichen striatus

Figure 3 : Nail lichen striatus

Table 2. Review of the various studies of lichen striatus

Discussion

The analysis of 29 patients with LS found a male:female ratio of 1.41:1 showing a clear preponderance of the disease in boys, in contrast to the findings of other studies.[2,3,4,5.6] Taieb et al 7 found an equal incidence in both sexes. The ages of our patients ranged from 1.6 to 12 years, the same age interval as has been reported in other series 2,3,4,7 Review of the various studies is shown in table 2.

As in the study of Kennedy and Rogers 5 and Sittart et al 8, who reported an incidence peak in preschool children, we also found 13(44.82%) cases of LS in 3 to 6 years age group.

In some reported series there was mostly involvement of the upper limbs 3,6,7. Kennedy and Rogers 5 found lesions on the superior limbs 1.7 times more often, as was also seen by Ruiz-Maldonado et al.2 In our study, 11( 40.7%) of 29 patients had lesions on the upper

limb and 6 had lesions on the lower limbs. This means that almost half of the instances occurred on the upper limbs; this location is 2 times more common than occurrence on the legs 4 (13.79%).Other locations were also affected, such as the trunk (thorax, abdomen, and dorsum) and neck. In all patients, the lesions followed a pattern corresponding to the lines of Blaschko.

Lichen striatus is a dermatosis of unilateral manifestation in the majority of cases.[2,5] In our study, all of the patients had unilateral lesions. The right side was involved more than left and the side involved was independent of gender. Bilateral lesions were described in few case reports.[9-13] Bilateral lesions were not found in our patients.

In addition, 16 (55.17%) of our patients were asymptomatic. This finding is in agreement with the series of Ruiz- Maldonado who described 80% of patients without associated symptoms. Thirteen (44.82%) patients in our study had pruritus

and this feature was independent of age. A relevant finding was that all of the atopic patients were 8 (27.58%) had pruritus .

Toda et al[14] , in a study of 26 patients with LS, found that 84.6% had atopy, suggesting that a personal or family history of atopy could favor the appearance of the disease. Di Lernia et al[15], studying a group of 19 children, found that 53% had atopy, a much lower percentage than that observed by Toda et al.[14] In our study, only 8 (27.58%) patients have personal history of atopy. These findings do not allow the association of LS with atopy, since this number is very close to the incidence of atopy in the general population, which is 15% .[16]

Kennedy et al[5] observed an increased incidence of LS in spring and summer, and suggested a possible viral origin. Significant differences in regard to the season of the year were not found in our study. In our study most of the patients 16 (55.16%) appeared in winter and autumn while 13 cases appeared in other rest of the seasons.

Differential diagnosis of LS may include different linear papular eruptions such as linear psoriasis, linear Darier’s disease, linear lichen planus, linear porokeratosis and inflammatory linear verrucous epidermal nevus (ILVEN). Hypopigmented lesions may be confused with linear vitiligo or nevoid hypomelanosis (the so-called hypomelanosis of Ito). Of these entities, ILVEN may be the most difficult to differentiate. In contrast to LS, ILVEN is always pruritic and it does not regress spontaneously but instead undergoes periods of exacerbation with periods of improvement.[17]

Conclusion

In conclusion, through this study we found that LS is a disease that predominately affects boys between 1.5 and 14 years of age, involving mostly the upper limbs unilaterally, with right side being affected more than left side and with a pattern following the lines of Blaschko.

Most of the children did not show any symptoms but when symptomatic, the most common finding was pruritus.

Asymptomatic lesions were twice as common as pruritic ones. Atopy was not a striking feature, as its proportion was similar to that found in the general population. Nevertheless, although the existence of atopy or pruritus was infrequent, they tended to be seen together in many patients. The majority of atopic patients presented with pruritic lesions and this may suggest that the sensitive skin of these children is more susceptible to the development of exacerbated reactions in LS lesions.

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