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Background
This eruption occurs in children and adolescents and usually resolves after 1-2 yrs. It is a linear, papular eruption occurring along one extremity and often follow Blaschko's lines. It may also occur on the trunk and face. After it resolves, it may leave hyperpigmentation. It is more common in females.
The pathologist must distinguish this disorder from other lichenoid inflammatory infiltrates including lichen planus. The clinical presentation is the most helpful clue to confirm the diagnosis.
EPIDEMIOLOGY CHARACTERIZATION AGE RANGE-MEDIAN 5-15 years most common
Range from 6 months to >50 yearsFemales more common
HISTOLOGICAL TYPES CHARACTERIZATION General The histopathology is variable depending upon the stage of the disease
Consistent histologic features include:
Hyperkeratosis
Parakeratosis
Few necrotic keratinocytes in epidermis
Mild spongiosis
Exocytosis of lymphocytes
Within the dermis, the inflammatory cells extend along the adnexal epithelium and in a superficial and deep perivascular location
Satellite cell necrosis
Colloid bodies
Lichen striatus. Histological, immunohistochemical, and ultrastructural study of 37 cases.Zhang Y, McNutt NS.
Department of Pathology, New York Hospital Medical Center of Queens, USA.
J Cutan Pathol 2001 Feb;28(2):65-71 Abstract quote BACKGROUND: Lichen striatus (LS) is a papulosquamous disorder with a distinctive linear distribution. The linearity has been shown to correspond in many cases to the pattern of Blaschko's lines. The etiology is unknown. LS can usually be identified by clinical history and histology of typical lesions. However, the histologic features are diverse and some have stated they are nonspecific.
METHODS: In an effort to identify those characteristic features, we have reviewed the routine slides in 37 cases for their diagnostic criteria. Ten cases were studied further by immunohistochemistry.
RESULTS: The patient's ages ranged from 1.3 to 49 years with mean age of 17.5 years. A female-to-male ratio was 1.6 to 1. The lesions were predominantly distributed on the extremities in 26/34 cases. The consistent histologic features were: hyperkeratosis (29/37), parakeratosis (21/37) with a few necrotic keratinocytes (28/37) in the epidermis, mild spongiosis (29/37) with exocytosis of lymphocytes (33/37). The dermal infiltrate comprised mainly lymphocytes and macrophages. At the dermal-epidermal junction, the infiltrate was either focal (20/37) or lichenoid (17/37) patterns. Superficial and deep perivascular lymphocytic inflammatory infiltrate was present in most of the cases (33/37). Appendageal involvement (34/37) was in hair follicles (24/37) or eccrine glands or ducts (22/37) or both (12/37). Satellite cell necrosis may be seen (11/37). Colloid bodies were present in 16/37 of the cases. Immunohistochemistry showed that most of the small lymphocytes in the upper dermis and epidermis were positive for CD7. Most of the lymphocytes in the epidermis were positive for CD8. CD1a Langerhans' cells were either decreased (5/10) or increased (3/10) or normal (2/10) in the epidermis.
CONCLUSION: The histologic diagnosis of LS can be made on the basis of the combination of these histologic features in the appropriate clinical context. Multiple biopsies may be necessary to determine whether all of these features are present in a given case.
SPECIAL STAINS/IMMUNOPEROXIDASE/OTHER CHARACTERIZATION Immunoperoxidase Most epidermal lymphocytes positive Most small lymphocytes in upper dermis and upper epidermis
DIFFERENTIAL DIAGNOSIS KEY DIFFERENTIATING FEATURES Inflammatory linear epidermal nevus Linear Lichen planus Linear psoriasis
PROGNOSIS AND TREATMENT CHARACTERIZATION Prognostic Factors Usually resolves within a year Metastasis None J Cutan Pathol 2001;28:65-71
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