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E-IJD CORRESPONDENCE
Year : 2016  |  Volume : 61  |  Issue : 3  |  Page : 348
A case of blaschkitis with features of both lichenoid and spongiotic dermatitis


1 Department of Dermatology, Razi Hospital, School of Medicine, Medical Sciences/University of Tehran, Tehran, Iran
2 Department of Pathology, Razi Hospital, School of Medicine, Medical Sciences/University of Tehran, Tehran, Iran

Date of Web Publication13-May-2016

Correspondence Address:
Ifa Etesami
Department of Dermatology, Razi Hospital, School of Medicine, Medical Sciences/University of Tehran, Tehran
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.182471

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How to cite this article:
Azizpour A, Nasimi M, Safaie-Naraghi Z, Etesami I. A case of blaschkitis with features of both lichenoid and spongiotic dermatitis. Indian J Dermatol 2016;61:348

How to cite this URL:
Azizpour A, Nasimi M, Safaie-Naraghi Z, Etesami I. A case of blaschkitis with features of both lichenoid and spongiotic dermatitis. Indian J Dermatol [serial online] 2016 [cited 2021 Nov 28];61:348. Available from: https://www.e-ijd.org/text.asp?2016/61/3/348/182471


Sir,

In 1990, Grosshan and Marot first described blaschkitis (BL), an acquired linear inflammatory dermatosis following Blaschko lines in an adult patient.[1] BL is a rare skin disease with many similarities to lichen striatus (LS). LS is an acquired inflammatory dermatosis that follows the Blaschko lines. LS occurs mainly in children and is rarely seen in adults. Clinically, it is presented by erythematous 1–2 mm flat-topped papules on extremities. The histopathological findings indicate mostly lichenoid dermatitis.[2]

The patient Grosshan and Marot reported was an adult presenting by multiple lines of erythematous papules and vesicles mainly located on the trunk with rapid resolution within 2 months and led them to introduce BL as a separate entity from LS. Histopathologically, BL has been characterized as a spongiotic dermatitis.[1],[3] We present a case of BL with histological features of both lichenoid dermatitis and spongiotic dermatitis which indicates similarities to both BL and LS.

A 56-year-old woman presented with a 2-month history of papules and few plaque-type lesions on her trunk, abdomen, upper back, and neck. The lesions had linear distribution along the  Lines of Blaschko More Details. Physical examination revealed multiple 3–6 mm erythematous papules involving the trunk, abdomen, and upper back in a linear pattern [Figure 1]. A biopsy from her lesions revealed parakeratosis and both features of lichenoid dermatitis and spongiotic dermatitis were present [Figure 2]. Treatment with topical steroids over 2 months showed relative resolution of the existing lesions, however new lesions developed.
Figure 1: (a) Linear eruptions following the lines of Blaschko on the trunk (b) thigh (c) and upper chest

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Figure 2: (a) The histopathological findings were consistent with both lichenoid dermatitis (H and E ×40) (b) and spongiotic dermatitis (H and E ×100)

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Whether LS and BL are separate entities or are variations of the same disease remain controversial. Keegan et al . in 2007 concluded that these two diseases are different in their clinical presentation and histopathological findings. They presented differentiating features between LS and BL which are shown in [Table 1].[1] In contrast, Hofer proposed that due to lack of differentiating clinical and histological features, BL and LS may actually be the same.[4] In 2011, Müller et al . reported six patients all presenting with erythematous papules along Blaschko lines. They found no association between clinical characteristics such as age, location or associated disorders, and histological findings such as lichenoid inflammatory infiltrate or spongiosis. Finally Müller et al . proposed the theory that both LS and BL are describing the same Blaschko linear dermatoses with slightly different clinical and histological findings. They believed that these differences could be explained by the “life of lesion” phenomenon, the fact that more spongiotic dermatitis in BL and more interface alterations in LS could be due to the existence of different stages of the disease pathologically.[5]
Table 1: Differentiating features between Lichen striatus and blaschkitis

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Considering the literature, the previously reported cases of BL were described mainly as spongiotic dermatitis. However, our case showed both spongiotic and lichenoid dermatitis, compatible with histopathological features of BL and LS, respectively. Our observation further supports the theory that BL and LS are describing the same disease. The unifying of these two diseases with similar clinical and histological features could be helpful for simplifying diagnosis and treatment clinically.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Keegan BR, Kamino H, Fangman W, Shin HT, Orlow SJ, Schaffer JV. “Pediatric blaschkitis”: Expanding the spectrum of childhood acquired blaschko-linear dermatoses. Pediatr Dermatol 2007;24:621-7.  Back to cited text no. 1
    
2.
Peramiquel L, Baselga E, Dalmau J, Roé E, del Mar Campos M, Alomar A. Lichen striatus: Clinical and epidemiological review of 23 cases. Eur J Pediatr 2006;165:267-9.  Back to cited text no. 2
    
3.
Lipsker D, Stark J, Schneider GA. Blaschko-linear dermatitis in adulthood (Grosshans-Marot disease) with antinuclear antibodies. Hautarzt 2000;51:774-7.  Back to cited text no. 3
    
4.
Hofer T. Lichen striatus in adults or 'adult blaschkitis'? There is no need for a new naming. Dermatology 2003;207:89-92.  Back to cited text no. 4
    
5.
Müller CS, Schmaltz R, Vogt T, Pföhler C. Lichen striatus and blaschkitis: Reappraisal of the concept of blaschkolinear dermatoses. Br Assoc Dermatol 2011;164:257-62.  Back to cited text no. 5
    


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