Indian Journal of Dermatology
CASE REPORT
Year
: 2006  |  Volume : 51  |  Issue : 1  |  Page : 42--43

Painful linear atrophic lichen planus along lines of Blaschko


Chembolli Lakshmi1, Jeevan Divakaran2, Ammu Sivaraman2, CR Srinivas1,  
1 Department of Dermatology, PSG Hospitals, Coimbatore-641 004, India
2 Department of Pathology, PSG Hospitals, Coimbatore-641 004, India

Correspondence Address:
C R Srinivas
Department of Dermatology, PSG Hospitals, Peelamedu, Coimbatore - 651 004
India

Abstract

Linear lichen planus along the lines of Blaschko is uncommon. Atrophic lichen planus is usually a sequel to resolving annular and ulcerative lesions. We herewith report a case of histopathologically proven lichen planus, presenting with atrophy at the outset, in a linear distribution along the lines of Blaschko. In addition to the cutaneous findings, she also had pain along the distribution of lesions.



How to cite this article:
Lakshmi C, Divakaran J, Sivaraman A, Srinivas C R. Painful linear atrophic lichen planus along lines of Blaschko.Indian J Dermatol 2006;51:42-43


How to cite this URL:
Lakshmi C, Divakaran J, Sivaraman A, Srinivas C R. Painful linear atrophic lichen planus along lines of Blaschko. Indian J Dermatol [serial online] 2006 [cited 2022 Jan 25 ];51:42-43
Available from: https://www.e-ijd.org/text.asp?2006/51/1/42/25190


Full Text

 Introduction



Lichen planus, a papulosquamous disease, is classically characterized by pruritic, violaceous papules on the extremitis. Approximately 20 clinical variants have been described.[1] Linear and zosteriform lichen planus following blaschko's lines has been reported and is considered as a subtype of lichen planus.[2],[3]

Linear lichen planus, first described in 1854 by Devergie, is uncommon and accounts for 0.24-0.62% of all patients with lichen planus.[3]

Blaschko's lines do not correspond to any known nervous vascular or lymphatic structures and are thought to reflect T-lymphocyte migration and clonal expansion during embryogenesis of the skin.[4],[5] Several congenital, naevoid and acquired skin diseases may follow Blaschko's lines. The genetic mosaicism in acquired Blaschko-linear inflammatory dermatoses could be responsible for cutaneous antigenic mosaicism that may induce mosaic T-cell response by the triggers of viral infection or drug.[5] We describe a patient with atrophic linear lichen planus along the lines of Blaschko. In addition she complained of pain along the course of lichen planus lesions.

 Case Report



A 25 year old lady presented with an eight month history of progressive linear violaceous macules both continuous and interrupted, which started on the medial aspect of the left forearm advancing both proximally and distally [Figure 1]. Proximal extension was linear along the left arm, curving over the left breast and ending close to the midline of the chest near the epigastrium.

Distally, the lesions extended till the hypothenar eminence. She complained of pain radiating along the distribution of lessions. The active lesions at the advancing proximal end showed violaceous mildly atrophic macules whereas the older inactive lesions were dark brown and markedly atrophic.

Since the lesions were linear and atrophic from the onset and there was no history of topical or systemic treatment, a diagnosis of linear atrophic lichen planus was made. Linear lichen planus pigmentosus was considered in the differential diagnosis. Skin biopsies were taken both from the advancing violaceous macules showing minimal atrophy and from the hyperpigmented markedly atrophic macules.

The first biopsy showed, hyperkeratosis, hypergranulosis, atrophy and basal liquefaction degeneration, with subepidermal clefts and a focal dense mononuclear infiltrate hugging the epidermis. Melanophages were present in the inflammatory infiltrate [Figure 2].

The second biopsy showed an extremely atrophic epidermis with a thin stratum corneum and melanophages in the superficial dermis. Occasional foci of basal liquefaction degeneration were seen with a very sparse inflammatory infiltrate in the dermis [Figure 3].

She was started on oral prednisolone 50 mg weekly which alleviated her pain. The dose was tappered every 2 wks by 10 mg. Since the last 2 months of follow-up, she shows no progression of the disease and is free from pain.

 Discussion



Based on clinical and histopathologic findings we diagnosed this case as linear atrophic lichen planus following Blaschko's lines. Atrophic lichen planus has only been described as a sequel to resolving annular and ulcerative lesions and has not been described at the outset. Few reports describe linear lichen planus along the lines of Blaschko.[2],[3] This is the first report of linear atrophic lichen planus along the lines of Blaschko. An interesting feature in our patient was pain felt along the distribution of lesions which ws relieved with pulse corticosteroids. Further studies are required to ascertain whether nerve infiltration is a cause of pain or pruritus in lichen planus. The early lesions in our patient were of lichen planus with atrophy while the older lesions could be consistent with lichen planus pigmentosus. It is well known that histopathologically it is impossible to differentiate old lesions of lichen planus from lichen planus pigmentosus, but the early macules showed typical features of lichen planus with atrophy evident clinically and microscopically, a feature not seen in lichen planus pigmentosus. Although liquefaction degeneration of the basal cells can be seen in both lichen planus and lichen planus pigmentosus, a focal dense dermal mononuclear infiltrate is seen only in lichen planus. The presence of atrophy clinically and histologically in early lesions of lichen planus, in a linear distribution alogn the lines of Blaschko has not been reported.

References

1Boyd AS, Neldner KH. Lichen planus. J Am Acad Dermatol. 1991; 25: 593-619.
2Munoz MA, Perez-Bernal AM, Camacho FM. Lichenoid drug eruption following the Blaschko lines. Dermatology 1996; 193: 66-7.
3Long CC, Finlay AY. Multiple linear lichen planus in the lines of Blaschko. Br J Dermatol 1996; 135: 275-6.
4Bolognia JL, Orlow SJ, Glick SA. Lines of Blaschko. J Am Acad Dermatol 1994; 31: 157-90.
5Lipsker D, Cribier B, Girard-Lemaire F, Flori E, Grosshans E. Genetic mosaicism in an acquired inflammatory dermatosis following the lines of Blaschko. Arch Dermatol 2000; 136: 805-7.