Eur J Pediatr (2006) 165: 267269

DOI 10.1007/s00431-005-0032-9

SH ORT REPO RT

Laura Peramiquel . Eullia Baselga . Joan Dalmau .

Esther Ro . Maria del Mar Campos . Agustn Alomar

Lichen striatus: clinical and epidemiological review of 23 cases

Received: 6 June 2005 / Accepted: 28 September 2005 / Published online: 13 January 2006
# Springer-Verlag 2006

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 [6]. Although LS is a frequent
dermatosis among children, especially in girls between 5
and 15 years of age, there are few reviews in the literature.
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 Blaschkos 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 624 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.

We retrospectively reviewed the pediatric cases handled

by the Department of Dermatology, Hospital de la Santa
Creu I Sant Pau, in Barcelona between 1987 and 2004
using the photographic files of the Department as a selection criterion. Only patients with available clinical history
were included. Diagnosis was based on clinical findings.

Results
We reviewed 24 episodes of LS in 23 patients. The main
clinical and epidemiological features are shown in Table 1.
The initial clinical presentation in most episodes of LS
consisted of erythematous papules in 11 episodes (11/24)
(Fig. 1), hypopigmented lesions (Fig. 2) from the beginning of the disease in eight cases, and vesicles in only
two instances, and there was a single patient in whom the
initial papules were not erythematous but flesh-colored.
Most of the patients had a solitary localized lesion. Only
two patients had extensive bilateral involvement. One was
a 7-month-old girl with disseminated lesions that involved
the anterior and posterior trunk as well as all of the
extremities.(Fig. 3). The other patient was a 3-year-old boy
whose lesions involved the posterior aspect of both lower
limbs.
All but one patient had a single episode of LS. One
patient had two episodes of LS in two different locations,
the dorsum of the right hand and the left side of the abdomen; these were separated in time by 26 months.
Two-thirds of the patients had an involvement of the
extremities; less frequent locations were the trunk (5/24)
and face (1/24).

Lichen striatus (LS) is an asymptomatic self-limited inflammatory

skin disease frequent among children. We retrospectively reviewed
the pediatric cases seen in our Department from 1987 to 2004.

Discussion

L. Peramiquel (*) . E. Baselga . J. Dalmau . E. Ro .

M. del Mar Campos . A. Alomar
Department of Dermatology,
Hospital de la Santa Creu I Sant Pau,
St. Antoni Ma Claret, 167,
08025 Barcelona, Spain
e-mail: Lperamiquel@hsp.santpau.es

LS is a relatively frequent dermatosis among children but

there are only a few case series in the literature [111]. A
comparison between our findings and those from the most
relevant reviews of the literature is depicted in Table 1.
The duration of these episodes may vary greatly, from
weeks to years, but they almost always last for over 6

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Table 1 Review of the literature (NC not considered)
Series of cases
by author/year

Number
of cases

Staricco/1959 [8]

15

Toda/1986 [11]
Sittart/1989 [7]

26
53

Patrone/1990 [5]

Di Lernia/1991 [1]

19

Taieb/1991 [9]

18

Kennedy/1996 [3]

61

Hauber/2000 [2]

12

Taniguchi/2004
[10]

89

Patrizi/2004 [4]

Peramiquel/Present
publication
a

115

24

Mean agea
(range/
age mean)

Gender Seasons of
M/F
presentation
(%)

Locationb Mean duration of Itch

(%)
episodea
(%)
(w, m, y)

Residual
hypopigmentation (%)

Atopy
(%)

24.26 m
(368 m)
(037 m)
2.5 y
(140 m)
8.17 m
(870 m)
6.0 m
(1713 m)
3m
(614 m)
2.98 y
(10 m9 y)
5y
(6 m48 y)
(29 d14 y)

1/2

NC

1/1.6
1/2.3
1.6/1

NC
Spring and
summer (75)
NC

EE 100
SE>IE
NC
EE 92

1.1/1

NC

1/1

NC

1/2

Spring and
summer (71)
NC

4y+5m
(1 m13 y)

3.41
(6 m11 y)

3/1
1/3

1/2

1/1

Spring (22.4)
Summer (34.2)
Autumn (22.4)
Winter (21)
Spring (24)
Summer (4)
Autumn (23)
Winter (48)
Spring and
summer (70.8)

6.8 m (3 w2 y)

46.6

NC

NC

NC
NC

NC
NC

NC
NC

84.6
20

EE 62
IE>SE
NC

12 m (2 m6 y)

25

25, 12 hyper

NC

6 m (130 m)

21

NC

47.3

EE 67
SE>IE
EE 77
IE>SE
EE 83
IE>SE
EE 86.5

9.5 m (1 m3 y)

50

33

NC

NC

NC

NC

12 m (4 m4 y)

16

42, 33 hyper

58

NC

34

NC

20

6m

11

28.57, 3.8
hyper

60.86

8.5 m (1 m2 y)

12.5

59.1

47.8

IE>SE
EE 62
IE>SE
EE 73.9
IE>SE

y, Years; m, months; w, weeks; d, days

EE, Extremities; IE, inferior extremities; SE, superior extremities; hypo, hypopigmentation; hyper, hyperpigmentation

months. Some patients continue to present residual hypopigmented lesions following remission of the active
episode characterized by the erythematous papules [2, 4,
5, 9].

Many studies have considered atopy as a possible predisposing factor for this cutaneous disease, but all have
found different results for this association. In our study,
almost one-half the patients had a personal history of atopy.

Fig. 1 Clinical presentation as papular erythematous lesions

spreading over a limb

Fig. 2 A case in which the first lesions were hypopigmented

269

as was observed for one of our patients. Genetic predisposition is therefore a second plausible explanation.
In conclusion, LS appears to equally affect boys and
girls under 5 years of age during the warmer months and in
a linear distribution along the extremities. It is not a rare
entity and is mainly asymptomatic, with the inflammatory
phase sometimes passing unnoticed. Long-lasting residual
hypopigmentation is common, and extensive and recurrent
episodes may occasionally be seen.
Although LS is a benign dermatosis, studies in larger
series are needed to determine not only its pathogenesis but
also whether there is any distinct precipitating factor.

References

Fig. 3 Clinical appearance of the 7-month-old girl described in the

text with disseminated lesions

However, we found no differences regarding age, duration,

and extension of LS between the atopic and nonatopic
patients.
Differential diagnosis of LS may include different linear
papular eruptions such as linear psoriasis, linear Dariers
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 [2].
Familial cases of LS have rarely been reported [3, 4]. In
cases where the eruption appears simultaneously, it may be
postulated that there is a common triggering factor. However, familial episodes of LS are not always simultaneous,

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