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ONLINE ONLY - CASE REPORT
Year : 2022  |  Volume : 6  |  Issue : 1  |  Page : 56

Blaschkitis or lichen striatus: A splitter's view


Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India

Date of Submission06-Aug-2020
Date of Decision23-Nov-2020
Date of Acceptance19-Dec-2020
Date of Web Publication25-Feb-2022

Correspondence Address:
S Salunke Tejaswini
Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CDR.CDR_112_20

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  Abstract 


Blaschkitis is an uncommon inflammatory dermatosis of unknown etiology, usually affecting adults. It is characterized by unilateral linear pruritic eruptions along the Blaschko's lines, usually seen on the trunk. Here, we report a case of this rare disorder and have put forward an argument why it is different from lichen striatus.

Keywords: Blaschkitis, lichen striatus, linear dermatoses


How to cite this article:
Pravin R B, Tejaswini S S, Vinay V K, Anil H P. Blaschkitis or lichen striatus: A splitter's view. Clin Dermatol Rev 2022;6:56

How to cite this URL:
Pravin R B, Tejaswini S S, Vinay V K, Anil H P. Blaschkitis or lichen striatus: A splitter's view. Clin Dermatol Rev [serial online] 2022 [cited 2022 May 22];6:56. Available from: https://www.cdriadvlkn.org/text.asp?2022/6/1/56/338578




  Introduction Top


Dermatologists are known for coining fancy Latin-derived names to describe various skin conditions. This sometimes leads to coining of different terms for apparently similar or same conditions. Splitters excel in arguing how conditions belonging to the same spectrum of disease differ clinically and histologically. Lumpers are relatively simple-minded and put together similar conditions under a unifying term. Inflammatory conditions occurring along Blaschko's lines form a spectrum of conditions which differ somewhat in clinical and histological features. We describe a case of adult blaschkitis and put forward a splitter's argument to differentiate it from lichen striatus.


  Case Report Top


A 31-year-old male patient presented with a 2-month history of multiple, small, raised, minimally itchy lesions linearly arranged on the right side of the chest, abdominal wall, and back. Skin examination revealed multiple, 1–4-mm-sized skin-colored and brown-colored papules distributed in multiple linear rows along the Blaschko's lines. They were distributed in a radiating manner and were on the background of brown streaks, mostly coalesced but with a discrete margin at places [Figure 1] and [Figure 2]. There was no history of any recent infection, illness, or medication intake. There was no history of similar illness in the past or in the family. Differential diagnoses of contact dermatitis, linear lichen planus, and adult blaschkitis were kept in mind. With no contact history, contact dermatitis was ruled out. The patient was asymptomatic and otherwise completely healthy. Routine laboratory tests were normal. Histopathological examination revealed hyperkeratosis, spongiosis with peri-vascular lymphocytic infiltrate, and pigment incontinence. There was no lymphocytic infiltrate around the eccrine glands. There was no vacuolar degeneration of basal cells or other features of lichenoid dermatitis. The pigment in dermis was seen in our patient. but it is seen in many inflammatory disorders in patients of skin of color [Figure 3]. Although pigment incontinence is seen in lichen planus, no other histopathological changes of lichen planus such as basal cell degeneration, interface dermatitis and infiltrate were seen and hence lichen planus was ruled out. We concluded it as a case of adult blaschkitis. The patient was given topical corticosteroid in the form of betamethasone dipropionate 0.05% cream for twice-daily application and significant improvement was noted within 4 weeks.
Figure 1: Adult blaschkitis – multiple, linear eruptions following the lines of Blaschko on the trunk

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Figure 2: Adult blaschkitis – Close-up of the skin lesions

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Figure 3: Histopathology findings showing spongiosis and a lymphocytic perivascular infiltrate with melanin incontinence (H and E, ×100)

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  Discussion Top


Adult blaschkitis is a rare acquired inflammatory linear eruption consisting of pruritic papules and vesicular eruptions along the ipsilateral lines of Blaschko. It is typically located on the trunk. Histopathologically, it shows spongiotic dermatitis. Its course is of rapid evolution with spontaneous resolution within 2 months. In 1990, Grosshans and Marot first described “blaschkitis” and proposed that it was distinct from lichen striatus.[1]

The exact pathogenesis of adult blaschkitis is not completely understood. It is considered a manifestation of mosaicism, characterized by the presence of genetically abnormal keratinocytes generating a T-cell mediated inflammatory response along the lines of Blaschko. This usually follows a trigger such as viral infection, vaccination, drugs, or trauma. Although mostly reported in adults, Keegan et al.[2] in 2007 reported two young children who developed relapsing pruritic papulovesicular eruptions in multiple bands along the Blaschko lines on the neck, trunk, and extremities. Skin biopsy of both those patients revealed spongiotic dermatitis. This was the first report of “blaschkitis” in children.

Lichen striatus primarily affects children, presenting in the form of single lines along the extremity, and resolves spontaneously over months to years. Its histopathological features are lichenoid and periadnexal (especially around the eccrine glands) inflammation. Many reports refer to lichen striatus as a polymorphic epidermal reaction process of variable lichenoid and spongiotic changes with no specific histopathological criteria as they change with the age of lesions.[3] There is a lot of controversy whether lichen striatus and adult blaschkitis are different conditions or represent two conditions on the same spectrum.[4],[5] Hauber et al. state that adult blaschkitis, in contrast to lichen striatus, exclusively affects adults and never heals with postinflammatory hypo- or hyperpigmentation. Most importantly, lesions of adult blaschkitis show a shorter duration than that of lichen striatus lesions and are usually followed by several relapses.[6] An exactly opposite view was expressed by Hofer stating that neither clinical nor morphological differences exist between adult blaschkitis and adult lichen striatus. They state that there are no convincing characteristics which justify creating a new name or even a new entity.[7] Whether lichen striatus and adult blaschkitis are separate entities or are variants of the same disease remains controversial. Taieb et al. proposed a new term, BLAISE, an acronym designating Blaschko Linear Acquired Inflammatory Skin Eruption.[8] Many authors suggested the encompassing term “blaschkitis” to different conditions with inflammatory linear lesions which follow lines of Blaschko such as lichen striatus, linear cutaneous lupus erythematosus, linear lichen planopilaris, linear morphea, linear psoriasis, linear contact dermatitis, and linear Darier's disease.[9] We believe that these two diseases are different entities and the striking differences between these two,[10] are enumerated in [Table 1].
Table 1: Differentiating features between blaschkitis and lichen striatus

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Our patient was an adult and had papular lesions along many radiating lines on the chest and abdominal wall.

His histopathological changes showed spongiotic dermatitis. In our patient, the clinicopathological presentation was consistent with that of adult blaschkitis.

Although lichen striatus and blaschkitis appear to be apparently similar, there are few but definite differences such as blaschkitis is most commonly seen in adults, on the trunk, in multiple lines, and has a spongiform pattern on histology unlike lichen striatus which exhibits a lichenoid pattern.

We have reported this case for its rarity.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Grosshans E, Marot L. Blaschkitis in adults. Ann Dermatol Venereol 1990;117:9-15.  Back to cited text no. 1
    
2.
Keegan BR, Kamino H, Fangman W, Shin HT, Orlow SJ, Schffer JV. 'Pediatric blaschkitis': Expanding the spectrum of childhood acquired Blaschko-linear dermatoses. Pediatr Dermatol 2007;24:621-7.  Back to cited text no. 2
    
3.
Gionotti R, Restano L, Grimalt R, Berti E, Alessi E, Caputo R. Lichen striatus a chameleon. A histopathological and immunohistological study of 41 cases. J Cutan Pathol 1995;22:18-22.  Back to cited text no. 3
    
4.
Lee MW, Choi JH, Sung KJ, Moon KC, Koh JK. Linear eruption of nose in childhood: A form of lichen striatus? Br J Dermatol 2000;142:1208-12.  Back to cited text no. 4
    
5.
Muller CS, Schmaltz R, Vogt T, Pfohler C. Lichen striatus and blaschkitis: Reappraisal of the concept of Blaschko linear dermatoses. Br J Dermatol 2011;164:257-62.  Back to cited text no. 5
    
6.
Hauber K, Rose C, Bröcker EB, Hamm H. Lichen striatus: Clinical features and follow-up in 12 patients. Eur J Dermatol 2000;10:536-9.  Back to cited text no. 6
    
7.
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. 7
    
8.
Taieb A, El Youbi A, Grosshans E, Maleville J. Lichen striatus: A Blaschko linear acquired inflammatory skin eruption. J Am Acad Dermatol 1991;25:637-42.  Back to cited text no. 8
    
9.
Aravind M, Do TT, Cha HC, Fullen DR, Cha KB. Blaschko linear acquired inflammatory skin eruption, or blaschkitis, with features of lichen nitidus. JAAD Case Rep 2016;2:102-4.  Back to cited text no. 9
    
10.
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.  Back to cited text no. 10
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