Lichen striatus (LS) is an acquired, linear, inflammatory dermatosis.1 Its etiology remains unclear. It is usually self-limiting, localized and asymptomatic; however, when the onset occurs in adulthood, patients may experience widespread lesions and pruritus.2 The therapeutic approach usually used is topical steroids, even though prolonged use may lead to several side-effects including cutaneous atrophy. We report a case of LS successfully treated with a short course of low-dose systemic corticosteroid.
A 29-year-old Korean woman presented with a 1-month history of linear erythematous rash extending from her right arm to shoulder and back. Skin examination revealed multiple erythematous to brown lichenoid papules coalescing in a linear arrangement from the right posterior arm to the shoulder and upper back (Fig. 1a). With a clinical impression of LS, a biopsy was performed. On histological examination, an inflammatory infiltrate of lymphocytes and histiocytes along the dermoepidermal junction and around blood vessels and skin appendage was seen (Fig. 2). Based on both clinical and histological features, it was diagnosed as LS.
In addition to LS, she had stable segmental vitiligo of 10-year duration on her left abdomen. We planned suction blister epidermal grafting for the treatment of segmental vitiligo. Because we recently experienced a case of segmental vitiligo that showed an excellent response to combination therapy of epidermal graft and systemic corticosteroid,3 a 2-week course of oral prednisolone (20 mg/day) was started before the epidermal grafting. Interestingly, we found that LS was improved rapidly by the use of oral prednisolone (Fig. 1b). No side-effects of systemic corticosteroid were noted. Eight-month follow up did not show any recurrence.
Differential diagnosis between LS and linear lichen planus is essential, and based on histopathology.1 Histopathological findings such as dense perivascular and lymphocytic infiltrate around the hair follicles, eccrine glands and ducts favor the diagnosis of LS. In our case, perivascular, peri-appendageal lymphocytic infiltration was present which ensures the diagnosis of LS.
To the best of our knowledge, this is the first case report of LS treated with systemic corticosteroid. The result shows that low-dose systemic corticosteroid for a short term may represent a useful therapeutic alternative for LS in adulthood, although further studies on a larger number of patients are needed to confirm its safety and efficacy in the treatment of this condition.