Lichen Striatus

What is lichen striatus? It is a sudden acquired and asymptomatic linear inflammatory skin disease.

The skin eruption is unilateral and usually found on the extremities. It follows Blaschko lines. It is a rare condition and predominantly affects the children population. ^{(1, 2)}

Who are at risk?

It commonly affects children between 5 years old and 15 years old. The prevalence is higher in women than men. ⁽²⁾

Lichen Striatus Pictures

Image 1: A close up view of lichen striatus on the arm of a child.
Picture Source: img.webmd.com

Photo 2: A lichen striatus on the lower extremities of a paediatric patient (child) .
Image Source: ozarkderm.com

Symptoms / clinical manifestations

It starts as a small spot, typically pink, flesh to reddish in color. As time passes by, the spot becomes dull red and forms a scaly linear band, which is typically 2mm to 2cm in width.

It commonly affects both the lower and upper extremities, but can also affect the neck and the entire torso. In some instances, the lesion can extend to the abdomen and buttocks area. The lesion itself is asymptomatic, although some patients complain of itching.

The nails can be affected too, but very rare. The patient’s nail become thick, split, and ridged. ^{(3, 4)}

Lichen Striatus Causes

The exact cause of lichen striatus is unknown up to this time. However, there are certain conditions that predispose lichen striatus. They are the following:

• Atopy – those with family history of atopic dermatitis, allergic rhinitis, and asthma are at risk for lichen striatus.
• Autoimmune – An autoimmune response can trigger lichen striatus. A case was reported during pregnancy, Vitiligo, and inflammatory skin disease.
• Environmental factors – a cause of lichen striatus is reported in children living in a shared environment. It could be associated with viral infection too.
• Other possible causes – a case of lichen striatus was reported following a BCG and hepatitis B vaccination. Another case reported after exposure to ultraviolet rays. ^{(4, 5, 6)}

How to diagnose lichen striatus?

To accurately diagnose lichen striatus, the clinical manifestations should be thoroughly checked. A thorough physical examination should be done. When deemed necessary, a histopathology of a skin biopsy is required. ⁽⁶⁾

Pathophysiology/ lichen striatus pathology

The exact cause of lichen striatus is still unknown up to this time. However, the blaschkoid distribution is indicative of post-zygotic mutation leading to a unique clone of genetically altered cells. These cells are sensitive to environmental stimuli. ⁽⁷⁾

Lichen Striatus Treatment

There is no definite treatment for lichen striatus since the exact cause is still unknown up to this time. The treatment and management is focused on the symptomatic relief. Lichen striatus usually resolves within six months, although the lesions do not completely disappear. There are instances wherein the lesions will leave a temporary pale or dark marks. ^{(7, 8)}

Below are the lichen striatus treatment tips

Emollients

A lichen striatus can lead to dryness and itching of the skin. If you experienced itching, it can be alleviated using emollients. Topical steroids can somehow alleviate the itching but it cannot shorten the recovery time. Topical calcineurin inhibitor can alleviate pruritus or itching. Pruritus can also be alleviated using antihistamines. ⁽⁹⁾

Combination of topical steroid and retinoid

A retinoid plays a very important role in the treatment of various skin conditions. It modulate keratinocyte proliferation and differentiation. If combined with a topical steroid, the entire duration of lichen striatus can be shorten significantly. The combination of topical steroid and retinoid can help improve post inflammatory dyspigmentation, which is common in people with dark skin. ⁽¹⁰⁾

Lichen striatus Natural treatment

• Increase your intake of essential vitamins – Vitamins A, C, and E can speed up the healing process.
• Eat nutritious foods – You should include nutritious foods in your diet such as fruits and vegetables specifically apples, limes, oranges, lemons, carrots, and the likes.
• Keep your skin moisturized – Use natural oil/essential oil in moisturizing the skin. Examples are jojoba oil, olive oil, and shea butter. By keeping the skin moisturized, you will be able to prevent the skin from drying out. ^{(8, 9)}
• Hydration – keep your body well hydrated by drinking plenty of fluids, especially water and natural fruit juices.
• Aloe Vera – It helps alleviate itching, soothes the skin, and promotes healing. Mix fresh aloe veral gel with a carrier oil like lavender or jojoba. Apply the mixture directly on the skin. Jojoba oil acts as a natural moisturizer. It effectively alleviates itching and dryness.
• Flax seeds – It is effective in treating various types of skin ailments. It contains healthy fat, which promotes skin healing and rejuvenation.
• Beeswax – It is rich in vitamin A, which is good for the skin. It facilitates skin cell repair and regeneration. ^{(2, 4)}
• Eucalyptus oil – It alleviates itching and reduces skin irritation.
• Peppermint oil – It has been used a long time ago to alleviate soreness and itching of the skin. ⁽¹⁾

Maintenance therapy and long-term follow up might not be necessary at all because of the self-limited nature of the disease. Patients with lichen striatus as an excellent prognosis. The patient may experience relapse, although highly unlikely.

If the nails are affected, it would take months to years for the nails to go back to its pre-disease state. On the positive note, the nail heals spontaneously without any deformity. ⁽⁷⁾

A lichen striatus can be quite alarming, especially if you notice the lesions for the first time. However, this disease does not possess any health risk at all and usually resolves on its own. Although, it might take months or even year for the lesion to completely go away.

The focus of care is on the symptomatic relief, especially if the patient complains of itching. Do not attempt to treat the lesion on your own, especially if you are not sure if it really is a lichen striatus. Have the lesion checked by your skin doctor.

That way, you will be able to know if it really is a lichen striatus and whether or not an aggressive treatment approach is needed. ^{(3, 6, 8)}

References:

1. www.dermnetnz.org
2. www.actasdermo.org
3. www.streetdirectory.com
4. www.skinsite.com
5. www.clinicaladvisor.com
6. www.tandurust.com
7. www.simple-remedies.com
8. www.aidanceproducts.com
9. https://iythealth.com
10. www.consultation.ayurvediccure.com