INTRODUCTION
Lichen striatus (LS) is an uncommon linear dermatosis
primarily seen in children between the ages of 4 months
and 15 years. Typically, the lesions consist of pink, red,
or flesh-colored flat-topped lichenoid papules arranged linearly,
often along the lines of Blaschko. Lesions are usually solitary,
but rare cases of multiple lesions distributed bilaterally have
been reported.1-3 Lesions occur most often on the limbs, and,
less frequently, on the trunk or face.4 Lichen striatus develops
at a higher frequency in children with a personal or family history
of atopy.5 While some of these eruptions are asymptomatic,
others can be quite pruritic. Reports of associated pruritus
range from 11% to 34%.5-6 Although LS is usually self-limited,
it may last up to 1 to 2 years. Treatment is considered elective
for either symptomatic or cosmetic concerns.7 While topical steroids
are considered first-line therapy for relief of pruritus, they
have not had significant effects on modulating the course or
duration of LS.6 In darker-skinned individuals, post-inflammatory
hypopigmentation can be significant, and may provide a
cause for concern for the patients and/or their parents.
Retinoids have proven to be a successful therapy for treatment
of a variety of cornification disorders and are known to modulate
keratinocyte proliferation and differentiation.8 In this report,
we will provide a case series of LS treated with a combination
of a topical steroid and a topical retinoid. In our experience,
the addition of a topical retinoid shortens the duration of the
treatment and leads to earlier resolution, when compared to
treatment with a topical steroid alone. This combination of
topical agents also appears to be effective in improving postinflammatory
dyspigmentation in patients with darker skin. The
most common side effect of the treatment is mild irritation.
CASE REPORT
Case 1
An African-American girl, aged one year, presented with a linear,
papular dermatitis involving the lower chin and right cheek. The
rash had been present for about 2 weeks, and the onset was insidious
without any known trigger. This had initially been treated
with hydrocortisone and nystatin, with little improvement. Exam
revealed monomorphic, 2 mm to 3 mm inflammatory papules
in a Blaschkoid distribution extending from the right infraorbital
area to the right buccal cheek, submandibular area, and lateral
neck (Figure 1). There was minimal scale, but no crusting, erosion,
or evidence of excoriation. The patient was diagnosed with
inflamed LS, and desonide 0.05% ointment and tazarotene 0.05%
cream were prescribed to be mixed and applied twice daily. At
her 2-month follow-up visit, the patient's mother reported that
within 2 weeks of starting the treatment, the LS had resolved almost
completely. The treatment was subsequently discontinued,
and follow-up exam revealed minimal residual hypopigmentation
following Blaschko's lines on the lower chin, extending to
the neck and postauricular area (Figure 2).
Case 2
An African-American boy, aged 4 years, presented with a 2 to
3-year history of an eruption that began on the right mid-back.
Over time, it had progressed to involve a wide area on the
back, as well as the right neck, cheek, arm, and hand. While
this eruption had remained asymptomatic, the patient's mother
was concerned about the increasing discoloration on his
face. Examination revealed multiple-grouped, hypopigmented
macules and flat-topped papules without erythema or scale in
a Blaschkoid distribution. The patient was initially diagnosed
with Blaschkoid hypomelanosis, with differential diagnoses
