Effective Topical Combination Therapy for Treatment of Lichen Striatus in Children: A Case Series and Review

July 2012 | Volume 11 | Issue 7 | Case Reports | 872 | Copyright © July 2012

table 2
mixed and applied to the affected area once or twice daily, as tolerated. At 2-month follow-up, the cutaneous lesions over the left 3rd and 4th fingers had cleared completely. The ridge over the nail plate persisted. Nail glue was suggested to minimize incidental trauma. The patient reported that all discomfort had resolved soon after treatment was initiated.

Case 4

A Caucasian boy, aged 2 years, presented with a history of atopic dermatitis since infancy. His mother noted that he had developed an itchy area on his right arm 4 to 5 months prior to the appointment. This had initially been treated with triamcinolone, without improvement. Examination revealed a linear streak of lichenified, flat-topped papules coalescing into a plaque on the right lateral upper extremity. This distribution was recognized as a Blaschkoid pattern, and the patient was diagnosed with LS. Fluocinonide 0.05% ointment and tazarotene 0.05% cream were prescribed, to be mixed and applied to the affected area twice daily. At his 2-month follow-up visit, a residual hypopigmented patch was noted along the lines of Blaschko on the right lateral upper extremity. Within the hypopigmented patch, there were a few mildly erythematous, thin plaques with minimal scale. Both the erythema and the extent of the plaque had improved. The parents reported that the pruritus in that area appeared to have resolved, as well.


Lichen striatus is an uncommon condition for which no clear, effective treatment has been established. In most cases, LS is self-limited, and usually lasts up to 1 to 2 years. Observation is a common approach, especially when the lesions are asymptomatic. Patients are more likely to seek treatment if the lesions are pruritic, located in a cosmetically sensitive area, or cause other cutaneous problems, such as nail fragility. The existing English-language literature on the treatment of LS is limited. Topical steroids are the most commonly employed class of agents when the lesions are inflamed and/or pruritic. There are conflicting reports about whether topical steroids shorten the duration of the lesions. In a retrospective study of 115 children with LS, Patrizi et al. did not note any shortening of the duration of either the inflammatory stage of LS or the duration of the postinflammatory hypopigmentation in patients treated with topical steroids as compared to those who were not treated.6 There have been several case reports and case studies of LS treated with calcineurin inhibitors, as well as a case series of treatment with calcipotriol +/- the addition of topical and intralesional steroids. The results of these treatments are varied, as shown in Table 1.6, 9-16
In this case series, we observed rapid resolution of LS by combining a topical retinoid with a topical steroid. To our knowledge, this is the first report of successful treatment with this kind of combination therapy in the English-language literature. The patients not only achieved satisfying cosmesis, but also complete resolution of their pruritus. The most common side effect of topical tazarotene is localized irritation at treatment sites, but the patients in this particular series tolerated the treatment well. The tolerability of the treatment may be due to using the topical steroid in combination with the retinoid, as the steroid may minimize local irritation. The use of topical tazarotene in children under 12 years of age is offlabel, as the safety and efficacy have not been determined in