including hypomelanosis of Ito, epidermal nevus, LS, and less
likely, lichen planus. A 4 mm punch biopsy revealed lichenoid
spongiotic dermatitis with focal inflammatory infiltrates
around eccrine glands and mild papillomatosis (Figure 3).
Therefore, LS was the most likely diagnosis. Although early-
stage linear epidermal nevus may have similar histologic
findings, this condition is usually progressive and recalcitrant
to topical treatment. Tazarotene cream and desonide ointment
were prescribed for application to the lesions on the right face
and right upper extremity. At the 2-month follow-up visit, the
patient showed noticeable improvement at the treated sites,
with minimal hypopigmentation along the right jaw and several
residual confetti-like hypopigmented macules on the
right malar cheek. Overall, there was less pigment change
compared to the surrounding area. The previous linear, hypopigmented
streak on the right arm improved markedly and
was no longer palpable.
Case 3
A Caucasian boy, aged 7 years, presented with a 1-year history
of changes in the nailbed of his right middle finger. Initially,
his parents had attributed these changes to trauma, but over
the following several months, the patient also developed linear
erythematous patches with flat-topped papules on the dorsal
hand extending to the adjacent ring finger. The patient complained
of pruritus and irritation. With use of 1% hydrocortisone
for over 2 months, little improvement was noted. Fluocinolone
0.025% ointment and tazarotene 0.1% gel were prescribed to be
