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.
DISCUSSION
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
