eISSN: 2299-0046
ISSN: 1642-395X
Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii
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4/2018
vol. 35
 
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Letter to the Editor

Reverse Kőbner response in lichen striatus: the first case described in the literature

Aleksandra Dańczak-Pazdrowska
,
Katarzyna Pawlaczyk-Gabriel
,
Monika Bowszyc-Dmochowska
,
Adriana Polańska
,
Marcin Gabriel
,
Zofia Gabriel
,
Ryszard Żaba
,
Zygmunt Adamski

Adv Dermatol Allergol 2018; XXXV (4): 434–435
Online publish date: 2018/08/21
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Lichen striatus is an uncommon, acquired and self-limiting inflammatory dermatosis that presents as small papules, which follows the Blaschko lines. It is considered as a cutaneous mosaicism and the interplay between genetic and environmental factors is postulated. The occasional appearance of lesions after trauma has been reported [1, 2]. Contrary to that, we present a case of lichen striatus in an adult woman in whom eruption disappeared after trauma. We believe it is an example of a rarely reported reverse Kőbner response and the first case of this phenomenon in lichen striatus.
A 48-year-old Caucasian female presented with a 6-month history of linear papular eruption of her left lower extremity. The lesion appeared suddenly, initially on the thigh. Over a few weeks it had extended distally to involve the shank and the patient suffered from mild pruritus. On examination there was a linear lesion following Blaschko lines, extending from the proximal thigh to the distal shank which consisted of multiple, flat-topped, erythematous papules of a few millimeters in diameter with a scaly surface (Figure 1 A). The other areas of the skin as well as mucous membranes and nails were spared.
The biopsy of the lesional skin from the upper thigh was taken. Histopathology of a biopsy specimen revealed two papules: one composed of spongiotic epidermis with hydropic degeneration of the basal layer and lymphocytic exocytosis with a dense lymphocytic infiltrate in the papillary dermis containing a few melanophages (Figure 2), while the second papule composed of slightly thickened epidermis with interface changes, hyperkeratosis with focal parakeratosis and a cluster of necrotic keratinocytes in the upper layers with a mild inflammatory lymphocytic infiltrate underneath.
Based on the clinical presentation and histopathological findings, a diagnosis of lichen striatus was made. The clobetasol propionate 0.05% ointment was recommended to be applied twice per day. Within 3–4 days after the biopsy the patient noticed disappearance of papules adjacent to the site of the biopsy. At the same time there was no improvement in another part of eruption. As our patient was a doctor (internist) she decided to incise a few next papules with a scalpel. After 2–3 weeks, the lesion cleared with pigmentation and within next 8–12 weeks the pigmentation disappeared completely (Figure 1 B). No recurrence during 3 years’ period of follow up was observed.
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