Lichen striatus (LS) occurs at any age, and presents most often (above 50% of cases) in children aged between 5 and 15 years. At first, small, pink, lichenoid, and discrete papules appear and coalesce rapidly, and then extend to form a dull red, slightly-scaly, linear band between 2 mm to 2 cm in width. The lesions, usually linear and unilateral, develop most commonly on the arms and legs, or on the neck, but may also develop on the trunk. The linearity has been shown to correspond to Blaschko lines. The histological features are diverse and some are nonspecific, but it has recently been reported that one of the remarkable features of LS is the presence of an inflammatory infiltrate in the reticular dermis around hair follicles and eccrine glands.
Lichen striatus (LS) is a self-resolving condition, which may occasionally need treatment for significant pruritus, a persistent course or cosmetic problems. The options for treatment usually include topical or intralesional corticosteroids, salicylic acid or coal tar. Although the cause of LS is uncertain, it has been reported that LS is a T-cell mediated inflammatory skin disease associated with autoimmune response to mutated keratinocytic cloning. Accordingly, topical tacrolimus and pimecrolimus have been highlighted as the new treatment for LS. The effects of these treatments have recently been reported in the Korean literature.
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Pimecrolimus, an ascomycin derivative, is one of the new classes of immuno-modulating macrolactams and is being developed for the special treatment of inflammatory skin diseases. The acting mechanism of pimecrolimus is the blockage of T-cell activation. It may specifically inhibit the synthesis of inflammatory cytokines such as Th1- and Th2-type cytokines. Thus, it prevents the local activation of T-lymphocytes and both immune and inflammatory response. The eruption is usually asymptomatic and recovers spontaneously within 3-6 months in most cases, but often leaves hypopigmentation especially in dark-skinned patients. In our case, complications of hypopigmentation or residual lesions were not nearly observed.
In our experience, 1% pimecrolimus cream is a beneficial and efficacious treatment option for lichen striatus in children because it carries no risk for skin atrophy compared with topical corticos- teroid application.
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