Case report

Lichen striatus following scarlet fever in a 3-year-old female

patient

-Novell1, MD, Vanessa Fatsini-Blanch1, MD,
Nina A. Richarz1, MD, Xavier Fusta
Claudia Fortuny2, MD, Marıa Antonia Gonzalez-Ensen~ at1, MD, and Asuncio
 n Vicente1, MD

1
Department of Dermatology, Hospital Sant
Joan de Deu, Barcelona, Spain, and
2
Department of Pediatrics, Hospital Sant
Joan de Deu, Barcelona, Spain

Correspondence
Asuncion Vicente, MD
Department of Dermatology, Hospital Sant
Joan de De u, Passeig de Sant Joan de
u 2, Esplugues de Llobregat, Barcelona,
De
08950, Spain
E-mail: avicente@sjdhospitalbarcelona.org

Funding sources: None.

Conflict of interest: None.

doi: 10.1111/ijd.13995

reported.2–7 Here, we report a case of a child developing LS

Introduction
Lichen striatus (LS) is a rare, benign, linear inflammatory der-
matosis that mainly affects children. It manifests as flat-topped
papules with a slightly scaly surface arranged in a single Blas-
chko line (BL). Lesions usually appear abruptly and heal after a
mean duration of 12–24 months.1 Although its pathogenesis
remains unknown, it seems to occur more frequently among
atopic patients, and a variety of possible triggers has been
2 weeks after scarlet fever.
Case report
A 3-year-old female patient with a medical history of celiac dis-
ease presented to the emergency department for a 6-day his-
tory of malaise and high fever (38.5 °C), without clear
symptoms of tonsillitis. She presented a strawberry tongue and

(a) (b)

Figure 1 Strawberry tongue (a) and skin

fold erythema (b) in the setting of scarlet
fever 1

ª 2018 The International Society of Dermatology International Journal of Dermatology 2018

2 Case report Lichen striatus following scarlet fever
(a) (b) (c)
skin fold erythema affecting the groin and axillae (Fig. 1). Scar-
let fever was suspected, and antibiotic treatment with amoxicillin
and clavulanic acid was prescribed for 10 days. However, due
to clinical improvement, the patient discontinued the treatment
after 7 days. Nine days after stopping the treatment, the patient
was admitted to our outpatient department for a mildly pruritic
linear skin lesion that appeared 2 days before. Physical exami-
nation revealed grouped erythematous scaly papules arranged
in a strikingly linear distribution extending from the left buttock
to the posterior aspect of the leg and sole (Fig. 2), findings con-
sistent with LS. A rapid antigen detection test (RADT) using a
qualitative immunochromatographic assay (Clearview Exact
Strep A Cassette) for group A streptococcal pharyngitis was
positive. Antibiotic treatment with amoxicillin was prescribed for
10 days, and the control RADT resulted negative. Treatment
was initiated with 0.1% methylprednisolone cream once daily,
obtaining a good control of pruritus, but lesions persisted
unchanged after 3 months of follow-up.
Discussion
Multiple acquired inflammatory dermatosis can manifest clini-
cally with a Blaschko-linear skin lesion. The affected BL is
believed to represent an underlying genetic mosaicism due to a
postzygotic event in a keratinocytic precursor.8,9 The genetic
alteration is initially immune-tolerated, and the clone remains
clinically inapparent. An acute triggering event may lead to
recognition of the genetically altered clone, causing the lesions
to appear in a linear distribution.8 In the case of LS, a variety of
possible triggers have been described, being viral infections
 rin,4
(varicella,2 influenza3) and vaccines (bacillus Calmette-Gue
measles, mumps, and rubella,5 hepatitis B virus,6 yellow fever7)
the most frequently reported. To our knowledge, only one case
has been described in relation to a clinical diagnosis of tonsilli-
tis, but microbiological studies were not performed.1
International Journal of Dermatology 2018
Richarz et al.
Figure 2 Linear skin lesion consisting of
multiple confluent erythematous scaly
papules following a Blaschko line, extending
from the posterior aspect of the thigh (a) to
the inner side of the lower leg (b) and sole
(c)
As previously reported in other cases, we believe in an envi-
ronmental factor that acts as a trigger in most cases of LS.1,2,8
Scarlet fever, very common in childhood, might be a trigger of
LS in children. Thus, we recommend performing an RADT for
the detection of paucisymptomatic oropharyngeal group A strep-
tococcal infection in children with recent onset LS, in order to
start antibiotic treatment promptly.
Acknowledgments
None.
References
1 Patrizi A, Neri I, Fiorentini C, et al. Lichen striatus: clinical and
laboratory features of 115 children. Pediatr Dermatol 2004; 21:
197–204.
2 Hafner C, Landthaler M, Vogt T. Lichen striatus (blaschkitis)
following varicella infection. J Eur Acad Dermatol Venereol 2006;
20: 1345–1347.
3 Ishikawa M, Ohashi T, Yamamoto T. Lichen striatus following
influenza infection. J Dermatol 2014; 41: 1133–1134.
4 Hwang SM, Ahn SK, Lee SH, et al. Lichen striatus following BCG
vaccination. Clin Exp Dermatol 1996; 21: 393–394.
5 Dragos V., Mervic L., Zgavec B. Lichen striatus in a child after
immunization. A case report. Acta Dermatovenerol Alp Pannonica
Adriat. 2006; 15: 178–180.
6 Karakasß M, Durdu M, Uzun S, et al. Lichen striatus following
HBV vaccination. J Dermatol 2005; 32: 506–508.
7 Karouni M, Kurban M, Abbas O. Lichen striatus following yellow
fever vaccination in an adult woman. Clin Exp Dermatol 2017; 42:
823–824.
8 Keegan BR, Kamino H, Fangman W, et al. ‘Pediatric blaschkitis’:
expanding the spectrum of childhood acquired Blaschko-linear
dermatoses. Pediatr Dermatol 2007; 24: 621–627.
9 Verma P, Singal A, Yadav P, et al. Concurrence of lichen striatus
and localised pityriasis rosea: cutaneous mosaicism. Austr J of
Dermatol. 2013; 54: 41–42.
ª 2018 The International Society of Dermatology