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PaediatricSelf-limitingICD-10 L44.2 / L44.8

Lichen striatus

LS · Blaschko-linear dermatitis · blaschkitis (adult variant)

Lichen striatus is a benign, self-limiting linear inflammatory dermatosis predominantly affecting children, characterised by pink-to-flesh-coloured papules distributed along Blaschko lines on a limb. Adult-onset blaschkitis is a recognised variant. It is a common DDx for inflammatory linear verrucous epidermal naevus (ILVEN), Blaschko-linear lichen planus, linear psoriasis and incontinentia pigmenti. Resolution typically within 6-24 months with post-inflammatory hypo- or hyperpigmentation that may persist.

CurrentLast reviewed 16 May 2026
Clinical image of Lichen striatus
Lichen striatus. Image sourced from DermNet New Zealand. Used under CC BY-NC-ND 4.0. No endorsement implied.

Pathogenesis

  • Idiopathic; postulated post-zygotic mosaicism in skin clones, with cell-autonomous immunological reactivity following viral trigger or local trauma.
  • Strong association with personal / family history of atopy.
  • Distribution follows lines of Blaschko, reflecting ectodermal clonal patterns.
  • Predominantly children 5-15 years; adult form (blaschkitis) less common.

Clinical features

  • Linear band of 1-3 mm pink, flesh-coloured, or violaceous papules with fine scale.
  • Unilateral; follows lines of Blaschko on a limb (more often lower limb), trunk or rarely face.
  • Onset over days-weeks; reaches its maximum extent in weeks; persists 6-24 months.
  • Asymptomatic or mildly pruritic.
  • Resolution with post-inflammatory hypo- or hyperpigmentation, sometimes for years.
  • Variants:
    • Nail involvement (longitudinal ridging / onycholysis) — uncommon but recognised.
    • Blaschkitis (adult variant) — recurrent eczematous, pruritic, vesicular.

Differentials

  • Linear lichen planus — violaceous, polygonal, Wickham striae; more chronic.
  • Inflammatory linear verrucous epidermal naevus (ILVEN) — congenital / very early; pruritic; verrucous, persistent.
  • Linear psoriasis — silvery scale, Auspitz, personal / family history.
  • Incontinentia pigmenti — early neonatal; X-linked dominant; vesicular → verrucous → hyperpigmented stages.
  • Blaschko-linear lupus / morphoea.
  • Linear porokeratosis — pathognomonic ridge / cornoid lamella; lifelong; SCC risk.
  • Linear epidermal naevus (sebaceous, comedonicus) — congenital.

Investigations

  • Clinical diagnosis in classic presentation.
  • Skin biopsy in atypical / persistent cases: lichenoid interface dermatitis with focal parakeratosis; perivascular & periadnexal lymphocytic infiltrate.
  • Photograph at baseline for monitoring.

Management

  • Reassurance: self-limiting; counsel parents about months-long course and post-inflammatory pigment change.
  • Topical:
    • Emollients.
    • Low-potency topical corticosteroid (hydrocortisone 1% to mid-potency mometasone) for active inflammation.
    • Topical calcineurin inhibitors (tacrolimus 0.03% / 0.1%; pimecrolimus 1%) — first-line in children where steroid avoidance preferred.
  • Sun protection during active phase; counsel about pigmentary residua.
  • Persistent disease may benefit from narrowband UVB phototherapy.
  • No systemic therapy usually required.

References

  1. Patrizi A et al. Lichen striatus: clinical and laboratory features in 115 children. Pediatr Dermatol. 2004;21:197-204.
  2. Müller CSL et al. Lichen striatus and blaschkitis. J Dtsch Dermatol Ges. 2011;9:809-822.
  3. Hofer T. Lichen striatus in adults or "adult blaschkitis"? Dermatology. 2003;207:89-92.
  4. Tilly JJ et al. Lichenoid eruptions in children. J Am Acad Dermatol. 2004;51:606-624.

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