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WHAT IS YOUR CALL?
A previously healthy 15-month-old boy presented with a papular, erythematous rash that had developed over the previous 5 weeks. The papules were arranged in a thin vertical line that extended along the inner side of his right leg from his foot to his upper thigh (Figure 1). The patient had no other skin lesions and was not bothered by the rash. He was immunocompetent and did not have a fever or other systemic symptoms. Apart from a recent bout of viral gastroenteritis that had resolved, his medical history was unremarkable.
What is your diagnosis?
a. Inflammatory linear verrucous epidermal nevus
b. Linear lichen planus
c. Incontinentia pigmenti
d. Linear scleroderma
e. Lichen striatus
How would you manage this patient's care?
a. Parental reassurance of benign prognosis
b. Topical corticosteroids
c. Acyclovir therapy
d. Tacrolimus ointment
e. Biopsy to confirm diagnosis
Discussion
Diagnosis: The diagnosis is lichen striatus, a relatively rare, benign and self-limiting dermatosis of childhood. It is most commonly seen in children between 5 months and 15 years of age and is more common in girls than in boys.1,2 Patients usually present with sudden-onset pink or flesh-coloured, lichenoid papules that are arranged in continuous or interrupted bands.3 Occasionally, patients have hypopigmented macules and papules (classified lichen striatus albus) or involvement of the nails.3
Lichen striatus typically occurs...