Lichen striatus following yellow fever vaccination in an adult woman

Abstract

Lichen striatus (LS) is an unusual, acquired, self-limiting, cutaneous disorder that commonly presents as unilateral, linearly arranged erythematous papules along the lines of Blaschko on the neck, trunk or limbs, which usually presents in children but it may be seen in adults. 1 After an abrupt appearance, LS lesions usually involute in 1-2 years. The aetiology of LS is unclear. 1 Suggested contributing factors include autoimmune response, atopy, genetic predisposition, viral infection and vaccination. Among the latter, LS has been reported to occur in patients after receipt of bacille Calmette-Gu erin (BCG), hepatitis B virus (HBV), and measles, mumps and rubella (MMR) vaccinations. 2-4 We describe a 32-year-old woman whose LS developed after yellow fever vaccination, an association that has not been reported previously.A 32-year-old woman from Ghana presented with a 3-month history of occasionally pruritic lesions on her left arm and hand. She was previously healthy, and her medical history was unremarkable, except for yellow fever vaccination 6 weeks prior to the onset of the skin lesions. The lesions had started at the site of the vaccine injection on the upper arm and extended down the arm and later involved the hand.On examination, the patient was found to have linear streaks of hypopigmented, flat-topped, slightly raised, scaly papules on the left arm and hand (Fig. 1a,b). There were no lesions elsewhere.Histopathology showed hyperkeratosis and a lichenoid interface dermatitis with dense band-like and perieccrine lymphocytic infiltrates (Fig. 1c,d).These findings were consistent with LS. Clobetazol propionate cream once daily was prescribed, which resulted in clearance of the lesions in 4 weeks with residual postinflammatory hyperpigmentation.Yellow fever is a potentially fatal, mosquito-borne, infectious viral disease endemic to areas of South America and Africa. 5 The yellow fever vaccine is considered one of the safest and most effective vaccines, and is recommended to those travelling to high-risk areas. It is a live attenuated version of the 17D strain grown in egg embryos, and imparts durable immunity for 10 years. (a) (b) (c) (d) Figure 1 (a,b) Linear streaks of hypopigmented, flat-topped, slightly elevated scaly papules on patient's left arm and hand. (c,d) Hyperkeratosis and lichenoid interface dermatitis with dense band-like and perieccrine lymphocytic infiltrates. Haematoxylin and eosin, original magnification: (c) 9 40; (d) 9 200.

Lichen striatus-like eruption in an adult following hepatitis B vaccination: a case report and review of the literature

“…In the case of vaccine-associated LS it has been proposed that the vaccine induces a cross-reactivity between shared epitopes on keratinocytes and viral proteins used in the vaccines. Thus, previous immune system tolerance is consequently broken in these mosaic epidermal cells distributed along the lines of Blaschko and a cell-mediated attack by cytotoxic T cells is triggered [8]. The HBV vaccine, available since 1982, is considered very safe and effective (95%) in protecting against hepatitis B infection [10].…”

“…Additionally, upon review of the case reports, we saw that the appearance of LS was typically two weeks after vaccination but up to eight weeks and began at the site of the vaccination. Most cases resolved within 6 months [4][5][6][7][8].…”

“…Suggested precipitating factors include autoimmune response, atopy, viral infection, trauma, and vaccination. Of the latter, there are currently only five case reports in the literature involving four vaccines: Bacille Calmette-Guerin (BCG), yellow fever (YFV), hepatitis B virus (HBV), and measles, mumps and rubella (MMR), [4][5][6][7][8]. We describe a 63-year-old woman who developed LS on her upper left extremity after immunization with the HBV vaccine, and present a synthesis of the vaccine associated cases of LS in the literature.…”

Lichen striatus following scarlet fever in a 3‐year‐old female patient

“…An acute triggering event may lead to recognition of the genetically altered clone, causing the lesions to appear in a linear distribution . In the case of LS, a variety of possible triggers have been described, being viral infections (varicella, influenza) and vaccines (bacillus Calmette‐Guérin, measles, mumps, and rubella, hepatitis B virus, yellow fever) the most frequently reported. To our knowledge, only one case has been described in relation to a clinical diagnosis of tonsillitis, but microbiological studies were not performed …”

“…Lesions usually appear abruptly and heal after a mean duration of 12–24 months . Although its pathogenesis remains unknown, it seems to occur more frequently among atopic patients, and a variety of possible triggers has been reported . Here, we report a case of a child developing LS 2 weeks after scarlet fever.…”