“Pediatric Blaschkitis”: Expanding the Spectrum of Childhood Acquired Blaschko‐linear Dermatoses

Abstract

We describe two young children who developed relapsing, pruritic, papulovesicular eruptions in multiple bands along Blaschko lines on the neck, trunk, and extremities. Skin specimens in both revealed spongiotic dermatitis. This represents the first report of "blaschkitis" in children, providing further evidence that lichen striatus and blaschkitis are related acquired Blaschko-linear dermatoses that exist on a spectrum rather than as the childhood and adult form of a single disease entity. We highlight the features that differentiate blaschkitis from lichen striatus, review the potential roles of cutaneous mosaicism, environmental triggers, and background immunologic state in their pathogenesis, and discuss the spectrum of inflammatory dermatoses that can follow Blaschko lines.

Líquen estriado no adulto

“…[1][2][3]5 It is typically unilateral, generally affecting one extremity, being unusual the occurrence on the chest or face, as in the case reported here. 1 It has an abrupt onset but its duration is selflimited, with spontaneous resolution of the condition within 12 months, most of the times.…”

“…1 It has an abrupt onset but its duration is selflimited, with spontaneous resolution of the condition within 12 months, most of the times. 1,3 Occasionally, there are ungual changes like longitudinal striations, thinning of the ungual plate and onychoschizia. 8 The most common treatment is topical corticosteroids and there are reports on the satisfactory use of tacrolimus and pimecrolimus for persistent cases.…”

“…9 The regression of lesions may result in residual hypopigmentation, especially in individuals with a high phototype. 1,3 Very controversial in the medical literature is the adult "blaschkitis", proposed by Grosshans and Marot in 1990 10 as a rare and distinct entity from LS. It is an acquired inflammatory linear eruption generally described in adults, consisting of pruritic papules and vesicular eruptions along the ipisilateral lines of Blaschko, generally on the chest.…”

“…It differs from classically described LS for its quick resolution and frequent recurrence. 2,3 Besides that, the histopathology corresponds more to a dermatitis spongiotic than to lichenoid, different from LS, in which the lichenoid alterations predominate. 3,11 However, "blaschkitis" as a Hofer suggests its non-classification as a new disease or entity, due to the subtle criteria that distinguish it from LS.…”

“…1,2 Its etiology is unknown but it is considered ,by many authors, as a manifestation of mosaicism, characterized by the presence of clones of epithelial cells genetically abnormal that through a precipitating event can be recognized by the immune system and induce the affected skin to generate an inflammatory response T-cells mediated, apparent in Blaschko lines. 3,4 So, it is believed that infections and environmental factors are involved with the majority of cases occurring during Spring and Summer. 1,2,5 Trauma, pregnancy and drugs are also reported as precipitating factors.…”