10.5826/dpc.1401a16
text/xml
2160-9381
3388
en
Giuseppe Argenziano
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
An Unusual Case of Lichen Striatus Onset Under Dupilumab in a Patient With Alopecia Areata 
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Image Letter
2024-01-31
2023-04-03
2024-01-31
2024-02-21
e2024016
Dermatol Pract Concept
Giuseppe Argenziano
2024/01/31
10.5826/dpc.1401a16
e2024016
Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
2160-9381
en
e2024016
Darsha AK, Cohen PR. Blaschkolinear Acquired Inflammatory Skin Eruption (BLAISE): Case Report of a Young Man Whose Dermatosis had Features of Lichen Striatus and Blaschkitis. Cureus. 2020;12(10):e10785. DOI: 10.7759/cureus.10785. PMID: 33154852. PMCID: PMC7606174.
An Unusual Case of Lichen Striatus Onset Under Dupilumab in a Patient With Alopecia Areata 
https://dpcj.org/index.php/dpc/article/download/3388/2545
     An Unusual Case of Lichen Striatus Onset Under
      Dupilumab in a Patient With Alopecia Areata
          Vittorio Tancredi1, Graziella Babino1, Elisabetta Fulgione1, Stefano Caccavale1,
                                       Giuseppe Argenziano1


1 Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli,
  Naples, Italy



Citation: Tancredi V, Babino G, Fulgione E, Caccavale S, Argenziano G. An Unusual Case of Lichen Striatus Onset Under Dupilumab in a
Patient With Alopecia Areata. Dermatol Pract Concept. 2024;14(1):e2024016. DOI: https://doi.org/10.5826/dpc.1401a16
Accepted: May 15, 2023; Published: January 2024
Copyright: ©2024 Tancredi et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Vittorio Tancredi, MD, Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine,
University of Campania Luigi Vanvitelli, Via Sergio Pansini, 5, 80131 Naples, Italy; phone: +39 3313919797; fax: +39 081 987252;
E-mail: tancredivittorio@ymail.com




Case Presentation                                                        Teaching Point
In October 2022 a 15-year-old boy acceded in our Department.             Some authors retained that post zygotic somatic mutations
He was already our patient for the management of his universal           of skin cells may determinate the genesis of a mosaicism,
alopecia areata, handled from May 2022 with d
                                            ­ upilumab, an               presenting different keratinocyte antigens. A mosaicism is
anti-IL-4 and IL-13 receptor inhibitor [1]. ­After 5 months only         that condition marked by the presence of more than one
partial improvement signs of his alopecia areata were detected.          ­genetic line as a result of a DNA mutation, in a multicellular
However, he showed us a curious skin rash on his lower left              ­organism [2]. A blaskhoid eruption may appear, when this
limb which had onset in August. Clinical examination revealed            clone is target by a not specific immune system response,
pink-red small papules, slighty wrinkled, grouped in plaques             probably triggered by unknown factors2. Dupilumab is able
and in blaskhoid fashioned distribution, from his left groin to          to switch the immune response from a Th2 to a Th1 and
the calf. Due to patient’s parents had refused skin biopsy, a clin-      Th17 pathway which, in our opinion, may induce autoim-
ical diagnosis of lichen striatus (LS) was made (Figure 1). LS is a      mune responses against mosaic cells and thus blaskhoid
rare cutaneous eruption of unknown etiology, that has been as-           eruption in predispose patients [1].
sociated with some conditions like atopic dermatitis and so on.




Image Letter | Dermatol Pract Concept. 2024;14(1):e2024016                                                                             1
Figure 1. (A, B) papules and plaques in blaskhoid distribution, from the left calf to the groin. (C) dermatoscopic evaluation displayed papules
and plaques characterized by dotted and linear vessels on a pink-yellow background and faint erythema.




References                                                                2. Darsha AK, Cohen PR. Blaschkolinear Acquired Inflammatory
                                                                             Skin Eruption (BLAISE): Case Report of a Young Man Whose
 1. Kychygina A, Cassagne M, Tauber M, et al. Dupilumab-Associated           Dermatosis had Features of Lichen Striatus and Blaschkitis.
    Adverse Events During Treatment of Allergic Diseases. Clin               ­Cureus. 2020;12(10):e10785. DOI: 10.7759/cureus.10785.
    Rev Allergy Immunol. 2022;62(3):519-533. DOI: 10.1007                     PMID: 33154852. PMCID: PMC7606174.
    /s12016-022-08934-0. PMID: 35275334.




2                                                                                Image Letter | Dermatol Pract Concept. 2024;14(1):e2024016
