10.5826/dpc.1304a208
text/xml
2160-9381
3232
en
Andrea Sechi
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Nail Lichen Striatus Affecting Adjacent Nails: A Sign of Blaschko Lines
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Image Letter
2023-10-31
2023-02-08
2023-10-31
2024-01-15
e2023208
Dermatol Pract Concept
Andrea Sechi
2023/10/31
10.5826/dpc.1304a208
e2023208
Dermatology Unit, San Bortolo Hospital, Vicenza, Italy
2160-9381
en
e2023208
Kim M, Jung HY, Eun YS, Cho BK, Park HJ. Nail lichen striatus: report of seven cases and review of the literature. Int J Dermatol. 2015;54(11):1255-1260. DOI: 10.1111/ijd.12643. PMID: 26474189
Nail Lichen Striatus Affecting Adjacent Nails: A Sign of Blaschko Lines
https://dpcj.org/index.php/dpc/article/download/3232/2378
         Nail Lichen Striatus Affecting Adjacent Nails:
                   A Sign of Blaschko Lines
             Laura Gnesotto1, Guido Mioso1, Michela Starace2, Bianca Maria Piraccini2,
                                  Luigi Naldi3, Andrea Sechi2,3


1 Department of Medicine-DIMED, Unit of Dermatology, University of Padova, Padova, Italy
2 Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
3 Dermatology Unit, San Bortolo Hospital, Vicenza, Italy



Citation: Gnesotto L, Mioso G, Starace M, Piraccini BM, Naldi L, Sechi A. Nail Lichen Striatus Affecting Adjacent Nails: A Sign of
Blaschko Lines. Dermatol Pract Concept. 2023;13(4):e2023208. DOI: https://doi.org/10.5826/dpc.1304a208
Accepted: March 28, 2023; Published: October 2023
Copyright: ©2023 Gnesotto 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: Andrea Sechi, Dermatology Unit, San Bortolo Hospital, Vicenza, Italy. E-mail: andrea.sechi@aulss8.veneto.it




Case Presentation                                                        findings, a diagnosis of lichen striatus (LS) was posed. The
                                                                         patient was treated with topical mometasone furoate 0.1%
A 5-year-old boy presented a 10-month history of an asymp-               cream twice a day for three months, leading to complete
tomatic linear eruption affecting the later aspects of his left          resolution of skin lesions; nail changes resolved completely
index and medial surface of the medium finger, which had                 within one year with no recurrence.
gradually spread to the periungual skin, the nail bed and
matrix causing an acquired nail plate dystrophy. Physical ex-
amination revealed multiple pinkish and hyperkeratotic pap-
                                                                         Teaching Point
ules of the affected digits associated with mild erythema of
proximal nail folds. The two nail plates were only partially             The involvement of the nail unit in LS is rare and generally
involved, showing longitudinal splitting and ridging associ-             localized to a single nail, either or not in association with
ated with splitting and hyperkeratosis of the distal margin              cutaneous lesions [1,2]. The involvement of two adjacent
(Figure 1A). Onychoscopy enhanced the detection of the                   nail plates reminds us of its blaschkoid distribution, a diag-
longitudinal streak, distal splitting, punctiform and splinter           nostic clue of LS. Dermoscopy reveals distinctive features of
hemorrhages in the nail bed (Figure 1B). The skin papules                nail LS, such as longitudinal white-yellowish streaks or lines
tended to coalesce near the proximal nail folds, displaying              parallel to the nail bed, interrupted by hyperkeratosis. These
a reticular white-yellowish structure with fine scales and               findings help to avoid unnecessary biopsies, given the disor-
peripheral radial capillaries (Figure 1C). Based on clinical             der’s positive prognosis.




Image Letter | Dermatol Pract Concept. 2023;13(4):e2023208                                                                           1
                     Figure 1. Nail lichen striatus. (A) Clinical presentation: multiple pinkish papules with blas-
                     hkoid distribution, affecting the left index and medium finger with partial involvement of
                     the two adjacent nail plates. (B) Onychoscopy reveals longitudinal ridging, distal splitting
                     and splinter hemorrhages in the nail bed. (C) Dermoscopy of skin papules shows a slight
                     erythematous background and reticular white-yellowish structure covered with whitish
                     scales.



References                                                             2. Kim M, Jung HY, Eun YS, Cho BK, Park HJ. Nail lichen striatus:
                                                                          report of seven cases and review of the literature. Int J Derma-
1. Kavak A, Kutluay L. Nail involvement in lichen striatus.               tol. 2015;54(11):1255-1260. DOI: 10.1111/ijd.12643. PMID:
   ­Pediatr Dermatol. 2002;19(2):136-138. DOI: 10.1046/j.1525             26474189.
    -1470.2002.00049.x. PMID: 11994177.




2                                                                            Image Letter | Dermatol Pract Concept. 2023;13(4):e2023208
