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Nasimi M, Abedini R, Azizpour A, Nikoo A. Isolated linear blaschkoid psoriasis. Clin Exp Dermatol 2016; 41:775-8. [PMID: 27663156 DOI: 10.1111/ced.12916] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2015] [Indexed: 11/26/2022]
Abstract
Linear psoriasis (LPs) is considered a rare clinical presentation of psoriasis, which is characterized by linear erythematous and scaly lesions along the lines of Blaschko. We report the case of a 20-year-old man who presented with asymptomatic linear and S-shaped erythematous, scaly plaques on right side of his trunk. The plaques were arranged along the lines of Blaschko with a sharp demarcation at the midline. Histological examination of a skin biopsy confirmed the diagnosis of psoriasis. Topical calcipotriol and betamethasone dipropionate ointments were prescribed for 2 months. A good clinical improvement was achieved, with reduction in lesion thickness and scaling. In patients with linear erythematous and scaly plaques along the lines of Blaschko, the diagnosis of LPs should be kept in mind, especially in patients with asymptomatic lesions of late onset.
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Affiliation(s)
- M Nasimi
- Autoimmune Bullous Disease Research Center, Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - R Abedini
- Autoimmune Bullous Disease Research Center, Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - A Azizpour
- Autoimmune Bullous Disease Research Center, Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - A Nikoo
- Department of Dermatopathology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
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2
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Figueiras DDA, Cauas RC, Takano DM, Ramos TB, Marinho AKDOF, Bezerra MSM. Linear psoriasis: case report on three year old child. An Bras Dermatol 2016; 90:194-6. [PMID: 26312714 PMCID: PMC4540548 DOI: 10.1590/abd1806-4841.20153838] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 09/08/2014] [Indexed: 11/26/2022] Open
Abstract
Atypical and unusual locations of psoriasis are very frequent. However, localized
linear psoriasis is rare, with few cases described in the literature. It is
characterized by a linear distribution of psoriasis lesions along Blaschko lines. We
report the case of a three years old child, who presented unilateral erythematous
scaly plaques arranged along Blaschko lines in the left hemithorax, with no
associated symptoms and no lesions in other parts of the body. The differentiation of
linear psoriasis from other linear dermatoses is not easy. The combination of a
thorough history, a careful examination of the skin and histopathology are essential
to ensure the correct diagnosis and appropriate treatment.
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3
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Ravikumar B, Sinhasan. Psoriasis sparing the polio-affected limb: is it merely the koebner phenomenon? Indian J Dermatol 2014; 59:505-6. [PMID: 25284862 PMCID: PMC4171925 DOI: 10.4103/0019-5154.139913] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Psoriasis being a common skin condition, atypical forms and unusual localizations of this disease are quite frequently seen. However, psoriasis sparing a polio-affected limb is extremely rare. We report a case of an adult male, who presented with psoriasis distributed all over the body but with almost complete sparing of the polio-affected left lower limb.
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Affiliation(s)
- Bc Ravikumar
- Department of Dermatology, Venereology and Leprology, Hassan Institute of Medical Sciences, Hassan, India
| | - Sinhasan
- Department of Pathology, Hassan Institute of Medical Sciences, Hassan, India
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4
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Abstract
Psoriasis is increasing in both children and adults. The association of comorbidities, specifically obesity and other components of the metabolic syndrome, are also increasing. The precise cause is unknown but genetic and complex immunologic factors play a role in the development of the disease and its comorbidities. There are multiple clinical variants, and the severity of the disease can range from mild localized lesions in most patients to severe generalized involvement in some. Most patients with mild to moderate disease can be controlled with topical treatments.
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Abstract
We report seven patients with facial lichen striatus along the lines of Blaschko who presented to our pediatric dermatology unit between 2003 and 2009. The mean age of diagnosis was 4.6 years (range 2.5-9 years). Three of the cases were associated with atopic dermatitis, and one case presented with vitiligo. In the six patients for whom we have follow-up, all lesions resolved without pigmentary changes in an average of 11 months. This case series describes the distribution, presentation, and natural history of lichen striatus along facial lines of Blaschko. From our experience, clinical diagnosis and monitoring without biopsy is a reasonable approach to the management of uncomplicated lichen striatus, particularly when the face is involved.
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Affiliation(s)
- Euphemia W Mu
- Department of Dermatology, School of Medicine, Johns Hopkins University, Baltimore, MD21287, USA
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6
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Sfia M, Roth-Mall B, Tortel MC, Guillaume JC, Cribier B. [Blasch-kolinear psoriasis revealed by infliximab therapy]. Ann Dermatol Venereol 2009; 136:898-903. [PMID: 20004317 DOI: 10.1016/j.annder.2009.09.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2008] [Accepted: 05/15/2009] [Indexed: 11/26/2022]
Abstract
BACKGROUND Blaschko-linear psoriasis is a rare disease about which only a few publications have appeared in the literature. This form of psoriasis poses problems of differential diagnosis with regard to other forms of inflammatory Blaschko-linear dermatoses. Herein, we report an original case, the linear nature of which was revealed by treatment with infliximab. CASE REPORT A 29-year-old man presented chronic psoriasis present for 17 years and resistant to various forms of systemic therapy. Treatment with infliximab 5mg/kg given on D1, D15 and two-monthly, thereafter resulted in practically complete resolution of all skin lesions after the fourth infusion. The only remaining lesions were psoriatic erythematous-squamous, non-pustular lesions with a Blaschko-linear pattern, limited to one side, on the left arm and left leg. These lesions persisted after 10 courses of infliximab, although no other lesions reappeared. DISCUSSION This case was original in terms of the revelation of Blaschko-linear lesions during treatment with infliximab, despite the complete disappearance of diffuse psoriatic plaques, thus suggesting the existence in this patient of two cell populations, each having a different response to biotherapy.
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Affiliation(s)
- M Sfia
- Service de dermatologie, hôpital Pasteur, 39, avenue de la Liberté, 68024 Colmar cedex, France.
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8
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Abstract
While childhood psoriasis is fairly common, congenital psoriasis appears to be rare and has not been well characterized. We present a patient with histologically confirmed congenital psoriasis. By reviewing the literature, we aim to both define this disease and compare it to infantile and childhood psoriasis. Electronic searches found articles reporting patients with biopsy-proven congenital psoriasis. We recorded clinical features, such as family history, anatomic involvement, and disease severity. We compared these data with previous descriptions of infantile and childhood psoriasis. We included nine patients with congenital psoriasis in our analysis. No patient had a first-degree family history of psoriasis. While the face, scalp, chest, and trunk were frequently involved, the buttocks generally were spared. Several patients had persistent disease despite therapy. In this series, congenital psoriasis differed from infantile and childhood psoriasis in several respects. Specifically, congenital psoriasis was associated with a lower prevalence of relevant family history, which could increase over time, and a different pattern of anatomic involvement, which may reflect exposure to age-associated environmental factors. Although several patients with congenital psoriasis had severe disease, this likely represents publication bias. Additional reports of congenital psoriasis with extended follow-up are needed to better characterize this condition.
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Affiliation(s)
- Julia S Lehman
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
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9
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WOLLENBERG A, BAUMANN L, PLEWIG G. Linear atrophoderma of Moulin: a disease which follows Blaschko's lines. Br J Dermatol 2008. [DOI: 10.1111/j.1365-2133.1996.tb01160.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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11
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Affiliation(s)
- Sandrine Benoit
- Department of Dermatology, University of Würzburg, D-97080 Würzburg, Germany
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12
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Happle R. Superimposed segmental manifestation of polygenic skin disorders. J Am Acad Dermatol 2007; 57:690-9. [PMID: 17870433 DOI: 10.1016/j.jaad.2007.06.039] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2007] [Revised: 05/01/2007] [Accepted: 06/29/2007] [Indexed: 10/22/2022]
Abstract
In common acquired skin disorders with a polygenic background such as psoriasis, a linear or otherwise segmental arrangement may sometimes be noted. The segmental involvement tends to be rather severe and may be associated with milder, nonsegmental lesions of the same disorder. Such cases may be best explained by an early postzygotic event in the form of loss of heterozygosity involving one of the genes that predispose to the disorder. The following pertinent examples are reviewed in this article: psoriasis vulgaris, pustular psoriasis, atopic dermatitis, lichen planus, systemic lupus erythematosus, pemphigus vulgaris, vitiligo, graft-versus-host disease, granuloma annulare, erythema multiforme, and drug eruption to ibuprofen. Such cases should not be categorized as a "type 2 segmental manifestation" because this term exclusively applies to monogenic traits, whereas in polygenic disorders the more descriptive term "superimposed segmental manifestation" seems appropriate. The concept of early loss of heterozygosity offers a plausible explanation as to why: the segmental involvement tends to appear at a rather young age and often precedes the development of milder, nonsegmental lesions of the same disorder; the segmental lesions are notoriously difficult to treat; and family members may show the disorder in its nonsegmental form. On the other hand, the theory of isolated versus superimposed segmental manifestation may help to elucidate the origin of polygenic skin disorders at the molecular level.
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Affiliation(s)
- Rudolf Happle
- Department of Dermatology, Philipp University of Marburg, Marburg, Germany.
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14
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Hofer T. Does Inflammatory Linear Verrucous Epidermal Nevus Represent a Segmental Type 1/Type 2 Mosaic of Psoriasis? Dermatology 2006; 212:103-7. [PMID: 16484814 DOI: 10.1159/000090648] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2005] [Accepted: 08/08/2005] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A 6-year-old girl with a symmetric linear eruption on both of her legs, clinically and histologically resembling inflammatory linear verrucous epidermal nevus (ILVEN) or linear psoriasis (LP), with concomitant psoriasis of the guttata type and a positive family history of psoriasis is presented. The questions as to whether LP actually exists and ILVEN represents a distinct entity are still under debate. OBJECTIVE AND METHODS The recent literature concerning case reports of ILVEN and LP is reviewed. RESULTS Case reports of ILVEN and LP can be subdivided into four different groups: (1) ILVEN with or without concomitant psoriasis, only in part reacting to antipsoriatic treatment, (2) ILVEN without concomitant psoriasis, (3) LP with concomitant psoriasis vulgaris, with both groups 2 and 3 reacting successfully to antipsoriatic treatment, and (4) LP without concomitant psoriasis vulgaris and with no family history of psoriasis (very rarely reported). CONCLUSION It is hypothesized that inflammatory linear verrucous eruption besides nevoid psoriasis/LP represents a further segmental type 1/type 2 mosaic of psoriasis which, if a (verrucous) epidermal nevus exists, shows a high affinity of occurrence in close context to such a nevus. Heritability is thought to be possible.
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Affiliation(s)
- Thomas Hofer
- Dermatology and Venereology FMH, Winkelriedstrasse 10, CH-5430 Wettingen, Switzerland.
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15
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Saraswat A, Jain R, Kaur I, Kumar B. Co-localization of epidermal nevi and psoriasis:are we closer to an explanation? Int J Dermatol 2005; 44:972-4. [PMID: 16336541 DOI: 10.1111/j.1365-4632.2005.02483.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
The term "epidermal nevus syndrome" (ENS) has been used to describe the association of epidermal hamartomas and extra-cutaneous abnormalities. Epidermal nevi follow the lines of Blaschko. The majority of the extra-cutaneous manifestations involve the brain, eye, and skeletal systems. Several subsets with characteristic features have been delineated including the nevus sebaceous syndrome, Proteus syndrome, CHILD syndrome, Becker nevus syndrome, nevus comedonicus syndrome, and phakomatosis pigmentokeratotica. Epidermal nevi have been associated with benign and malignant neoplasms. Advances in molecular biology have revealed that the manifestations of ENS are due to genomic mosaicism. It is likely that the varied clinical manifestations of ENS are due in great part to the functional effects of specific genetic defects. Optimal management of the patient with ENS involves an interdisciplinary approach. Amelioration of the cutaneous features of ENS has been difficult but there have been advances, especially in the use of lasers.
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Affiliation(s)
- Jeffrey L Sugarman
- Departments of Dermatology and Community and Family Medicine, University of California, San Francisco, CA 95404, USA.
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17
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Abstract
Congenital linear naevoid psoriasis along Blaschko's lines on the thigh of a 3-year-old girl is reported. The history of asymptomatic, erythematous scaly lesions since birth, the peculiar distribution and the histopathology confirmed the diagnosis.
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Affiliation(s)
- A Ghorpade
- Department of Dermatology, Venereology and Leprology, JLN Hospital and Research Centre, Bhilai (Chhattisgarh), India.
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18
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Yu HJ, Ko JY, Kwon HM, Kim JS. Linear psoriasis with porokeratotic eccrine ostial and dermal duct nevus. J Am Acad Dermatol 2004; 50:S81-3. [PMID: 15097935 DOI: 10.1016/s0190-9622(03)02797-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Linear psoriasis is an uncommon form of psoriasis characterized by the linear distribution of the psoriatic lesions. It usually follows the lines of Blaschko with unilateral involvement. Poro keratotic eccrine ostial and dermal duct (PEODD) nevus is another rare dermatosis that follows Blaschko's line. The pathogenesis of linear psoriasis and PEODD nevus is unclear, but both could be best explained by a specific somatic mutation. Hence, it has been suggested that the mutation responsible for PEODD nevus would constitute a rare but critical psoriasis gene. In the literature, 1 case of linear psoriasis with PEODD nevus was reported, which may support this suggestion. This article describes another case of linear psoriasis and PEODD nevus. A 7-year-old boy had a 4-month history of multiple psoriasiform plaques, arranged in linear distribution, and had congenital linear hyperkeratotic papules and pits on the right side of his trunk and right arm.
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Affiliation(s)
- Hee-Joon Yu
- Department of Dermatology, Guri Hospital, Hanyang University College of Medicine, Guri City, Gyunggi-do, Seoul 471-701, Korea.
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Abstract
Linear psoriasis is a rare entity. It is commonly confused clinically and histopathologically with verrucous epidermal nevus. We report a child who had linear psoriasis in a unilateral distribution with palmoplantar, nail, and scalp involvement.
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Affiliation(s)
- Abir Saraswat
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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20
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Durán-McKinster C, Moises C, Rodríguez-Jurado R, Tamayo-Sánchez L, Orozco-Covarrubias L, Ruiz-Maldonado R. Streptococcal exanthem in a blaschkolinear pattern: clinical evidence for genetic mosaicism in hypomelanosis of ito. Pediatr Dermatol 2002; 19:423-5. [PMID: 12383100 DOI: 10.1046/j.1525-1470.2002.00119.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Due to the presence of two different clones of cells in early embryogenesis, numerous congenital and acquired dermatoses have a linear distribution following the lines of Blaschko. Acquired inflammatory skin diseases are rarely observed in linear patterns. Our patient was born with macrocephaly, left eye glaucoma, and a left facial and contralateral corporal hemihypertrophy, cerebral dysgenesis, and skeletal abnormalities. Hypopigmented S-shaped linear macules on the trunk and linear streaks on the arms and legs were compatible with hypomelanosis of Ito. At 5 years of age the patient presented with an erythematous follicular exanthem compatible with scarlet fever exclusively in the lines of Blaschko. This fact suggests a genetic mosaicism.
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Affiliation(s)
- Carola Durán-McKinster
- Departments of Dermatology, National Institute of Pediatrics of Mexico, Mexico City, Mexico
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21
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Affiliation(s)
- Danielle Marcoux
- Division of Dermatology, Department of Pediatrics, Hôpital Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
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22
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Abstract
Psoriasis often presents in childhood. The diagnosis may be challenging if the disease is mild or the presentation is atypical. All of the forms recognised in adults are encountered in childhood (plaque, guttate, erythrodermic and pustular). Guttate and flexural forms are particularly common in children. Successful management requires education of the child and parents regarding the course of the disease and treatment options. Environmental triggers should be sought out and eliminated where possible. Most patients respond to topical treatment with emollients, coal tar, anthralin (dithranol) or calcipotriol. Treatment is tailored according to patient age, extent and distibution of psoriasis. For those who fail to respond, daycare or inpatient care is appropriate. Phototherapy with UVB may be combined with topical agents. Systemic therapy is required in a minority, usually those with resistant or erythrodermic disease, pustular psoriasis and arthropathic psoriasis. Retinoids are probably the systemic agent of choice. There are few data regarding the use of methotrexate or cyclosporin in childhood psoriais.
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Affiliation(s)
- J Leman
- Department of Dermatology, Western Infirmary, Glasgow, Scotland
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23
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Abstract
Our aim was to describe the types of psoriasis seen in a large series of patients presenting to a tertiary referral pediatric dermatology department using a classification system combining conventional terminology and additional categories based on the site and characteristics of the rash. A total of 1262 patients seen consecutively in the dermatology department of the Royal Alexandra Hospital for Children, Sydney, Australia, between 1981 and 1995 are described and classified according to the pattern of psoriasis at the time of presentation. Additional information recorded included family history, facial involvement, and history of a psoriatic type of diaper rash in infancy. The ages of the children ranged from 1 month to 15 years. There was an equal gender distribution and a high rate of positive family history at 71%. Twenty-six percent of children had a history of a psoriatic diaper rash and facial involvement occurred in 38% of children. Plaque psoriasis was the most common type overall, affecting 430 patients (34%). Three hundred forty-five children were less than 2 years of age, and this is the largest series of children with psoriasis in this age group presented to date. An entity defined by us as psoriatic diaper rash with dissemination was the most common type of psoriasis in the less than 2-year age group, affecting 155 (45%) patients. This large series offers information on the manifestations of psoriasis in childhood, but is particularly useful in examining the previously less well-described infant age group. The classification used is proposed as a practical way to describe psoriasis in children, particularly with respect to future descriptive studies.
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Affiliation(s)
- A Morris
- Department of Clinical Epidemiology, Royal Alexandra Hospital for Children, Westmead, New South Wales, Australia
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24
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Zhang Y, McNutt NS. Lichen striatus. Histological, immunohistochemical, and ultrastructural study of 37 cases. J Cutan Pathol 2001; 28:65-71. [PMID: 11168754 DOI: 10.1034/j.1600-0560.2001.280202.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Lichen striatus (LS) is a papulosquamous disorder with a distinctive linear distribution. The linearity has been shown to correspond in many cases to the pattern of Blaschko's lines. The etiology is unknown. LS can usually be identified by clinical history and histology of typical lesions. However, the histologic features are diverse and some have stated they are nonspecific. METHODS In an effort to identify those characteristic features, we have reviewed the routine slides in 37 cases for their diagnostic criteria. Ten cases were studied further by immunohistochemistry. RESULTS The patient's ages ranged from 1.3 to 49 years with mean age of 17.5 years. A female-to-male ratio was 1.6 to 1. The lesions were predominantly distributed on the extremities in 26/34 cases. The consistent histologic features were: hyperkeratosis (29/37), parakeratosis (21/37) with a few necrotic keratinocytes (28/37) in the epidermis, mild spongiosis (29/37) with exocytosis of lymphocytes (33/37). The dermal infiltrate comprised mainly lymphocytes and macrophages. At the dermal-epidermal junction, the infiltrate was either focal (20/37) or lichenoid (17/37) patterns. Superficial and deep perivascular lymphocytic inflammatory infiltrate was present in most of the cases (33/37). Appendageal involvement (34/37) was in hair follicles (24/37) or eccrine glands or ducts (22/37) or both (12/37). Satellite cell necrosis may be seen (11/37). Colloid bodies were present in 16/37 of the cases. Immunohistochemistry showed that most of the small lymphocytes in the upper dermis and epidermis were positive for CD7. Most of the lymphocytes in the epidermis were positive for CD8. CD1a Langerhans' cells were either decreased (5/10) or increased (3/10) or normal (2/10) in the epidermis. CONCLUSION The histologic diagnosis of LS can be made on the basis of the combination of these histologic features in the appropriate clinical context. Multiple biopsies may be necessary to determine whether all of these features are present in a given case.
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Affiliation(s)
- Y Zhang
- Department of Pathology, New York Hospital Medical Center of Queens, USA
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25
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Ozkaya-Bayazit E, Akasya E, Büyükbabani N, Baykal C. Pustular psoriasis with a striking linear pattern. J Am Acad Dermatol 2000; 42:329-31. [PMID: 10640925 DOI: 10.1016/s0190-9622(00)90104-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pustular psoriasis has different clinicomorphologic forms such as generalized, localized (mainly palmoplantar or acral), and annular. There are also few cases with a linear distribution pattern. We report a case of pustular psoriasis with a striking linear distribution probably related to Blaschko's lines. We suggest that linear pattern should also be considered among the morphologic variants of pustular psoriasis.
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Affiliation(s)
- E Ozkaya-Bayazit
- Department of Dermatology, Istanbul Medical Faculty, Istanbul University, Turkey.
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26
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Menni S, Restano L, Gianotti R, Boccardi D. Inflammatory linear verrucous epidermal nevus (ILVEN) and psoriasis in a child? Int J Dermatol 2000; 39:30-2. [PMID: 10651962 DOI: 10.1046/j.1365-4362.2000.00872.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- S Menni
- Institute of Dermatological Sciences, University of Milan, IRCCS, Ospedale Maggiore, Milan, Italy
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27
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Abstract
Adult onset of inflammatory linear verrucous epidermal nevus (ILVEN) is reported in a 44-year-old Japanese man. A mild pruritic eruption appeared one year earlier and extended from the left dorsal foot to the gluteal region. Histologically, acanthosis and papillomatous thickening of epidermis as well as spongiotic edema and exocytosis with lymphocytes and neutrophils were observed. Topical tacalcitol was not effective, but the pruritus as well as the eruption slightly improved with topical corticosteroid and vaseline containing salicylic acid. This adult onset of ILVEN is considered to be a rare case.
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Affiliation(s)
- H Kawaguchi
- Department of Dermatology, Yokohama City University, School of Medicine, Japan
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28
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Abstract
It is not unusual for psoriasis to start in childhood although a mild or atypical presentation sometimes makes it difficult to establish a confident diagnosis at this age. All adult forms occur but flexural psoriasis and guttate psoriasis are particularly common. Management involves education of the child and parents concerning the nature of psoriasis and the effects of treatment. Genetic counselling may be provided if needed based on population data. Environmental triggers of psoriasis should be sought particularly infection. Psoriasis can usually be treated effectively in children with topical agents including emollients, coal tar, corticosteroids, dithranol and calcipotriol according to age and the sites affected. In those who do not respond, consideration should be given first to day care or in-patient treatment which may be combined with UVB phototherapy. Systemic therapy should be used only under extreme circumstances such as resistant erythrodermic, pustular or arthropathic psoriasis. There are no controlled trials in this age group but the most experience has been with retinoids which are probably the second-line drug of choice for children. Methotrexate and cyclosporin appear to be effective in children but more efficacy and safety data are required.
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Affiliation(s)
- A D Burden
- Department of Dermatology, Western Infirmary, Glasgow, UK.
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29
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30
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Green JJ, Baker DJ. Linear childhood discoid lupus erythematosus following the lines of Blaschko: a case report with review of the linear manifestations of lupus erythematosus. Pediatr Dermatol 1999; 16:128-33. [PMID: 10337677 DOI: 10.1046/j.1525-1470.1999.00030.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Seventeen cases of childhood discoid lupus erythematosus (DLE) have been previously reported in the literature. We describe the first reported case of childhood linear DLE following the lines of Blaschko. The clinical and histologic characteristics of childhood DLE are discussed and a review of the linear manifestations of childhood LE is presented.
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Affiliation(s)
- J J Green
- UMDNJ-Robert Wood Johnson Medical School at Camden, New Jersey, USA
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31
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Kanoh H, Ichihashi N, Kamiya H, Seishima M, Akiyama T, Ichiki Y, Kitajima Y. Linear pustular psoriasis that developed in a patient with generalized pustular psoriasis. J Am Acad Dermatol 1998; 39:635-7. [PMID: 9777772 DOI: 10.1016/s0190-9622(98)70014-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- H Kanoh
- Department of Dermatology, Gifu University School of Medicine, Japan
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Lehners-Weber C, de la Brassinne M, Dezfoulian B, Richert B, Bonardeaux C, Willemaers V. Congenital psoriasis following the lines of Blaschko. Pediatr Dermatol 1996; 13:219-21. [PMID: 8806122 DOI: 10.1111/j.1525-1470.1996.tb01206.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Congenital psoriasis without an underlying nevus following the lines of Blaschko is described in a 6-year-old girl. In addition to this special type of psoriasis, she suffered from atopic dermatitis. The lesions were aggravated by sun exposure and phototherapy treatments, as well as by upper airways infections, without any clear explanation of these trigger factors. We propose to call this form of psoriasis congenital blaschkoid psoriasis.
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Abstract
Although psoriasis has been recognized at least since Biblical times new forms, associations and influences continue to be described in the twentieth century. New forms include the rupioid erythema annulare centrifugum-like and follicular patterns. Associations with vitiligo bullous pemphigoid and lupus erythematosus have been recently described. Endoscopic surgery has increased para umbilical psoriasis while Sun Smart campaign have reduced photo-aggravated psoriasis. Infections such as paediatric perianal streptococcal cellulitis and drugs including angiotensin converting enzyme inhibitors and cytokines exacerbate psoriasis.
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Affiliation(s)
- H Rotstein
- Department of Dermatology, St Vincent's Hospital, Melbourne, Victoria, Australia
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Abstract
A 4-year-old girl was seen in our department for erythroderma, palmoplantar hyperkeratosis, and scalp desquamation present since birth. The dermatosis had run an intermittent course, with exacerbations after infections and spontaneous remissions. A specimen from a skin biopsy performed at 1 year of age showed the characteristic features of psoriasis, findings that were confirmed in our biopsy specimen. Treatment with acitretin controlled the outbreaks. At 7 years of age she has developed, for the first time, plaque type psoriasis. Congenital erythroderma is an unusual form of psoriasis with a wide differential diagnosis.
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Affiliation(s)
- M Salleras
- Department of Dermatology, Hospital Sagrado Corazón-QSA, University of Barcelona, Spain
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Elder JT, Henseler T, Christophers E, Voorhees JJ, Nair RP. Of genes and antigens: the inheritance of psoriasis. J Invest Dermatol 1994; 103:150S-153S. [PMID: 7963679 DOI: 10.1111/1523-1747.ep12399486] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Psoriasis is one of a number of autoimmune diseases that display significant HLA associations. In particular, individuals with onset of disease prior to 40 years of age display striking associations with HLA-Cw6 and are much more likely to have a positive family for psoriasis. However, only about 10% of Cw6-positive individuals develop disease, suggesting that other genetic and/or environmental factors must be involved. Several compelling lines of epidemiologic evidence indicate that psoriasis susceptibility is inherited, albeit not in a simple monogenic fashion, and that genetic, rather than environmental, factors are primarily responsible for the variability in inheritance of psoriasis. Taken together, these observations suggest that one or more loci in addition to HLA are necessary for the development of psoriasis. The number of additional loci is likely to be small, because i) the disease is very common ii) substantial excess risk of psoriasis is observed in first degree relatives, and iii) nevoid variants of psoriasis have been reported, suggestive of somatic mutation of a single gene during development. The substantial homogeneity of the psoriatic phenotype and the clear evidence for increased HLA association and heritability in juvenile onset disease indicate that despite its complexity, psoriasis is a common disease whose etiology is amendable to elucidation through the techniques of modern molecular genetics.
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Affiliation(s)
- J T Elder
- Department of Dermatology, University of Michigan, Ann Arbor 48109-0672
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Megahed M, Reinauer S, Scharffetter-Kochanek K, Milde P, Hölzle E, Goerz G, Ruzicka T. Acquired relapsing self-healing Blaschko dermatitis. J Am Acad Dermatol 1994; 31:849-52. [PMID: 7962734 DOI: 10.1016/s0190-9622(94)70244-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We describe a 44-year-old woman who had a unilateral relapsing linear dermatosis for 12 years. The lesions consisted of erythematous, discrete and grouped papules and papulovesicles that were localized to the left side of the upper and lower limbs, chest, abdomen, and back. They were distributed along Blaschko's lines. There was also a diffuse erythematous scaly hyperkeratosis of both palms. The lesions healed spontaneously. Examination of biopsy specimens from the back and the left palm revealed acute and subacute spongiotic dermatitis, respectively. This dermatosis was first described by Grosshans and Marot in 1990 and termed "Blaschkite de l'adulte." Because the disease is acquired, relapsing, heals spontaneously, follows Blaschko's lines, and is characterized histopathologically by a spongiotic dermatitis, we propose the term "acquired relapsing self-healing Blaschko dermatitis."
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Affiliation(s)
- M Megahed
- Department of Dermatology, Heinrich-Heine University, Düsseldorf, Germany
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38
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Loopez-Avila A, Diiaz ER, Vicente IH, Armesto S, Armijo M. Congenital linear psoriasis: case report and differences with ILVEN. J Eur Acad Dermatol Venereol 1994. [DOI: 10.1111/j.1468-3083.1994.tb00373.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Holzmann H, Schmitt M, Happle R, Kaltwasser P, Hör G. Osteoarthropathia psoriatica of one leg: a manifestation of somatic mosaicism? Clin Genet 1994; 46:193-7. [PMID: 7820930 DOI: 10.1111/j.1399-0004.1994.tb04223.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A psoriatic osteoarthropathy localized in the left quadrant of a male patient is described. Diagnosis was made on the basis of bone scintigraphy (specific distribution pattern) and histological evaluation of a bone biopsy. There is no indication of psoriasis in the patient's family. Nor is there an association to psoriasis-typical HLA markers. Psoriasis of the skin has not been found. Environmental factors, including a Köbner phenomenon on the skeleton resulting from a trauma 13 years ago (hallux rigidus operation), are discussed in connection with this manifestation. The genetic aspects of this unusual localization are considered.
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Affiliation(s)
- H Holzmann
- Dept. I of the Centre for Dermatology and Venerology, University of Frankfurt, Germany
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40
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Abstract
The lines of Blaschko represent a pattern followed by many skin disorders. We review the clinical and histologic features of X-linked, congenital/nevoid, and acquired skin diseases that follow these lines. We also include cutaneous disorders that have a linear distribution but do not follow Blaschko's lines. Finally, we differentiate Blaschko's lines from other patterns on the skin such as dermatomes and Langer's lines.
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Affiliation(s)
- J L Bolognia
- Department of Dermatology, Yale University School of Medicine, New Haven, CT
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Abstract
Two unrelated children with von Recklinghausen's neurofibromatosis (NF1) had mothers with cutaneous NF1 lesions in a limited distribution. The cutaneous pattern in the mother of case 1 was clearly segmental, and probably represents mosaicism for the NF1 mutation which was passed on to the child. In the second case the distribution in the mother was less obviously segmental, but may still represent mosaicism. It is more difficult to diagnose mosaicism for NF1 in individuals with no affected offspring, or with more limited cutaneous manifestations. The difficulties in defining segmental NF and assigning a genetic risk are discussed.
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Affiliation(s)
- C Moss
- Department of Dermatology, Birmingham Children's Hospital, Ladywood Middleway, U.K
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Baselga E, Puig L, Llobet J, Musulén E, de Moragas JM. Linear psoriasis associated with systemic lupus erythematosus. J Am Acad Dermatol 1994; 30:130-3. [PMID: 8277015 DOI: 10.1016/s0190-9622(08)81901-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- E Baselga
- Department of Dermatology, Universitat Autònoma de Barcelona, Spain
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Abstract
A 2-year-old boy experienced lichen striatus localized to the left half of the body. Some weeks later he developed a peculiar form of eruptive psoriasis limited to the right half of the body. To our knowledge, unilateral eruptive psoriasis has never been described in the literature. The coincidence in this young patient of lichen striatus and this unusual form of psoriasis arising in so short a period of time leads us to hypothesize a common trigger factor.
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Affiliation(s)
- S Menni
- First Department of Dermatology and Pediatric Dermatology, University of Milan, I.R.C.C.S. Ospedale Maggiore di Milano, Italy
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Taieb A, el Youbi A, Grosshans E, Maleville J. Lichen striatus: a Blaschko linear acquired inflammatory skin eruption. J Am Acad Dermatol 1991; 25:637-42. [PMID: 1791221 DOI: 10.1016/0190-9622(91)70245-w] [Citation(s) in RCA: 84] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
An illustrative case report and a series of 18 well-documented cases of lichen striatus are presented. The mean age at diagnosis was 3 years (6 months to 14 years; median 2 years). The lesions were predominantly distributed on the trunk in 33% of cases and on the limbs in the remaining two thirds (upper limb: 48%; lower limb: 19%). Pruritus was noted in only 1 of 18 cases. Six cases were associated with clinical features of atopy and/or minor signs of atopic dermatitis (e.g., pityriasis alba). Two cases were considered to be clinically associated with lesions consistent with psoriasis. The mean duration was 9.5 months (4 weeks to 3 years; median 6 months). In one patient, two relapses occurred in 4 years. Hypochromic sequelae were noted in 50% of cases. Lichen striatus is the most common acquired self-limited linear eruption in childhood that follows Blaschko's lines. A new acronym is proposed to emphasize the developmental background of the disease: BLAISE for Blaschko linear acquired inflammatory skin eruption.
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Affiliation(s)
- A Taieb
- Hôpital des Enfants, Bordeaux, France
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Affiliation(s)
- R Happle
- Department of Dermatology, University of Nijmegen, The Netherlands
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47
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Abstract
A 10-year-old girl had two localized psoriasiform plaques at birth. Subsequently, she developed generalized, asymptomatic, scaly plaques arranged in linear bands and streaks along the lines of Blaschko. The morphologic and histopathologic features, the clinical course, and HLA (CW6,A2) association were characteristic of psoriasis. Although rare, true linear psoriasis exists.
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Affiliation(s)
- A S al-Fouzan
- Department of Dermatology, PUVA Unit, Al-Sabah Hospital, Kuwait
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