Unilateral Blaschkoid lichen planus in successive pregnancies

Abstract

A number of genetic, congenital and acquired dermatoses have been known to follow Blaschko's lines. A common disorder like lichen planus can very rarely present with pruritic lesions in atypical patterns such as unilateral distribution, painful eruptions and along Blaschko's lines. Various triggering factors varying from viral infections and vaccinations to trauma have been implicated in lichen planus. We describe a female patient in the second trimester of her second pregnancy who developed unilateral lichen planus along Blaschko's lines during both pregnancies. No case of lichen planus along Blaschko's lines recurring during pregnancy is reported so far. Could pregnancy itself be a contributory factor towards onset of lichen planus in this case?

Linear lichen planus along the lines of Blaschko in three adult women

“…LP in the dermatomes following herpes zoster at the same location has been observed by some authors (Braun et al, 1998;Shemer et al, 2001). Two cases of healthy women who developed recurrent unilateral LP along Blaschko's lines following successive deliveries of healthy babies have been described (Krasowska et al, 2001;Kumar et al, 2011).…”

“…Patient 3 manifested LLP at 65 years of age without a known trigger. Most LLP cases in adults affect young and middle-aged individuals (Braun et al, 1998;Krasowska et al, 2001;Shemer et al, 2001;Ber Rahman et al, 2007;Vachiramon et al, 2010;Kumar et al, 2011). The latest reports indicate, however, that the LLP may also affect individuals older than 60 years of age (Aggarwal et al, 2013;Kavoussi et al, 2013;Yayla et al, 2014).…”

“…Skin lesions may develop at the site of an injury (Koebner phenomenon); during the course of an autoimmune disorder or viral infection (hepatitis A and C viruses, varicella zoster virus); during pregnancy; and after severe emotional trauma. Precipitators of LP can also include some medicines (neuroleptics, gold salts, penicillamine, β-blockers, thiazide diuretics, angiotensin convertase inhibitors, NSAIDs, antimalarial agents, and quinidine) (Braun et al, 1998, Krasowska et al, 2001, Shemer et al, 2001, Handa and Sahoo, 2002, Vachiramon et al, 2010, Kumar et al, 2011. Various clinical variants of LP have been described: papular, hypertrophic, atrophic, actinic, pigmentosus, bullous, and ulcerative.…”

Blaschkoid lichen planus: Throwing a “curve” in the nomenclature of linear lichen planus

“…[2][3][4] Although there are no definitive associations between specific antigens and Blaschkoid LP, several cases are reported of Blaschkoid LP developing after vaccinations 5 and in the setting of known neoplasms 6 and recurring with successive pregnancies. 7 Thus, it is speculated that the Blaschkoid distribution of LP may be predetermined during embryogenesis, allowing for development of LP lesions after exposure to antigenic trigger. 3 Although no exact trigger was identified for our patient, one must consider his history of stage I colon cancer and as his surgical intervention.…”

Lichen Planus Distributed Along the Lines of Blaschko: A Case Report

“…Blaschko's lines are not justifiable and could have any cutaneous pattern, such as dermatomes, Langer's lines, Voight's lines, embryonic clefts, pigmentary demarcation lines, or any nervous, vascular or lymphatic structures(2). These lines are imperceptible and may become obvious in certain conditions, such as pigmentary disorders (nevic lesions), X-linked genetic skin disease (Incontinentia pigmenti), acquired inflammatory skin disorders (LP, lichen striatus), and chimerism(3). It seems that during early embryonic development, cells migrate to certain areas of the skin, and if a post zygotic mutation oc-…”