Parents Frightened by Son's Thigh Lesion

dermaDiagnosis Parents Frightened by Son’s Thigh Lesion 6-year-old boy is brought although he does have seasonal ANSWER in by his mother, re- allergies. There is no family his- The correct answer is lichen A ferred to dermatology tory of skin problems. striatus (choice “d”), a rare, self- for evaluation of a lesion on his The affected site is a hypopig- limited condition usually seen on right thigh that manifested three mented linear patch of skin from the extremities of children. It will months ago. Although asymp- the mid-medial right thigh to the be discussed further in the next tomatic, the lesion has frightened mid-medial calf area. The width section. the boy’s parents. They first took of the patch varies, from 3 to 5 cm. The differential for lichen stria- him to a local urgent care clinic, The margins are somewhat irreg- tus includes psoriasis (choice “a”). where a diagnosis of “probable ular, and in several places, slightly However, typical psoriatic lesions fungal infection” was made. But rough, scaly sections are noted. would not assume this configu- twice- daily application of the pre- The hypopigmentation, though ration and would likely manifest scribed ketoconazole cream did partial, is evident in the context of with other corroborative areas of not produce results. the boy’s type IV Hispanic skin. involvement. The boy is otherwise healthy, No erythema or edema is noted. Eczema (choice “b”) is cer- Elsewhere, the child’s skin is free tainly common in children, but it Joe R. Monroe, of significant changes or lesions. is unlikely to be relegated to one MPAS, Pa, practices The most likely diagnostic linear area. The same can be said at dawkins explanation for this child’s skin of pityriasis rosea (choice “c”). Dermatology Clinic in Oklahoma City. changes is He is also the a) Psoriasis DISCUSSION founder of the b) Eczema Lichen striatus, also known as Society of Dermatology c) Pityriasis rosea Blaschko linear acquired skin in- Physician Assistants. d) Lichen striatus flammation, is an unusual self- 12 Clinician Reviews • AUGUST 2015 clinicianreviews.com limited condition of unknown even the digits, where it can lead Additional items in the differ- etiology seen mostly on the ex- to dystrophy of the affected nail. ential include lichen planus, li- tremities of children ages 3 to 10. It almost always resolves within chen nitidus, and warts. More common on legs than on a few weeks to months, with or arms, it can occasionally appear without treatment (which is lim- TreatmENT on the face. ited to symptom relief). For most cases of lichen striatus, Its linear configuration is in- Several potential causes of li- treatment is supportive: topical stantly diagnostic: The lesion chen striatus have been posited. steroids for the itching, which is typically follows the Blaschko The most convincing theory is seldom severe. Given the self- lines, which represent a segmen- a possible connection with hu- limited but prolonged nature of tal clone of cutaneous cells de- man herpesviruses 6 and 7, which the problem, patient education is posited at an embryonic stage of are also triggers for pityriasis the more important component; development. rosea. There have been cases in these days, there are web-based As seen in this case, post- which both conditions are pres- sources to which you can direct inflammatory hypopigmentation ent, producing somewhat simi- your patients for reliable informa- is common. In a minority of cas- lar microscopic changes in the tion, including the Mayo Clinic es, the condition can involve the skin (and both resolving without and the American Academy of entire length of the extremity— treatment). Dermatology. CR WRiTENOW • Provide a practical clinical review “Writing will always be hard article for primary care clinicians work—but if you stick to it, it will be a rewarding and • Chronicle a teachable case study from essential part of your your practice, from presentation to professional life.” – Randy D. Danielsen, PhD, PA-C, diagnosis and discussion DFAAPA, Editor-in-Chief • Share an incident or observation that has “Do you have a particular changed the way you practice specialty area or a “pet” disease state or condition? • Sound off in depth on a burning issue … Have you maneuvered write a commentary around a barrier to practice? Others might benefit from • Reach out to leadership…Editors-in-Chief knowing the keys to your Drs. Onieal and Danielsen want to hear your accomplishment.” ideas about building a better profession – Marie-Eileen Onieal, PhD, CPNP, FAANP, Editor-in-Chief E-Mail youR quERy lETTER To: Karen Clemments, Editor, [email protected] All manuscripts are subject to peer review before acceptance. clinicianreviews.com AUGUST 2015 • Clinician Reviews 13.

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