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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Lichen striatus &#40;LS&#41; is an uncommon asymptomatic acquired dermatosis that mainly affects children&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The diagnosis is usually clinical&#44; as the histologic findings are variable and depend on the phase of the disease&#46; It presents with flat-topped&#44; desquamating erythematous papules with a linear distribution along the Blaschko lines &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">A possible association with atopic dermatitis has been suggested&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1&#8211;5</span></a> We designed this retrospective study in order to describe the characteristics of children with this disease and to determine whether a higher prevalence of atopic dermatitis existed in our population&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">We present a case series of children diagnosed with LS at our centre in Valencia&#44; Spain&#44; from January 2008 to the present time&#44; including all patients under 18 years old with compatible clinical manifestations&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Socio-demographic&#44; clinical&#44; histological&#44; and therapeutic variables were analyzed&#44; as well any relationship with possible triggering factors&#44; including in particular atopic dermatitis&#44; diagnosed in accordance with the Hanifin and Rajka criteria&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">A total of 35 patients were included in the study&#46; The mean age was 5 years and there was a predominance of female &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Only 3 diagnostic biopsies were required in cases with atypical clinical manifestations&#46; In the other patients&#44; the characteristics of the lesions were consistent with LS and there was no need to perform an invasive procedure for confirmation&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The lesions were mostly asymptomatic &#40;85&#46;7&#37;&#41;&#46; When symptomatic&#44; the most common complaint was pruritus &#40;14&#46;3&#37;&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The site most frequently affected was the lower limbs &#40;57&#46;2&#37;&#41;&#46; None of the children presented associated onychodystrophy&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The majority of the lesions were managed with emollients and photoprotection &#40;73&#46;5&#37;&#41;&#46; Topical corticosteroids were used in the remaining patients&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Sixteen patients were lost to follow-up&#46; None of those children were subsequently referred back to our department by their pediatrician or primary care physician for further follow-up&#46; A complete response was achieved in all the other children except one who presented a partial improvement&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">With regard to possible related factors&#44; the medical histories of 2 patients revealed that the lesions appeared after a previous diagnosis of infection&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Nine patients presented a previous diagnosis of atopic dermatitis made by a specialist&#46; In 5 patients&#44; manifestations of atopy were found in the medical history &#40;most frequently pityriasis alba&#41; and in 1 patient a family history was found in first-degree relatives&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">With respect to other related diseases&#44; 9 children presented bronchial hyperreactivity &#40;25&#46;7&#37;&#41; and 3 patients had been diagnosed with some form of allergy&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Lichen striatus is an uncommon&#44; asymptomatic acquired dermatosis that mainly affects children&#44; with a predominance in female&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1&#44;2&#44;6</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The lesions do not usually produce symptoms&#44; but when they are present&#44; the most common is pruritus&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">This disease tends to resolve spontaneously in 6 to 24 months&#46; In some cases a transitory residual hypopigmentation can remain&#46; It is therefore useful to explain to patients and their parents that this is a benign condition&#44; and to individualize therapeutic management&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Several authors have proposed seasonal changes as possible triggering stimuli&#44; though there is no general agreement&#46; Some of them report an increase in incidence of LS in summer&#44;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">3&#44;7</span></a> while others report the increase in autumn and winter&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> This observation has given rise to the association with infectious diseases as a triggering factor&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> nevertheless no relationship was found in our patients&#46; In the series of 115 patients with LS studied by Patrizi et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> only 3 children presented prodromal symptoms suggestive of viral infection&#46; Because of that&#44; this theory cannot be confirmed despite studying a larger number of patients&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Retrospective studies have highlighted the relationship between atopic dermatitis and LS&#44;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1&#8211;5</span></a> considering that the immune changes present in atopic dermatitis could be a predisposing factors for the induction of LS&#46; Other authors&#44; such as Happle&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> suggest that this disease should be included in the list of acquired disorders with a nevoid distribution&#47;pattern and postulate that it could represent a mosaic form of atopic dermatitis&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Our series supports the findings of previous studies with a larger number of patients&#44; 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Case and Research Letters
Lichen Striatus in Childhood: Is It Associated With Atopic Dermatitis?
Liquen estriado en la infancia. ¿Una entidad relacionada con la dermatitis atópica?
M.I. García-Briz
Corresponding author
mariwelchy@gmail.com

Corresponding author.
, S. Santos-Alarcón, M.D. Fuertes-Prosper, A. Mateu-Puchades
Servicio de Dermatología, Hospital Universitario Doctor Peset, Valencia, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Lichen striatus &#40;LS&#41; is an uncommon asymptomatic acquired dermatosis that mainly affects children&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The diagnosis is usually clinical&#44; as the histologic findings are variable and depend on the phase of the disease&#46; It presents with flat-topped&#44; desquamating erythematous papules with a linear distribution along the Blaschko lines &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">A possible association with atopic dermatitis has been suggested&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1&#8211;5</span></a> We designed this retrospective study in order to describe the characteristics of children with this disease and to determine whether a higher prevalence of atopic dermatitis existed in our population&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">We present a case series of children diagnosed with LS at our centre in Valencia&#44; Spain&#44; from January 2008 to the present time&#44; including all patients under 18 years old with compatible clinical manifestations&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Socio-demographic&#44; clinical&#44; histological&#44; and therapeutic variables were analyzed&#44; as well any relationship with possible triggering factors&#44; including in particular atopic dermatitis&#44; diagnosed in accordance with the Hanifin and Rajka criteria&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">A total of 35 patients were included in the study&#46; The mean age was 5 years and there was a predominance of female &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Only 3 diagnostic biopsies were required in cases with atypical clinical manifestations&#46; In the other patients&#44; the characteristics of the lesions were consistent with LS and there was no need to perform an invasive procedure for confirmation&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The lesions were mostly asymptomatic &#40;85&#46;7&#37;&#41;&#46; When symptomatic&#44; the most common complaint was pruritus &#40;14&#46;3&#37;&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The site most frequently affected was the lower limbs &#40;57&#46;2&#37;&#41;&#46; None of the children presented associated onychodystrophy&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The majority of the lesions were managed with emollients and photoprotection &#40;73&#46;5&#37;&#41;&#46; Topical corticosteroids were used in the remaining patients&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Sixteen patients were lost to follow-up&#46; None of those children were subsequently referred back to our department by their pediatrician or primary care physician for further follow-up&#46; A complete response was achieved in all the other children except one who presented a partial improvement&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">With regard to possible related factors&#44; the medical histories of 2 patients revealed that the lesions appeared after a previous diagnosis of infection&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Nine patients presented a previous diagnosis of atopic dermatitis made by a specialist&#46; In 5 patients&#44; manifestations of atopy were found in the medical history &#40;most frequently pityriasis alba&#41; and in 1 patient a family history was found in first-degree relatives&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">With respect to other related diseases&#44; 9 children presented bronchial hyperreactivity &#40;25&#46;7&#37;&#41; and 3 patients had been diagnosed with some form of allergy&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Lichen striatus is an uncommon&#44; asymptomatic acquired dermatosis that mainly affects children&#44; with a predominance in female&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1&#44;2&#44;6</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The lesions do not usually produce symptoms&#44; but when they are present&#44; the most common is pruritus&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">This disease tends to resolve spontaneously in 6 to 24 months&#46; In some cases a transitory residual hypopigmentation can remain&#46; It is therefore useful to explain to patients and their parents that this is a benign condition&#44; and to individualize therapeutic management&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Several authors have proposed seasonal changes as possible triggering stimuli&#44; though there is no general agreement&#46; Some of them report an increase in incidence of LS in summer&#44;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">3&#44;7</span></a> while others report the increase in autumn and winter&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> This observation has given rise to the association with infectious diseases as a triggering factor&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> nevertheless no relationship was found in our patients&#46; In the series of 115 patients with LS studied by Patrizi et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> only 3 children presented prodromal symptoms suggestive of viral infection&#46; Because of that&#44; this theory cannot be confirmed despite studying a larger number of patients&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Retrospective studies have highlighted the relationship between atopic dermatitis and LS&#44;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1&#8211;5</span></a> considering that the immune changes present in atopic dermatitis could be a predisposing factors for the induction of LS&#46; Other authors&#44; such as Happle&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> suggest that this disease should be included in the list of acquired disorders with a nevoid distribution&#47;pattern and postulate that it could represent a mosaic form of atopic dermatitis&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Our series supports the findings of previous studies with a larger number of patients&#44; in which atopic dermatitis could be considered to be a predisposing factors for LS&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">However&#44; the results reported in the literature are based on retrospective studies&#44; and prospective studies with a larger number of patients are needed to investigate the association of LS with triggering factors and concomitant diseases&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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