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Clinical Dermatology Open Access Journal Research Article 3 min read

Blashkolinear Psoriasis: A Rare Clinical Form

EL Jouari O*, Gallouj S, Lamouaffaq L, Baybay H, and Mernissi FZ
* Corresponding author
ISSN: 2574-7800  10.23880/cdoaj-16000138  Received: December 05, 2017  Published: January 11, 2018
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Keywords
Psoriasis Blashkow’s lines
Abstract

<p>Linear psoriasis is a rare clinical presentation of psoriasis. It is characterized by linear erythematous and scaly lesions along the lines of Blaschko and usually appears in childhood. Its Pathogenesis could be explained by the concept of genetic mosaicism. We report a rare, but a typical and an interesting case of linear psoriasis a 13 year old girl with onset at the age of 2 months.</p>

EL Jouari O*, Gallouj S, Lamouaffaq L, Baybay H, and Mernissi FZ

Morocco

at the age of 2 months.

Keywords: Psoriasis; Blashkow’s lines

Introduction

Linear psoriasis is a rare clinical presentation of psoriasis. It is characterized by linear erythematous and scaly lesions along the lines of Blaschko and usually appears in childhood. Its Pathogenesis is still unknown. A few cases have been reported in the literature.

Case Report

A 13-year-old girl presenting asymptomatic linear erythematous and scaly lesions, with onset at the age of 2 months, having progressively increased in number and in size. There was no family history of psoriasis. The dermatological examination revealed erythematous plaques covered by whitish scales, along the lines of Blaschko, interesting the limbs and the trunk (Figures 1- 3). The Sign of the curette was negative. There were no mucous, nail or scalp lesions. The dermoscopic examination showed a regular and homogeneous diffuse dotted vascularisation (Figure 4). The main differential diagnosis was related to the inflammatory linear verrucous epidermal nevus and lichen striatus. A skin biopsy was performed to confirm the diagnosis of psoriasis linear and removed an interface lichenoid reaction (Figure 5). The patient was treated with a topical Clobetasol 0, 05%, without evident response.UVB phototherapy 3 times a week for 10 weeks had been associated. In 4 weeks there was a significant decrease of the plaques.

Figure 1: Erythematous-squamous plaques following the lines of Blashkow.
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Figure 1: Erythematous-squamous plaques following the lines of Blashkow.
Figure 2: The palmar localisation.
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Figure 2: The palmar localisation.
Figure 3: Erythematous and scaly plaques with linear disposition localised to the right leg, a) Anterior face, b) Posterior face.
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Figure 3: Erythematous and scaly plaques with linear disposition localised to the right leg, a) Anterior face, b) Posterior face.
Figure 4: Dermoscopic image showed a homogeneous and regular dotted vascularization.
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Figure 4: Dermoscopic image showed a homogeneous and regular dotted vascularization.
Figure 5: a) Coloration HES G x 50Regular psoriasiform hyperplasia, b) Coloration HES G x 200 Parakeratosis with tortulous vessels of the papillary dermis, c) Coloration HES G x 400Microabcies in parakeratosis.
Click to enlarge
Figure 5: a) Coloration HES G x 50Regular psoriasiform hyperplasia, b) Coloration HES G x 200 Parakeratosis with tortulous vessels of the papillary dermis, c) Coloration HES G x 400Microabcies in parakeratosis.

Discussion

Linear psoriasis is an unusual subtype of psoriasis first described in 1951. A few cases are reported in the literature. The pathogenesis is still unknown but could be explained by the concept of genetic mosaicism. It can occur in early childhood and defined by presence of linear erythematous and scaly lesions along the lines of Blaschko. Linear psoriasis is often asymptomatic or with mild pruritus. Homogeneous diffuse dotted vascularization is a specific dermoscopic finding of psoriasis. The main differential diagnosis is the inflammatory linear verrucous epidermal nevus which are intensely pruritic and resistant to antipsoriatic treatments. Histologically, linear psoriasis presents Hyperkeratosis parakeratosis associated with agranulosis with elongation of the ridges, thinning of the suprapapillary epidermis and the presence of Munro’s microabscess in the stratum corneum, considered as specific of psoriasis. Linear psoriasis characterized by defined a favorable response to antipsoriatic treatment. In contrast our patient doesn’t response to topical treatment alone [1, 2, 3, 4].

Conclusion

Linear psoriasis is an entity distinct from psoriasis whose diagnosis requires different anamnestic, physical and histological arguments.

References

  1. Nasimi M, Abedini R, Azizpour A, Nikoo A (2016) Isolated linear blaschkoid psoriasis. Clin Exp Dermatol 41(7): 775–778.
  2. Brinca A, Santiago F, Serra D, Andrade P, Vieira R, et al. (2011) Linear psoriasis-a case report. Case Rep Dermatol 3(1): 8-12.
  3. Figueiras Dde A, Cauas RC, Takano DM, Ramos TB, Marinho AK, et al. (2015) Linear psoriasis: case report onthree year old child. An Bras Dermatol 90(3):194-196.
  4. Happle R (1991) Somatic recombination may explain linear psoriasis. J Med Genet 28(5): 337.
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@article{el2018,
  title   = {Blashkolinear Psoriasis: A Rare Clinical Form},
  author  = {EL Jouari O, Gallouj S, Lamouaffaq L, Baybay H, and Mernissi FZ},
  journal = {Clinical Dermatology Open Access Journal},
  year    = {2018},
  volume  = {3},
  number  = {1},
  doi     = {10.23880/cdoaj-16000138}
}
EL Jouari O, Gallouj S, Lamouaffaq L, Baybay H, and Mernissi FZ (2018). Blashkolinear Psoriasis: A Rare Clinical Form. Clinical Dermatology Open Access Journal, 3(1). https://doi.org/10.23880/cdoaj-16000138
TY  - JOUR
TI  - Blashkolinear Psoriasis: A Rare Clinical Form
AU  - EL Jouari O, Gallouj S, Lamouaffaq L, Baybay H, and Mernissi FZ
JO  - Clinical Dermatology Open Access Journal
PY  - 2018
VL  - 3
IS  - 1
DO  - 10.23880/cdoaj-16000138
ER  -